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18 52 7 PB PDF
18 52 7 PB PDF
ABSTRACT
Background: The prevalence of exclusive breast feeding was 39.05% in Sukoharjo in 2015, which
is far bellow the national target of 80%. A study has shown that massage oxytocin increases
oxytocin (OT) hormone release, and eventually decreases adrenocorticotropin hormone (ACTH),
nitric oxide (NO), and beta-endorphin (BE). This OT hormone release will increase milk ejection,
which facilitate milk production. This study aimed to investigate the effect of breast care and
oxytocin massages on breast milk production in post–partum mothers.
Subjects and method: This was a Randomized Controlled Trial (RCT), conducted at Sukoharjo
Hospital, Central Java 19 October to November 18, 2016. A total of 90 post – partum mothers were
selected at random and then allocated into breast care group and oxytocin massage group. The
dependent variable was breast milk production. The independent variable was breast care and
oxytocin massage. Changes in breast milk production before and after intervention between the
two groups were tested by Mann-Whitney test.
Results: The increase in breast milk production in breast care and oxytocin massage group
(mea = 17.37, SD= 9.70) was larger than that of the control group (mean= 1.58, SD= 1.69), and it
was statistically significant (p<0.001).
Conclusion: Breast care and oxytocin massage can significantly increase breast milk production.
Post-partum mothers are recommended to practice breast care and oxytocin massage, in order to
increase breast milk production.
Correspondende:
Tutik Rahayuningsih. School of Health Polytechnics, Poltekkes Bhakti Mulia, Surakarta. Email:
tutikrahayu_abm@yahoo.co.id.
13% of infants under 2 months have been function of breastfeeding and baby sucking
given milk formula and 1 in 3 infants aged that cause mothers be lazy and delay to
2-3 months have been given additional breastfeed their babies. From the initial
food (Lactation Center Indonesia, 2012). assessment, there got 10 post-partum
One of the factors contributing to this mothers. On the first day, the breast milk
high IMR is the low coverage of exclusive from 6 of the study subjects (60%) had not
breastfeeding, because without exclusive come out. The mothers complained that
breastfeeding infants are more susceptible they had a low milk supply, and worried
to various diseases that increase morbidity that the baby was not breastfed so they
and mortality. Exclusive breastfeeding chose to give milk formula.
helps in decreasing IMR by 13% (Roesli, The fact in the hospital shows the low
2013). production and ejection of breast milk in
The report data released by the IDHS the post-partum mother on the first day
Institution in 2007 shows the exclusive after giving birth become obstacles in early
breastfeeding coverage of infants aged 0-6 breastfeeding. A study by Nilamsari et al.
months by 32%. While the IDHS report in (2014) showed that 60% of 47 post-partum
2012 there is an increase in infants who get women have low breast milk supply on the
exclusive breastfeeding by 42%. This num- first day until the third day after delivery.
ber of survey result is clearly below the A study by Isnaini (2015) showed that of
WHO target of breastfeeding coverage of at 78 post-partum women, there are 44
least 50%. The coverage of exclusive (56.4%) of them who complain about no
breastfeeding in Indonesia is still below breast milk on the first day post-partum,
the target that is infants aged 0-6 months and 13 (16.6%) post-partum mothers com-
with coverage rate of 61.5%, while exclu- plain about their low breast milk supply
sive breastfeeding coverage in 2012 is and 21 (27%) post-partum complain of bre-
33.6%, and in 2013 at 54.3%. Coverage of ast milk are not coming out smoothly caus-
exclusive ASI in Central Java in 2011 es mothers to choose formula milk.
amounted to 45.86%, in 2012 to 25.06% According to Cox (2006) mothers who do
and in 2013 to 57.67%, that number is still not breastfeed their babies in the first days
far from the national target for exclusive were caused by anxiety and mother's fear
breastfeeding coverage in 2014 that is of low breast milk production and lack of
80%. mother's knowledge of the breastfeeding
The coverage of exclusive breastfeed- process. Twenty-four hours after delivery
ing in Sukoharjo Regency is 54.73% and is a very important moment for the success
the coverage of exclusive breastfeeding in of further breastfeeding.
Sukoharjo Hospital has a rate of 39.05%, The inadequacy of breast milk
where the Sukoharjo Regency Health production is the main reason for a mother
Office targets the infant to receive exclu- to stop breastfeeding early. The mother
sive breastfeeding by 65% (Kemenkes feels she does not have enough breast milk
2014, Pangesti et al., 2015). to meet the baby's needs and support the
Based on the interviews with the baby's weight gain. Effective treatments to
Head of Maternity Room Sukoharjo Hospi- increase milk production include breast-
tal, obtained data of post-natal mothers care by maintaining breast health and
have not breastfed their babies because of breast massage, breast exercise and oxyto-
fatigue during labor, do not know the cin massage.
Based on Table 1,30 study subjects who while post test results produced milk
performed breast care and oxytocin production maximum 50 cc.
massage and 60 study subjects as control b. Normality test
group largely dominated by mothers aged Normality test result in treatment group
20-35 years as many as 76 people (84.4%) and control group obtained result
and the lowest group of mothers with age p<0.001) then the data is not normal
<20 years as many 6 people (6.7%). distribution.
Characteristics of data sample categorized c. Bivariate Analysis
the intervention group and the control Bivariate analysis results of breast milk
group and 90 subjects in the intervention production differences before and after
group study of 30 people (33.33%) and the breast and oxytocin massage treatment
control group was 60 (66.7%). were shown in Table 2.
2. Hypothesis Testing
a. Analisis univariat
Univariate analysis presented about the
influence of breast care and oxytocin
massage on the results of pre-production
of breast milk produced maximum 10 cc
Table 2. Mann Whitney Test Results on changes in breast milk production before
and after treatment between intervention and control group
Variable n Mean Median SD p
mothers who do not perform breast care. the mammary glands (Departement of
Movement on breast care with massage Health, 2007).
techniques is recommended with the This study was conducted on post-
hands and fingers because it is more partum mother with regard to the time of
practical, effective, efficient and has the execution, since the mother gave birth and
advantage of a better pressure that is performed one day in the morning and
useful to stimulate the reflex of breast milk afternoon. Intervention was done on the
expenditure and it is also an effective way first day until the third day post-partum.
to increase the volume of breast milk. The amount of breastmilk production prior
Breast care is a special treatment to breast treatment and the oxytocin
effort through the provision of stimulation massage was excluded by milking by hand
of the breast muscles of the mother by and measured using a measuring cup in
giving body massage. This activity is better ml. The results obtained by the maximum
done in the morning and evening before volume of breast milk before the breast
bathing and is expected to provide stimu- treatment and massage of oxytocin was 10
lation to the mother's milk glands in order ml. Judging from the volume was still
to produce milk (Wulandari, 2011). Physio- somewhat small, this occurs because the
logically, breast care is done by stimulating mother's efforts to breastfeed in over-
the breast to affect the posterior hypofise coming the problem of breastfeeding was
to release more hormone oxytocin through not optimal and breastfeeding mothers
massage. Oxytocin expenditure is also who made the subject of study have not
affected by infant sucking by a receptor in known and have never done breast care
the ductal system. When the ducts are and massage oxytocin.
stimulated by massage, the ducts will Based on the Mann Whitney test the
become wide or softened by releasing mean ± SD pre test and post test in the
oxytocin by hypofise that plays a role to intervention group was 17.57 ± 9.70 and in
squeeze Mother's Milk from the alveoli the control group was 1.57 ± 1.69. This
(Saleha, 2009). In the first days of the study showed that breast implants and
baby's birth, if suction is adequate enough, oxytocin massage may increase breast milk
it will be generated gradually 10-100 ml of production, increased breastfeeding prod-
milk. uction received breast treatment and oxy-
The oxytocin massage is a spinal tocin massage (mean= 17.37; SD= 9.70) >
massage on the back area from the rib cage untreated mothers (mean= 1.58, SD=
to 5-6 extending both sides of the spine to 1.69), and the difference was statistically
the scapula that will speed up the work of significant (p <0.001).
the parasympathetic nerves, the nerves It showed that Ho was rejected and
that originate on the medulla oblongata Ha was accepted meaning there was positi-
and on the sacrum region of spinal cord, ve influence of breast care and oxytocin
stimulates the posterior hipofise to release massage to milk production of mother's
oxytocin, oxytocin stimulates the contract- milk. It is seen that there was a significant
ion of smooth muscle cells that circle the difference in the production of breast milk
lactific ducts of the mammary gland before and after a combination of breast
causing breast myoepithel contractility so care and oxytocin massage methods in the
as to enhance breastmilk emissions from post-partum mother. Increased milk pro-
duction could be seen from the volume of
breast milk before the intervention of in the smoothness of breast milk product-
breast care and oxytocin massage from 0- ion before and after the back massage
10 ml to 10-50 ml after a combination of (oxytocin) and warm breast compresses.
two massages. The conclusion is that back massage is
Breast milk production refers to the more effective in the production of breast
volume of breast milk released by the milk than warm breast compresses. Study
breast. Interventions of both breast care conducted by Isnaini (2015) said that there
and oxytocin massage methods, in is a relationship between oxytocin massage
principle, aimed to make the myocardial on postpartum mothers with breastfeeding
muscles contract, relax the mind and expenditure. The relationship of breast
facilitate the expenditure of breast milk. care and oxytocin massage to breast milk
Breast milk expenditure occurs because production can increase the production of
smooth muscle cells around the breast breast milk significantly through stimu-
gland shrink so that squeeze milk to come lation of massage on the breast muscles
out. Breast milk could come out of the directly causing contraction of mioephitel
breast due to the shrinking muscles that cells and causes the milk to go out
could be stimulated by a hormone called smoothly when the baby is feeding on her
oxytocin. Through stimulation of breast mother.
massage or stimulation of the spine would Another study by Mardyaningsih
relax the tension and relieve stress, (2010), on the effectiveness of combina-
assisted by the baby's suction on the nipple tions of marmetted and oxytocin massage
as soon as the baby was born with a techniques on breastmilk production in
normal baby's condition, the neurotrans- post-cesarean mothers, the results of a
mitter would stimulate the medulla combination of Marmet techniques and
oblongata and then sent a message to the oxytocin massage have an effect on
hypothalamus in the posterior hypofise to increasing milk production. The conclu-
release oxytocin causing breasts removed sion of breast milk production study is
milk. strongly influenced by the hormone
The volume of breastmilk produced prolactin that will produce milk, and the
and released by the breast glands may hormone oxytocin effect on the smooth
differ by influencing factors such as the expenditure of breast milk, because the
food the mother consumes, the peace of more milk out, milk production will
mind and soul, the use of contraceptives, increase, so in the above study can be
breast care, breast anatomy, physiological concluded combination of marmet tech-
factors, resting patterns, child sucking nique and massage oxytocin can stimulate
factors or the frequency of breastfeeding, prolactin hormone and oxytocin.
born baby, age of pregnancy during The success of the mother in breast-
childbirth, and consumption of cigarettes feeding is influenced by factors after
and alcohol (Astutik, 2014). Sulistyawati delivery. Breast milk production may
(2009) argued that the release of oxytocin increase or decrease depending on stimu-
may be inhibited by the emotional state of lation of the breast especially in the first
the mother, fear, fatigue, shame, week of breastfeeding. This study conducts
uncertainty, or pain. two concurrent interventions namely
The results of this study as conducted breast care and oxytocin massage and
by Nurhanifah (2013) there is a difference obtains results significantly increase milk
production. Previous studies have used two luaran kolostrum pada ibu post par-
different methods and only one of them tum di ruang kebidanan rumah sakit
has been effective in increasing breast milk muhammadiyah Bandung. Jurnal
production, so this study combines the two kesehatan kartika.
methods of previous study whose results Hidayat AA (2008). Metode penelitian ke-
have effectively increased milk production. perawatan dan teknik analisis data.
Jakarta: Salemba Medika.
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