THE RELATIONSHIP BETWEEN POSTPARTUM EXERCISES AND DECREASED UTERINE FUNDAL LEVEL IN POSTPARTUM MOTHER

The postpartum period begins after the placenta is born and ends when the womb returns to its original state (before pregnancy), which lasts approximately six weeks or 42 days. It is a period of adjustment for the mother to a new role, during which the mother experiences physical and psychological changes. Several factors, including postpartum exercise, influence the uterine involution process. If the involution process is disturbed, it can cause uterine subinvolution. The aim of this research was to determine the relationship between postpartum exercise and a decrease in uterine fundal level in postpartum mothers on the third day. This research uses a quasi-experimental treatment group and a control group. The population was 15 multiparous postpartum mothers who gave birth at TPMB Ida Priyanti and 15 multiparous postpartum mothers who gave birth at TPMB Sidemiarti. Sampling used a purposive sampling technique. Data was collected using postpartum exercise observation sheets, and the uterine fundal level was decreased with the use of the fingers. Data analysis used the Chi-Square test and then continued with the Mann-Whitney test. The research findings are significant, indicating that postpartum mothers who engaged in postpartum exercise (40%) experienced a rapid decrease in uterine fundal level. In contrast, postpartum mothers who did not engage in postpartum exercise (30%) experienced a delay in decreasing uterine fundal levels. The Mann-Whitney test analysis further underscores the importance of these findings, showing a significance value of <0.001. It suggests that postpartum exercise can significantly influence the reduction in uterine fundal height in postpartum mothers on the third day. This research concludes that postpartum exercise can influence a decrease in the level of the uterine fundus because postpartum exercise on the third day includes exercises to return the uterus to its original shape and position and reduce heartburn in postpartum mothers.


INTRODUCTION
The postpartum period, also known as Puerperium, is a crucial phase that commences after the birth of the placenta and concludes when the uterine organs revert to their pre-pregnancy state.This   Based on Table 2, it is known that most of the respondents in the treatment group had a high school education (60%), and most of the control group respondents had a high school education (60%).
figures highlight the pressing need for interventions to reduce maternal mortality rates.
all, it determine the level of maturity in logical thinking.Usually, respondents do postpartum exercise because of their scientific and logical reach in responding to healthy needs during the postpartum period.Ideally, the older the mother is, the more mature and logical thinking she will give to form positive behavior for doing postpartum exercise.Characteristics of RespondentsBased on Education Our research findings reveal a robust correlation between education and maternal health.The majority of mothers in both the treatment and control groups had a high school education.This education empowers mothers to pay more attention to health problems, not just for themselves but also for their families.It equips them with the knowledge and understanding needed for self-care and children's health and helps them adapt to their essential roles, making it easier for them to navigate the world around them.Education has the transformative power to eliminate negative views on childbirth issues and the role of mothers.crucial tool for instilling understanding and purpose, fostering positive understanding, attitudes, and actions in society.It is not just about imparting knowledge but about effecting positive changes in human behavior and attitudes by mitigating negative behavioral and socio-cultural factors.It underscores the importance of education in shaping a healthier future for mothers and their families.The researcher's opinion on the level of education of respondents creates an urge to obtain information and do something that can maintain a healthy status by speeding up recovery during postpartum.On the other hand, respondents with low education will likely be reluctant to look for, get, or do something new, so they will assume that postpartum exercise is not beneficial for postpartum health.mothers, experienced a decrease in fundal level to normal, and almost all 12 people (80%) postpartum mothers experienced a decreased level of the uterine fundus quickly.After giving birth, a mother's body will enter a recovery period and slowly return to its original condition.In theory, if a birthing mother ambulates, it can facilitate uterine involution (the return of the uterus to its original shape).One of the activities recommended for mothers to do after giving birth is postpartum exercise, namely the first day's rib-breathing exercises and ankle movement exercises; the second day's exercises are abdominal, leg, and chest muscle exercises, and finally, the third day's exercises namely, exercises to return the uterus to its original shape and position, as well as excellent and light posture exercises (Rini, 2017the reduction in uterine fundal level.This can be seen in the process of decreasing the uterine fundal level of mothers who do postpartum exercise more quickly than those who do not.In mothers who do postpartum exercises, the lochea expels smoothly, so the process of decreasing the level of the uterine fundus runs normally.The decrease in uterine fundal height is also supported by the age of postpartum mothers, where postpartum mothers who experience a rapid decrease in uterine fundal height are, on average, no more than 35 years old and not less than 20 years old.It is supported by the theory of Walyani and Purwoastuti (2017), where mothers who are over 35 years old Based on the research results, almost half of the nine people (60%) experienced a slight decrease in uterine fundal height, a small portion of the respondents, five people (33.3%) mothers, experienced an average decrease in uterine fundal level, and a small portion of the respondents, one person (6.7%) postpartum mother, experienced a rapid decrease in uterine fundal height at TPMB S Malang Regency In theory, if a birthing mother ambulates, it can facilitate uterine involution (the return of the uterus to its original shape).The results of this research are almost the same as research conducted by Saputri, Gurusinga, and Friska (2020) regarding the effect of postpartum exercise on the uterine involution process in postpartum mothers.The results were ten people (66.6%) in the fast category and five people (33.3%), while there were none in the slow category (0.00%).Meanwhile, nine people (60.6%) did not do postpartum exercise, four people (26.6%) were found to be slow, and two people (13.3%) were fast.The researcher's opinion, whether the level of the uterine fundus decreases quickly or slowly in postpartum mothers in TPMB I and S, Malang Regency, can be seen from the observation sheet where there is a rapid decrease in uterine fundal level in postpartum mothers who do postpartum exercise and a slight decrease in uterine fundus level in mothers who are not doing postpartum exercises due to lack of activity so that the process of expelling the lochea is not smooth so that the process of decreasing the level of the uterine fundus is also hampered.Chi-Square test shows p-value = 0.000 or p < 0.05 then, followed by the Mann-Whitney test with a significance value of p-value <0.001, which means that there is a relationship between postpartum exercise and a decrease in TFU in postpartum mothers on the third day in TPMB I and TPMB S Malang Regency.The results of this research are the same as those of Rati (2020) regarding the benefits of postpartum exercise in terms of postpartum maternal uterine involution.In that study, it was concluded that postpartum exercise reduced the level of the uterine fundus.The decrease in the uterine fundal level was faster in the intervention group compared to the control group.Postpartum exercises offer a practical and effective way to speed up the decrease in the uterine fundus.By stimulating the uterine muscles to function optimally, these exercises can help prevent postpartum bleeding and return the uterus to its original position.They also aid in the healing of the traumatized uterus, stomach, and hip muscles and expedite the return of these parts to their standard shape.Additionally, they help normalize joints that may have become loose due to pregnancy and childbirth and prevent further weakening and stretching.Conducted postpartum exercise is a form of early ambulation for postpartum mothers whose aim is to stimulate contraction of the abdominal muscles, which will help reduce the height of the uterine fundus.However, in reality, what is found in postpartum exercise is that it is rarely done because, firstly, they do not know how to do postpartum exercise.Secondly, because they are too happy according to the postpartum stage of taking on all they think about is their child.Thirdly, mothers, after giving birth, are afraid to do much movement, afraid of the stitches coming out and the pain.Suppose the mother has stitches in the perineum.of researchers based on research result and theory (Zubaidah et al., 2021) there is no gap, there is a relationship between postpartum exercise and a decrease in the level of the uterine fundus because doing postpartum exercise will stimulate uterine contractions, so that uterine contractions get better, where increasing the work of the uterine muscles will result in the muscles in the uterus being squeezed, causing the muscle tissue to lack substances.-Substances are needed so that muscle tissue can shrink, the size of the uterus will also decrease, and the release of the lochea becomes smoother, half of the respondents were postpartum mothers who did not do postpartum exercises on the third day and were experiencing a slow decline: 9 people (60%).3.There is a relationship between the decrease in uterine fundal level in postpartum mothers on the third day who did postpartum exercises at TPMB I Malang Regency.

Table 1 Age Frequency Distribution of Postpartum Mothers at TPMB Ida Priyanti and TPMB Sidemiarti in 2023 Age Treatment Group
Table1shows that almost all respondents in the treatment group were aged 20-35 (80%), and almost all respondents in the control group were aged 20-35 (86.7%).

Table 3
shows that most of the treatment group respondents (73.3%) worked as housewives, and almost half of the control group respondents (46.6%) worked as housewives

Table 4 Cross Tabulation of Decrease in Uterine Fundal Level (UFL) for Postpartum Mothers on 3 rd Day at TPMB Ida Priyanti and TPMB Sidemiarti in 2023 Reduction of UFL on 3 rd Day Treatment Group
Because the result of the Chisquare test does not meet the Chi-square test requirements, the researchers

Table 5 Mann-Whitney Test Results
bracket is crucial as it is directly related to the mother's level of developmental maturity and experience.For instance, adolescent mothers, due to their age, can