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breastfeeding.(Wahyuningsih & Machmudah, 2013).
Data from the World Health Organization (WHO) reports that 4-13.8% of
children under five worldwide have poor nutritional status. Then motor
development disorders reach 25%(Ministry of Health RI, 2019). Meanwhile,
according to the Indonesian Child Profile (2019), in Indonesia, around 30.8% of
children under five are stunted (nutritional disorders) and it is known that the
normal growth and development of toddlers according to their age is 69.2%.
The percentage of malnutrition in East Kalimantan Province in 2019 reached
7.40%. Meanwhile, in Kutai Kartanegara Regency, around 14% of babies are born
with low weight, and 28% of children under five years are stunted. Meanwhile, in
the Bukit Biru Village, Tenggarong District, in November 2020, a 75% increase
in infant weight was found and from a preliminary study, it was found that from
10 babies who were weighed 4 of them did not receive exclusive breastfeeding,
therefore it is necessary to do research on growth and development that is
influenced by exclusive breastfeeding. . The reason is that Bukit Biru's
breastfeeding rate in 2019 is still low at 61.54% and the infant mortality rate in
Kutai Kartanegara Regency is still high.
Based on the data above, it is necessary to provide exclusive breastfeeding as
an effort to support the growth and development of babies. Based on research
conducted(Riyanti & Hanifah, 2014) states that there is a relationship between
exclusive breastfeeding and the development of infants aged 6-12, as well as
research by Sandewi (2018), there is a relationship between breastfeeding and
infant growth and development.
Based on the data and research results that have been mentioned, researchers
are interested in researching "The Relationship of Exclusive Breastfeeding with
the Growth and Development of Infants Age 6-12 Months in Bukit Biru Village,
Tenggarong District in 2021".
This study aims to determine the relationship between exclusive breastfeeding
and the growth and development of infants aged 6-12 months in Bukit Biru
Village, Tenggarong District in 2021.
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RESEARCH METHODS
This study uses a quantitative research type with a retrospective research
design, where the independent variable in this study is exclusive breastfeeding
seen as a past history and resulting in current events or affecting current
conditions with the dependent variable being growth and development in infants
aged 6- 12 months.
This research was conducted in July 2021 at the Bukit Biru Sub-Puskesmas.
The population in this study were infants aged 6-12 months in the Sub District
Health Center, Bukit Biru Village. The sample of this study used a total sampling
technique, namely 39 babies in the Bukit Biru Sub-district Health Center Area. In
December 2021 with the criteria of mothers who were willing to be respondents,
babies aged 6-12 months, mothers living in the Bukit Biru Sub-district Health
Center Work Area, infants in good health.
The research instrument for breastfeeding using the Breastfeeding Checklist,
the growth instrument used in the study in the form of Weight Scales, Height or
Body Length Measurement tools based on World Health Organization National
Statistics (WHO-NCHS) standards, MCH handbooks, and developmental research
instruments using checklist of Developmental Pre-Screening Questionnaire
(KPSP).
The analysis used is Univariate and Bivariate analysis. In this study, univariate
analysis will be carried out to determine the frequency distribution of maternal
characteristics, namely Education, Occupation, and infant characteristics
including infant age and gestational age. Data on Exclusive Breastfeeding with
Growth and Development of Infants Age 6-12 Months.
In this study, bivariate analysis was used to find the relationship between the
independent variable (exclusive breastfeeding) and the dependent variable
(development and growth). Chi Square formula (X2) was used with the condition
that if the calculated Chi Square price was greater than the table (X2 count > X2
table). ) then the relationship is significant, which means Ho is accepted.
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RESULTS AND DISCUSSION
Univariate Analysis
Mother's Education
Table 1. Frequency Distribution of Respondents Based on Respondent's Education in the Working
Area of Bukit Biru Sub-Puskesmas in 2021
No Level of education Frequency Percentage
1 Low education 24 61.5
(SD-SLTP) 14 35.9
1 2.6
2 Middle education
(high school/high 39 100
3 school)
Higher Education
(PT)
Total
Source: The results of the 2021 survey
Based on Table 1 shows that most of the respondents have low education
(SD/SLTP) as many as 24 people (61.5%), 14 people (35.9%) have secondary
education (SMA or equivalent) and a small proportion have a higher education
level of 1 person ( 2.6%
Mother's Job
Table 2. Frequency Distribution Based on Mother's Occupation in Work Area Bukit Biru
Auxiliary Health Center in 2021
No Work Frequency Percentage
1 Does not work 25 64.1
2 Private sector 13
3 employee 1 33.3
civil servant 39 2.6
100
Total
Source: The results of the 2021 survey
Based on Table 2 shows that most of the respondents are unemployed
mothers, as many as 25 people (64.1%) 13 mothers (33.3%) work as private
employees and a small number of mothers as civil servants as much as 1 mother
(2.6%).
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Baby Age
Table 3. Frequency Distribution of Infant Age in the Working Area of Bukit Biru Sub-Puskesmas
in 2021
No baby age Frequency Percentage
1 6-9 months 20 51
2 9-12 months 19 49
Total 39 100
Source: The results of the 2021 survey
Based on Table 3 most of the babies are aged 6-9 months, as many as 20
babies (51%), and 19 babies (49%) aged 9-12 months.
Gestation at Birth
Table 4. Distribution of the Frequency of Baby's Gestation Period in the Working Area of the
Bukit Biru Sub-Puskesmas in 2021
No Gestation at Frequency Percentage
birth
1 enough month 36 93
2 less month 3 7.7
Total 39 100
Source: The results of the 2021 survey
Based on table 4 of the gestational period when the baby was born, data was
obtained that most of the babies were born at term, namely 36 babies (92.3%),
while babies who were born prematurely were 3 (7.7%) babies.
Exclusive Breastfeeding in the Bukit Biru Sub-Puskesmas Working Area in
2021
Table 5. Exclusive Breastfeeding in the Bukit Biru Sub-Puskesmas Working Area in 2021
Exclusive Frequency Percentage
breastfeedi
ng
Yes 29 75
No 10 25
Total 39 100
Source: The results of the 2021 survey
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Based on table 5 above, it can be seen that most of the babies received
exclusive breastfeeding as many as 29 babies (75%) while a small proportion who
did not get exclusive breastfeeding were 10 babies (25%).
Baby Growth in the Bukit Biru Sub-Puskesmas Working Area in 2021
Table 6. Baby Growth 6-12 Months in the Working Area of Bukit Biru Sub-Puskesmas in 2021
Baby Frequency Percentage
Growth
Normal 27 69.2
Thin 6 15.4
Fat 6 15.4
Total 39 100
Source: The results of the 2021 survey
Based on table 6 above, it can be seen that most of the babies aged 6-12
months experienced normal growth as many as 27 babies (69.2%), 6 babies thin
growth (15.4%) and fat growth as many as 6 babies (15.4%).
Baby Development in the Bukit Biru Sub-Puskesmas Working Area in 2021
Table 7. Baby Development 6-12 Months in the Working Area of Bukit Biru Sub-
Puskesmas in 2021
Baby Frequency Percentage
Development
In accordance 33 84.6
It is not in 6 15.4
accordance with
Total 39 100
Source: The results of the 2021 survey
Based on table 7 above, it can be seen that most of the babies aged 6-12
months, 33 babies (84.6%) experienced appropriate development and 6 babies
(15.4%) experienced inappropriate development.
Bivariate Analysis
The Relationship of Exclusive Breastfeeding with Baby Growth in the Bukit
Biru Health Center Work Area in 2021.
Based on the results of statistical tests using Chi Square with a 95%
confidence level, the following results were obtained:
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Table 8. Relationship of Exclusive Breastfeeding with Baby Growth in the Working Area of Bukit
Biru Sub-Puskesmas year 2021
Exclusive Growth Total
breastfeedi Normal Thin Fat P Value
ng
Yes 23 3 3 29
(79.3%) (10.3%) (10.3%) 0.077
No 4 (40%) 3 ( 30%) 3 (30%) 10
Total 27 6 6 39
Based on table 4.8, it can be seen that most of the babies who were given
exclusive breastfeeding were 29 babies who experienced normal growth as many
as 23 babies (79.3%), who experienced lean growth as many as 3 babies (10.3%)
and who experienced fat growth 3 infants (10.3%). While those who were not
given exclusive breastfeeding were 10 babies with normal growth as many as 4
(40%), 3 thin (30%) and 3 fat (30%).
From the results of the statistical test with Chi Square, a p value of 0.077 >
0.05 means that there is no relationship between exclusive breastfeeding and the
growth of babies in the working area of the Bukit Biru Community Health Center.
The Relationship of Exclusive Breastfeeding with Baby Development in the
Bukit Biru Sub-Puskesmas Working Area in 2021
Based on the results of statistical tests using the Chi-Square chapter with a
95% confidence level, the following results are obtained:
Table 9. The Relationship of Exclusive Breastfeeding with Baby Development in the Bukit Biru
Sub-Puskesmas Working Area in 2021
Exclusive Development Total
breastfee OR P
ding Value
In It is not in
accordance accordance
with
Yes 27 (93%) 2 (7%) 29
9.0 0.028
No 6 (60%) 4 (40%) 10
Total 33 6 39
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Based on table 4.9, it can be seen that most of the babies who received
exclusive breastfeeding were 29 babies, 27 babies (93%) were developed
properly, while 2 babies were not suitable (7%). Meanwhile, there were 10 babies
who were not given exclusive breastfeeding, with 6 (60%) the development was
appropriate and 4 (40%) the development was not appropriate.
The results of the chi square statistical test obtained a p value of 0.028 < 0.05,
which means that there is a relationship between exclusive breastfeeding and
infant development. With an OR of 9.00, it means that babies who are exclusively
breastfed have a 9x greater chance of experiencing development according to the
baby's age.
DISCUSSION
The Relationship of Exclusive Breastfeeding with Baby Growth and
Development
The Relationship of Exclusive Breastfeeding with Baby Growth
Based on table 8 above, the researchers found that there was no relationship
between exclusive breastfeeding and infant growth. From the results of the Chi
Square test with p value = 0.077 > 0.05 so that Ha failed to be accepted and Ho
was accepted, meaning that exclusive breastfeeding was not related to the growth
of the baby.
Growth is related to changes that are quantitative in nature which refer to large
and extensive quantities, and are concrete in nature which usually involve
biological sequences and structures.(Armini, 2016). According to Supariasa
(2016), balanced intake of protein, minerals and vitamins as well as carbohydrates
in breastfeeding mothers can increase milk production in quantity and quality.
The results of this study are comparable to the research conducted by Budi
Cahyadi in Linggajaya sub-district, Mangkubumi sub-district, Tasikmalaya city in
2012 that the relationship between breastfeeding was not significant with infant
growth with p value 0.153 > 0.05. Growth is a physiological change as a result of
the maturation of physical functions that take place normally in the course of a
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certain time. Babies who are exclusively breastfed will generally experience rapid
growth at the age of 2-3 months, but slower than babies who are breastfed non-
exclusively.(Cahyadi, 2012).
This is in line with research(Insana et al, 2018) the results of statistical tests
with chi square obtained p value = 0.696 > 0.05 which concluded that the
relationship between breastfeeding was not significant with infant growth. The
relationship between breastfeeding is not significant and the baby's growth is
probably caused by the quantity and quality of breast milk given by the mother
which is still lacking and does not meet the needs of the baby so that the increase
in body weight and length of the baby is not optimal. In addition, nutritional
factors for mothers during pregnancy and lactation, improper and correct
breastfeeding methods so that breast milk production is not perfect(Insana et al.,
2018).
According to the researcher's assumption, this result could be caused by the
nutritional content of breast milk produced by the mother is not optimal. Lack of
nutritional content in breast milk can occur due to lack of nutritious food intake in
breastfeeding mothers.
The Relationship of Exclusive Breastfeeding with Baby Development
Based on table 9 above, the results of the chi square statistical test were
obtained with p value = 0.028 < 0.05, which means that there is a relationship
between exclusive breastfeeding and infant development. This can be seen from
the results of the study that respondents whobreast milkExclusively as many as 27
respondents (93%) where the development was normal and only 5 respondents
(7%) whose development was not in accordance with the OR 9.00 meaning that
babies who received exclusive breastfeeding had a 9x greater chance of
developing according to the baby's age. Based on the results of research
respondents who receivedbreast milk Exclusive development is better than
respondents who do not receive breast milk Exclusive.
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This is in accordance with the theory which states that the content contained in
breast milk such as protein, minerals, water, fat, carbohydrates and vitamins as
well as more immune substances than formula milk so that normal development is
obtained. breast milkExclusive. Another factor that greatly affects the
development of babies is the provision of stimulation by parents from an early
age. Development is the increase in abilities or skills in the structure of more
complex body functions which are the result of the maturation process. This stage
is called the differentiation of body cells, tissues, organs and organ systems that
develop so that they fulfill their respective functions. One of the results of the
maturation process is the increase in fine motor development. Givingbreast milk
exclusively affects development because breast milk has a good content for the
development of the baby in addition to giving breast milkcan also be a stimulation
for the development of the baby. This is because when breastfeeding the baby and
mother interact so as to shape the development of the baby(Maria, 2020).
This is in line with research Al-Rahmad & Fadillah, (2016), which states that
there is a significant relationship between giving breast milk with Infant
Development with p value = 0.000 < 0.05. Babies who are not exclusively
breastfed have the opportunity to experience psychomotor development below the
standard by an average of 2 (two) times greater than those who are exclusively
breastfed. Based on the aspect of cognitive function, exclusive breastfeeding gives
better results on motor development.It is different with respondents who do not
get stimulus from their parents, which can be seen from the results of the study
that there are respondents who getbreast milkExclusive but the level of
development is at risk of interference. It can be concluded that givingbreast milk
Exclusive and good stimulus can affect intelligence and fine motor development
so that respondents who get breast milk Exclusive and good stimulus the
development will be good (Al-Rahmad & Fadillah, 2016).
The results of this study are comparable with research conducted by Riyanti
and Hanifah, (2014) that there is a significant relationship between giving breast
milkwith the development of the baby with the results of the chi square test p
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value of 0.005 < 0.05. In addition to nutrition frombreast milk environmental,
stimulation, and socio-economic factors also influence the development process.
This research is in line with researchNi Made, (2014) entitled the relationship
of giving breast milk Exclusively with growth and development in infants aged 3-
6 months explained that there was a significant relationship between giving breast
milk Exclusive to the baby's growth and development.
According to the researcher's assumptions, infants who getbreast
milkExclusive but lack of stimulus, the baby will be at risk of experiencing
developmental disorders. So it can be concluded that with a good stimulus the
baby's development will also be better.
The limitation of this study is that it only examines the growth and
development of infants who are exclusively breastfed and those who are not
exclusively breastfed by not controlling for other confounding factors such as
environment, prenatal health history (pregnant nutrition, radiation, infection, etc.).
CONCLUSION
Most babies receive exclusive breastfeeding at the age of 6 months. Most of
the baby's growth is normal and the baby's development is age-appropriate. There
is no relationship between exclusive breastfeeding and infant growth (p value =
0.077 > 0.05). There is a relationship between exclusive breastfeeding and infant
development (p value = 0.028 < 0.05)
Suggestions for further researchers to be able to develop and research further
on the factors that influence the growth and development of infants by looking at
the limitations of the study, namely by controlling other triggering factors such as
stimulus, environment, prenatal health history (infection, radiation and toxins).
REFERENCES
Al-Rahmad, A. H., & Fadillah, I. (2016). Perkembangan Psikomotorik Bayi 6 – 9
Bulan berdasarkan Pemberian ASI Eksklusif. AcTion: Aceh Nutrition
Journal, 1(2), 99. https://doi.org/10.30867/action.v1i2.18
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Armini, N. W. (2016). Hypnobreastfeeding Awali Suksesnya ASI Eksklusif.
Jurnal Skala Husada.
Cahyadi, B. (2012). Hubungan ASI Ekslusif dengan Status Gizibayi 6-8 bulan di
Puskesmas Tasikmalaya. Journal Unsil.
http://journal.unsil.ac.id/jurnalunsil-753-.html%0A20.
Insana, D., Chundrayanti, & Eva, R. (2018). Hubungan Pemberian ASI dengan
Tumbuh kembang Bayi umur 6 bulan. Jurnal Fk Unand, 11(1), 50–52.
https://doi.org/10.1111/ases.12406
Kementrian Kesehatan RI. (2019). Profil Kesehatan Indonesia 2019. Kementrian
Kesehatan RI.
Maria, apolonia. (2020). Hubungan Pemberian ASI Ekslusif dan tidak Ekslusif
dengan perkembangan motorik halus pada bayi usia 6 bulan. 8(1), 58–65.
Ni Made. (2014). Hubungan ASI Ekslusif dengan Tumbuh Kembang anak 3-6
bulan di Puskesmas Karanganyar. Ejornal STIKESMHK, 1.
Riyanti, F., & Hanifah, L. (2014). HUBUNGAN PEMBERIAN ASI EKSKLUSIF
DENGAN PERKEMBANGAN BAYI USIA 6 – 12 BULAN DI DESA
CARIKAN JUWIRING KLATEN TAHUN 2013. Jurnal Kebidanan
Indonesia. https://doi.org/10.36419/jkebin.v5i2.182
Wahyuningsih, D., & Machmudah. (2013). Dukungan suami dalam pemberian asi
eksklusif. Jurnal Keperawatan Maternitas.
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CORRELATION BETWEEN MATERNAL HEMOGLOBIN LEVELS
DURING PREGNANCY AND LACTATION HEMOGLOBIN LEVELS
Endah Wahyutri1 , RosalinAriefah Putri2.
1 Nursing Departement , Health Polytechnique of East Kalimantan
2Midwife Departement Health Polytechnique of East Kalimantan
[email protected]
Abstract: During pregnancy, hemodilution occurs so that there is a risk of
anemia, regulation takes 90 Fe tablets, and during lactation, hemoglobin levels are
expected to be within normal limits. The hemoglobin of nursing mothers is
expected to be expected so that the mother's milk as baby food contains enough Fe
minerals which prevent anemia in infants.PurposeThis study aimed to determine
the relationship between the hemoglobin levels of pregnant women and levels of
hemoglobin during breastfeeding.Data on hemoglobin levels during pregnancy are
secondary data . Examination of lactating hemoglobin levels using the POCT
method. The type of research used in this study was observational analytic with a
cross-sectional design, using a sampling technique is purposive sampling, with 30
people. This research has been conducted on ethical tests.During pregnancy, the
average hemoglobin level is 11.77gr/dl, and the average hemoglobin level during
breastfeeding is 12.480 gr/dl. The result of Spearman correlation analysis value
0.024 P-Value <0.005, so there is a correlation between HB levels in pregnant and
lactating women with a correlation coefficient strength of 0.412 at a moderate
stage.There is a correlation between HB levels during pregnancy and lactation
with a moderate level of correlation.
Keywords: Hemoglobin level, pregnancy, lactating.
BACKGROUND
During pregnancy there is haemodilusi so that the risk of anemia occurs,
regulation of pregnancy takes 90 fe tablets and breastfeeding period haemoglobin
levels are expected within normal limits. Haemoglobin of nursing mothers is
expected to be normal so that breast milk as a baby food contains enough Fe
minerals that prevent anemia in infants.
Assessment of nutritional status with Hb levels is an assessment of nutritional
status biochemically. Its function to find out one disorder that most often occurs
during pregnancy is nutritional anemia (Supariasa et al, 2002, p.145). Pregnant
women generally experience iron deficiency so that it only gives a little iron to the
fetus needed for normal iron metabolism. Next they will become anemic by the
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time the mother's hemoglobin levels drop to below 11 gr/dl during the third
trimester.
Everyone has different hb levels, Hb can be affected by sex, age, iron
adequacy in the body, drug influence, smoking and consuming alcohol (Kiswari,
2014). There are also several factors that can affect Hb levels, namely blood loss
due to menstruation, lack of iron in the food consumed, chronic diseases, adverse
adolescent lifestyle, imbalance between nutritional intake and activities carried
out (Wahyuningsih, 2012). According to Kalsum (2016) the decrease in
hemoglobin levels is due to chronic blood loss, insufficient iron intake, inadequate
absorption and increased need for iron to find red blood cells that usually take
place including at puberty and increased activity arena, wrong diet, irregular diet
and menstruation.
Nutrient intake becomes one of the factors that affect the levels of hemoglobin
in the blood, the essential nutrients in the formation of hemoglobin are iron,
vitamin C, and protein. Iron serves as a means of transport of oxygen from the
lungs to the entire tissue, in addition iron also serves as a form of hemoglobin.
Iron is categorized into two, namely heme (derived from animal foods) and non-
heme (derived from vegetables and fruits).
Vitamin C is beneficial as an auxiliary factor in the formation of hemoglobin
to be faster when reacting with non-heme iron. (Soedijanto, 2015).Iron is a micro-
essential element for the body, which is necessary in the formation of blood,
namely to synthesize hemoglobin. Excess iron is stored as ferritin and
hemosiderin in the liver, spinal cord and stored in lymph and muscle. Iron
deficiency will cause a decrease in ferritin levels followed by a decrease in
transferin saturation or an increase in protoforifin. If the situation continues there
will be iron deficiency anemia, where hemoglobin levels fall below normal values
(Almatsier,2011).
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METHODS
The type of research used in this study is observational analytics with cross
sectional design, using sampling techniques in the form of purposive sampling,
with a sample number of 30 people. Data on the level of haemoglobin during habil
is secondary data from the book KIA Examination of breastfeeding haemoglobin
levels using the POCT method. This research has been conducted ethical tests of
the Health Polytechnic of East Kalimantan Ethics Commission
No.:LB.02.01/7/2103/2020.
RESULT AND DISCUSSION
Table 1. Characteristic Responden Infant
Karakteristik Responden F% F%
Kelompok Kontrol Intervensi
Age 15 100 14 93.3
<6 Month 00 1 6.7
>6 Month
Weight Of Baby 00 00
<2500 gram 15 100 15 100
2500-4000 gram 00 00
>4000 gram
Breastfeed Frequent 00 00
<6 times 15 100 15 100
>6 times
Based on table 1 in the Control group and intervention of all infants under 6
months of age, with the end of weight within the normal limit of 2500 - 4000 gr,
and the frequency of breastfeeding a day more than 6 times
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Table 2. Characteristic Respondent from Mother
Respondent F% F%
Group Control Intervention
Occupation 12 80 7 46,7
Housewife 1 6,7 2 13,3
Civil Departement 2 13,3 00
Swasta 00 6 40
Honorer
Paritas 10 66,7 12 80
Primipara 5 33,3 3 20
Multipara
00
Lila 00 15 100
<23 cm 15 100
>23 cm 00
00 15 100
Age of Pregnant 15 100 00
< 36 Week 00
36 – 40 Week 15 100
>42 Week 15 100 00
00
Educational of Health 15 100
Yes 15 100 00
No 00
Galactogous
Yes
No
Based on table 2 In the Control group and intervention the majority of
maternal work is housewife, Parity is primipara, Upper arm circumference (LILA)
within the normal limit of > 23.5 cm, pregnancy age is quite months, mothers
have been counseled about breast milk because they have KIA books and have
been read, all consume breast milk launches in the form of Lagtogog which is a
breast milk proxy launch food such as nuts and vegetables.
Table 3. Variable Median dan Normality Test
Median Mean SD Shapiro-wilk
Variabel 30.67 3.863 0.158*
11.77 1.011 0.000
Age 31 12.48 0.873 0.008
0,86 0.540 0.000
Hemohlobin Levels Pregnant Mother 12**
Hemoglobin levels Breastfeed Mother 12.45**
Hemoglobin Levels in Breast milk 0.59**
*Data berdistribusi normal; **Nilai median
Based on table 3 In the Control and Intervention group, the middle age value
of mother 31 is a condition not at risk for breastfeeding, normal distribution age
with a value of 0.158 > from α 0.005. LILA middle value of 26.50 and an average
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of 26.83 indicates that the nutritional status of mothers is good because there is no
less chronic energy or KEK with a < value of 23.5 CM, HB pregnant women
average 11.77 lower than normal HB levels of women 12-14 gr%, Hb Mother
breastfeeding average 12.48 has increased from pregnant HB and including
normal conditions in women. Kada r Fe BREAST MILK averaged 0.86, median
0.59 is in fairly good condition, normal value of at least 0.4 mg/L. The data
normality test was conducted with Shapiro-wilk because the number of
respondents was less than 50, HB Pregnant Women, HB Breastfeeding Mothers
and Fe levels distributed abnormally with P Value < α.
Table 4.The Correlation Between Maternal Hemoglobin Levels During Pregnancy And Lactation
Hemoglobin Levels
Variabel Koef. Korelasi P value
Hemoglobin levels Pregnant Mother and Breastfeed Mother 0.412 0.024
Hemoglobin Levels when breastfeedand HB Levels on breast milk 0.910 0.000
Table 4 with a sperman correlation analysis of 0.024 P Value < 0.005 there is a
correlation of HB levels of pregnant women and nursing mothers with a
correlation coefficient strength of 0.412 at a moderate stage. The correlation of
maternal HB levels when breastfeeding to febreast milk levels value p value 0.000
means there is a correlation of hb levels of breastfeeding mothers with fe breast
milk levels, with the strength of the correlation of 0.910 at a very strong level.
Discussion
Pregnant women average 11.77 in mild anemia conditions. An average
breastfeeding mother of 12.48 has increased from hb pregnant and includes
normal conditions in women (12 - 14 gr%). Analysis of sperm correlation of hb
levels of pregnant women and nursing mothers 0.024 which means there is a
relationship between hb levels of pregnant women and nursing mothers. In a
preliminary study that has been conducted at the Samarinda Acid Coral Health
Center until August 2019 showed that there were 73 pregnant women who had a
history of anemia, 18 pregnant women suffered from Chronic Energy Deficiency
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(KEK), and there were 66 breastfeeding mothers who had a history of anemia.
This shows anemia in pregnant women is still a health problem in Samarinda.
Hb levels are affected by age, gender, height of residence, smoking habits,
pregnancy, and nutritional deficiencies. Everyone has different hb levels, Hb can
be affected by sex, age, iron adequacy in the body, drug influence, smoking and
consuming alcohol (Kiswari, 2014). There are also several factors that can affect
Hb levels, namely blood loss due to menstruation, lack of iron in the food
consumed, chronic diseases, adverse adolescent lifestyle, imbalance between
nutritional intake and activities carried out (Wahyuningsih, 2012). According to
Kalsum (2016) the decrease in hemoglobin levels is due to chronic blood loss,
insufficient iron intake, inadequate absorption and increased need for iron to find
red blood cells that usually take place including at puberty and increased activity
arena, wrong diet, irregular diet and menstruation.
Nutrient intake becomes one of the factors that affect the levels of hemoglobin
in the blood, the essential nutrients in the formation of hemoglobin are iron,
vitamin C, and protein. Iron serves as a means of transport of oxygen from the
lungs to the entire tissue, in addition iron also serves as a form of hemoglobin.
Iron is categorized into two, namely heme (derived from animal foods) and non-
heme (derived from vegetables and fruits). Vitamin C is beneficial as an auxiliary
factor in the formation of hemoglobin to be faster when reacting with non-heme
iron. Protein is needed in the formation of hemoglobin levels, protein becomes a
means of iron transportation in the process of erythrocy formation that occurs in
bone marrow. Protein intake that is less than the body needs will inhibit the
transportation of iron to bone marrow is disrupted, so that bone marrow fails in
the erythrocyte formation process. (Soedijanto, 2015).
Breast milk is the main food for babies aged 0-6 months. The milk produced is
influenced by the mother's food intake and nutritional history. Anemia is one of
the nutritional problems caused by a lack of intake of micronutrients such as iron,
folic acid, and vitamin B12. Maternal anemia will be related to the mother's
performance, quality and quantity ofASI that will affect the nutritional status of
the baby. In a study conducted by Siti Helmyatidkk (2003), hemoglobin levels in
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nursing mothers are associated with iron levels (Fe) in breast milk. Of the 158
samples of breastfeeding mothers, 55 (34.8%) found anemia at 4 months after
delivery and 103 (65.2%) did not have anemia. It was found that every 1 unit of
increased hemoglobin concentration was associated with an increase of 0.098
units of iron content (Fe) (p=0.058).
Breast milk production is influenced by hormonal factors, food intake,
maternal psychic condition, frequency of breastfeeding, consumption of hormonal
drugs / contraceptives and breast care (Kompas, 2013). One method of breast care
is to do breast massage with oketani method can increase the production and
excretion of breast milk that is closely related to the development and growth of
the baby (Foda, et al, 2004). Machmudah (2013) explained that the combination
of oketani massage and oxytocin can increase breast milk production seen in the
parameters of infant frequency of breastfeeding, phlegve and BAK. This study
aims to find out how the quality of colostrum before and after the massage
oketani.
Research conducted by Mahmudah et al in 2020 with the title hemoglobin
levels and breast milk composition in postpartum mothers who do breast massage
with oketani method This type of research is quasi experiment with the design
used is pre post test design with control group. Statistical test results showed that
there was a significant difference between hemoglobin levels and the chemical
composition of breast milk (proteins and carbohydrates) with a value of p = 0.000.
To improve the nutritional status of the baby, it is necessary to intake macro and
micro nutrients and efforts to reduce the production of breast milk one of which is
massage in nursing mothers because it will stimulate the hormone prolactin and
oxytocin and increase the hemoglobin levels of nursing mothers who will affect
the levels of fe in breast milk.
CONCLUSION
The results of hb measurements of pregnant women and breastfeeding on
average there is an increase. There is a correlation of HB of pregnant women and
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HB of nursing mothers with P Value of 0.024 and strongness of correlation at a
moderate level of 0.412
REFERENCES
Almatsier, S. 2011. Prinsip Dasar Ilmu Gizi. Jakarta : Gramedia Pustaka Utama.
Bora R, Sable C, Wolfson J. 2013.Prevalence of anemia in pregnant women and
its effect on neonatal outcomes in Northeast India. Journal of Maternal
Fetal and Neonatal Medicine; 27(9) : 887-91
Cai, C.; Harding, S.V.; Friel, J.K. Breast milk iron concentrations may be lower
than previously reported:implications for exclusively breastfed infants.
Matern Pediatr. Nutr.2015, 2, 2. [CrossRef]
Dahlan. 2012. Statistik untuk Kedokteran dan Kesehatan. Jakarta. Salemba
Medika
Departemen Kesehatan RI. 2005. Anemia Gizi dan Tablet Tambah
Darah(TTD)untuk Wanita Subur. Jakarta : Direktorat Bina Gizi
Masyarakat
Hidayah.W. dan Anasari, T. 2012.Hubungan Kepatuhan Ibu Hamil
Mengkonsumsi Tablet Fe dengan Kejadian Anemia di Desa Pageragi
kecamatan Cilongok Kabupaten Banyumas.
Hendarto, A. & Pringgadini, K., (2013).Nilai Nutrisi Air Susu
Ibu.http://www.idai.or.id/artikel/klinik/asi/nilai-nutrisi-air-susu-ibu.
IDAI. 2010. Indonesia Menyusui. Jakarta : Badan Penerbit IDAI
Istiany, Ari dan Rusilanti. 2013. Gizi Terapan. Jakarta: Remaja Rosdakarya.
Kalsum dan Raden.2016. Kebiasaan Sarapan Pagi Berhubungan Dengan
Kejadian Anemia Pada Remasa Di SMA Negeri 8 Muaro Jambi. Jurnal
Penelitian Universitas Jambi Seri Sains. Vol. 18 No.1 Hal : 09 - 19
Kirana, DP. 2011. Hubungan Asupan Zat Gizi dan Pola Menstruasi Dengan
KejadianAnemia Pada Remaja Putri Di SMA N 2
Semarang.Skripsi.UniversitasDiponegoro.
Kiswari, Rukman. 2014. Hematologi & Transfusi. Jakarta : Erlangga
Linder, MC. 2006.Biokimia Nutrisi dan Metabolisme.UI-Press. Jakarta:
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Marengo-Rowe AJ. 2006. Structure-function relations of human
hemoglobinsProceedings (Baylor University. Medical Center).19(3).hlm.
239–45.
Motee & Jeewon, Curr.Importance of Exclusive Breast Feeding
andComplementary Feeding Among Infants. Current Research Nutrition
and Food Science Journal., Vol. 2(2), 56-72 (2014)
Murray, R. K., Granner, D. K., & Rodwell, V. W. 2009. Biokimia Harper. Jakarta
:BukuKedokteran EGC.
Proverawati, A dan Siti, A. 2009.Buku Ajar Gizi Untuk Kebidanan.Yogyakarta
:Nuha Medika
Purbadewi, L. Dan Ulvie, Y. N. S. 2013. Hubungan Tingkt Pengetahuan
TentangAnemia dengan Kejadian Anemia pada Ibu Hamil. Jurnal Gizi
UNIMUS 2
Purwitasari, D., dan Maryanti, D., 2009.Gizi dalam Kesehatan Reproduksi.
Yogyakarta : NuhaMedika.
Ramayulis, dkk. 2016. Menu dan Resep Bekal Sehat. Jakarta : Penebar Plus.
Riset Kesehatan Dasar (Riskesdas). 2018. Badan Penelitian dan Pengembangan
Kesehatan Kementrian RI tahun 2018.
http://www.depkes.go.id/resources/download/infoterkini/materirakorpop2
018/Hasil%20Riskesdas%202018.pdf
Siti Helmyati, dkk. 2003.Hubungan Antara Kadar Hemoglobin Ibu Menyusui Dan
Kadar Zat Besi Dalam Air Susu Ibu 6 Bulan Postpartum. Jurnal
Kedokteran UGM
Sofro, Abdul Salam M. 2012.Darah.Yogyakarta : Pustaka Pelajar.
Soedijanto, S. G. 2015. Hubungan antara Asupan Zat Besi dan Protein
denganKejadian Anemia pada Siswi SMP Negeri 10 Manado. Pharmacon,
4(4).http://ejournal.unsrat.ac.id/index.php/pharmacon/article/view/10239
Wahyuningsih A, dan Astuti S.P. 2012. Hubungan Kadar Hemoglobin
denganKeteraturan Siklus Menstruasi Pada Mahasiswi Prodi DIII
KebidananTingkat III Stikes Muhammadiyah Klaten. Skripsi.
StikesMuhammadiyah Klaten. Klaten
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World Health Organization (WHO). 2012. Worldwide prevalence of anaemia.
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Yi, S. W., Han, Y. J., and Ohrr, H. 2013. Anemia Before Pregnancy and Risk
Factorof Aterm Birth, Low Birth Weight and Small for Gestational Age
Birth in Korean Women. Eouropean Journal of Clinical Nutrition. 67, 337-
342
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EFFECTIVENESS OF HOME VISITS TREATMENT ON
BREASTFEEDING IN BALIKPAPAN 2019
Ernani Setyawati1, Novi Pasiriani2
Lecture of midwifery major, Polytechnic Ministry of Health, EastKalimantan
Lecture of midwifery major, Polytechnic Ministry of Health, EastKalimantan
*Correspondence Author : Ernani Setyawati, Department of Midwifery Balikpapan,
Polytechnic Ministry of Health of East Kalimantan, Indonesia
Abstract: Background: Breastfeeding is not always easy. It can be hard, and
influence by many factors from mother and baby. The psychologis factors was
very influence for mother to breasfeed the baby until 6 month. Decreased of
hormone prolactine as effect of sadness, fearnes, worries, and lack of confidence
on breasfeed can treat the continuity of breastfeeding. There for, home care from
midwife can help the mother in breasfeeding. The aim of this research is to know
the effectivity of homecare towards breasfeeding.
Design: The method was quasi experiment design conduct in 2019. Sample of this
research is 46 mother devided in to two group. Group A used home fisit as
standard (3 times home visit in 40 days), and group B used modification program
(3 times home visit in 1 week). The result of this research was evaluate after 1
months.
Results: Mann whitney score is 135 and Wilcoxon is 213, and p-value 0,046 > α
and reject the H0. It’s shows that group B are better than grup A regard to
breastfeeding after one month.
Conclusions: The conclusion of this research is home care group B methods are
promising for increasing breastfeeding after one month, so it need more research.
Midwife as professional can use modification program for home visit to achieve
exclusife breastfeeding.
Keywords: breastfeeding, standard, modification, home visit
INTRODUCTION
Breastfeeding is a great start for both mother and her newborn baby. Mother's
milk is following the needs and digestion of newborns to achieve maximum
growth and development with exclusive breastfeeding in the first 6 months of the
baby's life to prevent digestive tract disorders (Backstrom CA, 2010)
The success of breastfeeding in infants can be influenced by infant factors and
maternal factors. The baby factor is influenced by the development of oral-motor
function which is very dependent on the gestational age. (Suradi R et al, 2010).
The psychological is the most important factor of the mother which can cause a
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mother stop to breastfeed her baby even though she does not experience breast
problems. Psychological factors can affect the process of milk
production/prolactin reflex and milk ejection reflex/oxytocin reflex so that milk
production is not optimal or mothers feel that their milk production is not optimal.
Psychological conditions that play a major role are sadness, fear, lack of self-
confidence, and lack of support for breastfeeding (Suradi R et al, 2010).
Previous research has shown positive results to help breastfeeding mothers
through family support, especially husbands, support from health workers, and
support from peers. The support of health workers through home visits is believed
to be able to support the success of breastfeeding mothers in term babies
compared to mothers who only receive hospital treatment.
Increased knowledge about the importance of breastfeeding for infants
through outreach activities in health services has not been able to increase the rate
of continuity of breastfeeding mothers in East Kalimantan, indicated by the low
rate of breastfeeding continuity of 70.5% for exclusive breastfeeding and
continuity of breastfeeding until the age of 23 months ( Riskesdas, 2018).
Balikpapan is one of the cities in East Kalimantan province with an overall
exclusive breastfeeding coverage in 2018 which only reached 78.61%. The factors
that cause it are unsupportive breastfeeding behavior, feeding/drinks before the
milk comes out, the mother's lack of confidence that breast milk is sufficient for
her baby, the mother returning to work after maternity leave, the lack of
breastfeeding support from the office and the lack of breastfeeding
facilities/facilities, and incessant promotion of formula milk (DKK Balikpapan,
2018).
Researchers have researched increasing self-confidence in breastfeeding
mothers through home visits and self-care methods. The results showed that home
visits can increase the confidence of breastfeeding mothers and are expected to
increase the rate of exclusive breastfeeding.
Many studies have been carried out on the factors causing the failure of
exclusive breastfeeding, but the research that relates postpartum home care to
breastfeeding in the city of Balikpapan has not been widely studied. The purpose
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of this study was to determine the effectiveness of home visits with modified
methods of breastfeeding in the city of Balikpapan.
METHODS
This research is a comparative analytic study using a quasi-experimental
design. The population was mothers who gave birth to babies with normal birth
weight in Balikpapan City, East Kalimantan.
The sample was mothers who gave birth to live babies at the time when the
research was conduct. Samples were obtained by a consecutive sampling of
research subjects who came to hospitals/clinics/BPM in the city of Balikpapan
and met the research criteria until the number of samples was met.
The sample size formula used is the sample size formula for comparative
analytics. The number of samples is 23 people per group. After getting the
number of samples for this study, then the number of samples was increased by
10% to avoid the risk of being lost to follow-up during the study so that the
number of samples for each group in this study was 25 people.
The subjects selected in this study met the inclusion criteria and were not
included in the exclusion criteria.
1) The inclusion criteria in this study are:
a. Mothers who gave birth to a baby for the first time and were treated at the
hospital/BPM/Clinic where the research was conducted.
b. Gestational age greater than or equal to 37 weeks at the time of delivery
c. Minimum birth weight 2,500 gr
2) The exclusion criteria in this study are:
a. The mother is sick and is not recommended by the doctor to breastfeed her
baby due to her illness
b. Babies who are seriously ill and need to have fasted
This study explains the effect of home care on breastfeeding.
The independent variable in this study was the home visit care method. The
dependent variable in this study was breastfeeding. The confounding variables in
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the study were age, parity, and education, and history of attending classes for
pregnant women.
Data collection in this study took place in 2019. All mothers in the study (both
home visit group A and home visit group B) were followed from the beginning of
the postpartum to 1 month of age of the child being born. At the beginning of the
puerperium, the subject was asked to fill out a consent form after the explanation.
Mothers and babies who are included in the conventional model home visit
group will receive postpartum care and BBL care by standards from the Ministry
of Health. Meanwhile, mothers and babies in the model B home visit group will
receive home visits on the first, second, and third days. The model B home visit is
a modification of the standard home visit from the ministry of health and
strengthening the breastfeeding process and is carried out in the first week of
postpartum.
The midwife will conduct an assessment of the mother's breastfeeding skills
including the attachment of the mother and baby during breastfeeding, and
observe signs of the baby getting enough milk. Mothers' breastfeeding skills were
assessed using breastfeeding observation sheets from UNICEF and WHO.
Midwives provide care according to breastfeeding problems faced by mothers.
The Data was analysis using a computerized system. Data before and after
treatment for each group were analyzed to obtain differences in the increase in
self-confidence using paired t-test and Wilcoxon test. The data on the confidence
comparison of the home visit group and the self-care group were tested by t-test
and Mann-Whitney test. The significance of the test results was determined based
on the p-value < 0.05.
RESULT AND DISCUSSION
The results of the study for general characteristics of respondents show in the
table below.
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Table 1. General Characteristics of Research Subjects
Characteristics Group
Home Visit A Home Visit B
n=23 n=23 P
Breas Breast milk Breas Breast milk
t milk and formula t and formula
1 milk 1 0,042
13 2
Age: 32
< 20 years 6 18
> 20 years
Education
Elementary 1 1 2 0
Junior 0 1 1 0 0,269
Senior 86 15 2
College 42 2 1
History of
attending
maternity
classes
Never 10 7 19 2
Once 2 1 0 1 0,458
Twice 20 1 0
Three Times or 1 0 0 0
more
Breastfeeding
Problems
Yes 12 52,2 18 78,3 0,015
No 11 47,8 5 21,7
Table 1 shows that most of the respondents in both groups are over 20 years
old, with primary and secondary education levels, and have never attended classes
for pregnant women. Meanwhile, the problem of breastfeeding was more
experienced by respondents at home visits in group B.
There is a significant relationship between age and breastfeeding after 1
month. The age of the subjects in the two groups which are not much different
allows for the similarity of emotional maturity, experience, and information
possessed by the subject.
Mothers with an older age are expected to have more knowledge and better
emotional maturity in carrying out their roles as mothers.
Age is also associated with the increasing amount of experience and
information obtained so that it can build a good self-concept and be able to grow
self-confidence in carrying out an activity
The education level of the research subjects also did not differ in the two
research groups. The respondent of the two research groups has the same ability to
receive and analyze new information. A person's ability to read is crucial to
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finding information about breastfeeding a baby through various ways and storing
it in memory.
Breastfeeding knowledge is also obtained through classes for pregnant women
that can attend by pregnant women at the primary health care center or hospital.
Most respondents had never taken a class on pregnant women, so they did not
have a clear picture and sufficient knowledge about breastfeeding. Lack of
knowledge and experience of breastfeeding can affect the confidence of
breastfeeding mothers (Cindy Lee, 2012)
Dennis stated that mothers with higher education tend to have higher
confidence in breastfeeding their babies. Mother's education will influence the
mother in receiving and analyzing the new information received. Intellectual
capacity such as reading will affect the retention stage of new behavior observed.
Meanwhile, the new behavior that has formed is very dependent on physical
abilities, communication, and learning abilities to behave in the same way as the
model exemplified.
Respondents in the home visit group A experienced fewer breastfeeding
problems than respondents in the home visit group B.
This happened because the midwives identified more difficulties with
breastfeeding at the beginning of the postpartum because they had more frequent
contact with respondents in the home visit group B than those in the home visit
group A.
The comparison of the two methods for feeding infants after one month shows
in the table below:
Table 2. Comparison of home visits for group A and group B on breastfeeding
Home Food after one month Mann- Wilcox P
visit Whitn on
ey
Breastm % Breastm %
ilk ilk and
formula
A 14 60,8 9 39,1
(conven 7 3 135,0 213,0 0,046
tional)
B 20 86,9 3 13,0
(modifi 5 4
kation)
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The table shows, it can conclude that there is an average difference between
group A and group B with p < value.
Respondents in group B more exclusively breastfed their babies than
respondents in group A even though they had difficulties in breastfeeding
example wrong breastfeeding position, and the lack of breastfeeding syndrome.
Breastfeeding problems can be resolved faster and without complications and
higher risks after receiving care by a midwife during a 3-day home visit in the
first week of the postpartum.
In addition, it can increase postpartum mother's satisfaction with the
midwifery care she gets during the visit
Scheduling home visits at the beginning of the postpartum can provide an
opportunity for midwives to detect breastfeeding problems, especially in the first
week of a baby's life.
The ability of mothers and babies to adapt can also affect the breastfeeding
process. By having home visits for 3 times in a row in the first week, it can help
mothers in overcoming breastfeeding problems.
The results of this study indicate that model B home visits are effective in
increasing breastfeeding for infants aged 1 month. Even though, further research
is still needed.
CONCLUSION
Based on the results of research and discussion on the effectiveness of home
visit care for breastfeeding, it can be concluded that there is a difference between
home visits B and home visits A for breastfeeding and home visits B tend to be
more effective in breastfeeding than home visits A. Midwives are expected to
develop home visit care methods to support exclusive breastfeeding programs.
Midwives are advised to increase the confidence of breastfeeding mothers by
providing individual breastfeeding support to mothers, through modification
program for home visit to achieve exclusive breastfeeding.
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ETHICAL CLEARANCE
The implications/ethical aspects of research no. LB.02.01/7.1/2733/2019 from
Polytechnic Ministry of Health, EastKalimantan include Ethical clearance (ethical
feasibility), informed consent (approval after explanation), Respect for persons
(respect for human dignity), Beneficence and Non-maleficence (beneficial, and
not harmful), and Justice (fairness).
REFERENCES
Awano M, Shimada K. (2010). Development and evaluation of a self care
program on breastfeeding in Japan: a quasi-experimental study.
International breastfeeding journal,5:9
Backstrom CA, Wahn EIH, Ekstrom AC. (2016). Two side of breastfeeding
support: experiences of women and midwives. International breastfeeding
journal. 29 nov:5.
Bowles BC. Promoting breastfeeding self-efficacy: fear appeals in breastfeeding
management. United State Lactation Concultant Association, dilihat 28
Juni 2012]. Tersedia dari
http://www.clinicallactation.org/article.php?id=7&journal_id5.
Fjeld E, Siziya S, Katepa-Bwalya M, Kankasa C, Tylleskar T. 2008. ‘ No sister,
the breast alone is not enough for my baby’s, a qualitative assesment of
otentials and barriers in the promotion of exclusive breastfeeding in
southern Zambia. International breastfeeding journal. [online serial].
Dilihat 16 Juli 2012. Tersedia dari:
http://www.internationalbreastfeedingjournal.com.
Glanz K, Rimer BK, Viswanath K. 2008. Health behaviour and health education:
Theory, research, and practice. 4 ed. San Francisco: Jossey-Bass.
Roesli U. 2008. Panduan praktis menyusui. Sentra laktasi Indonesia. Jakarta:
Puspaswara
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Suradi R, Hegar B, Partiwi IGAN, Marzuki ANS, Ananta Y, editor. 2010.
Indonesia menyusui. Badan Penerbit IDAI.
Setyawati, E. 2018. Efektivitas perawatan ,mandiri dibandingkan perawatan
kunjungan rumah terhadap kepercayaan diri ibu menyusui di kota
Balikpapan. Tersedia dari http://www.ejournal MIK.
Yonemoto N, Dowswell T, Naga S. Mori R. 2017. Schedules for home visits in
the early postpartum period. CochcrainDatabase of systematic reviews,
issue 8.
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THE EFFECT OF TRADITIONAL MUSIC AND CLASSICAL
MUSIC (MOZART) IN BREAST MILK PRODUCTION
AT PUSKESMAS RAPAK MAHANG
Wahyu Eka Novita*, Hj. Endah Wahyutri 2, Nursari Abdul Syukur 3
1*Polytechnic Ministry of Health, East Kalimantan
2Polytechnic Ministry of Health, East Kalimantan
3Polytechnic Ministry of Health, East Kalimantan
Abstract: World Health Organization in 2016 showed percentage of exclusive
breastfeeding in the world around 38%. In East Kalimantan, exclusive
breastfeeding in 2019 became 78.53%. Breast milk is perfect, and clean for baby,
contains all nutrients that babies need. The purpose of this study was to determine
an effect of traditional music sape' and classical music Mozart on milk production
of breastfeeding mothers at Rapak Mahang Health Center. This research method
was quasi-experimental research with Non-equivalent control group design. The
sampling technique used purposive sampling. The sample in this study amounted
to 22 mothers. This study was carried out around one month. The results showed
that were differences in breast milk production after treatment with traditional
music p-value 0.004 and classical music p-value 0.003 (p < 0.05). Classical and
traditional music aims as relaxation therapy because it affects the system in the
brain, has soft strains and functions to calm mind so that it gives a calming effect.
The results showed that H0 was rejected, and Ha was accepted, i.e. there was a
difference in milk production after the music intervention was given, both in the
sape' traditional music, and in the Mozart classical music. Music therapy can be
used as an option in relaxation for smooth breastfeeding.
Keyword: Breast milk production, Breastfeeding Mother, Traditional Music,
Classical Music
INTRODUCTION
Stunting is one of the nutritional problems experienced by toddlers in the
world today. In 2017, around 150.8 million children under five in the world were
stunted. Data on the prevalence of stunting under five collected by WHO,
Indonesia is included in the third country with the highest prevalence in the
Southeast Asia/South-East Asia Regional (SEAR) region. The average prevalence
of stunting under five in Indonesia in 2005-2017 was 36.4%.
WHO in 2016 still shows the average rate of exclusive breastfeeding in the
world is around 38%. East Kalimantan the coverage of infants who received
exclusive breastfeeding in 2019 around 78.53% and got second rank in terms of
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exclusive breastfeeding coverage (Kemenkes RI, 2020). This figure has been
increasing every year, but this figure is still below the target of 80%. The
coverage of exclusive breastfeeding in Kutai Kartanegara Regency is 67% (Dinas
Kesehatan Provinsi Kalimantan Timur, 2018).
One of the factors that can affect breast milk production are prolactin and
oxytocin hormones, lack of mother's knowledge, self-confidence and lack of
family support. Disturbances in the breastfeeding process are also influenced how
mother’s feel and relaxed mood, it will cause breast milk production easy to come
out and the mother's nutrition while breastfeeding must also be fulfilled
(Sulistyoningsih, 2011).
Classical music therapy is based on the belief of many music experts, that the
rhythm and tempo of most classical music follows the speed of the human heart
rate, which is around 60 beats per minute. That's why babies are often soothed
with classical music, especially music composed or arranged by Chopin, Mozart,
and Vivaldi which consistently uses a tempo that is reminiscent of the human
heartbeat (Sulistyorini, 2014).
In East Kalimantan, there is a strain of music that is also known to foreign
countries, namely the strains of Sape' music which is played by picking from the
Dayak tribe. According to Khalish's 2016 research, the strains of Sape music can
reduce stress levels and relax with slow tempo strains that can calm the mind and
relax muscles (University of Nevada, 2012)
METHOD
This study uses quasi-experimental research, Non-equivalent control group
design. The time of the study was carried out around one month start from June
until July 2021 and the research location was in the Work Area of the Rapak
Mahang Health Center, Kutai Kartanegara Regency. The population of this study
were all primiparous breastfeeding mothers with infants aged 0-6 months.
Researchers used non-probability sampling with purposive sampling technique.
The samples in the experimental group and in the control group each amounted to
11 people who were taken according to the inclusion criteria.
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RESULT AND DISCUSSION
Table 1. Characteristics of Respondents
Characteristics Classiccal % Traditional
Baby’s Age f f%
< 1 month 1 33.3 2 66.7
1 month 5 55.6 4 44.4
2 month 3 42.9 4 57.1
3 month 2 66.7 1 33.3
Mom’s Age
<20 years 001 100
20-35 years 10 50 10 50
>35 years 1 100 0 0
Mom’s Education
SMP 4 66.7 2 33.3
SMA 5 45.5 6 54.5
College 2 40 3 60
Mom’s Job
Housewife 9 47.4 10 52.6
Work 2 66.7 1 33.3
Sumber: Data primer, 2021
The results showed that the classical music respondents for 1 month old babies
were 55.6%, mothers aged 20-35 years were 50%, mothers were high school
education 45.5%, and the mothers did not work 47.4%. Respondents of traditional
music for babies aged 2 months were 57.1%, 50% of mothers were aged 20-35
years, most of mothers' education was high school 54.5%, and mothers did not
work 52.6%.
Asrifah (2018) stated that of 29 pregnant women aged 20-35 years who had a
low-risk pregnancy of 58.6%, this is the ideal age of pregnancy until delivery and
breastfeeding because get pregnancy, delivery until breastfeeding at this age is
considered sufficient. They will mature in psychology and reproductive organs.
The good frequency of breastfeeding baby about 10-12 times a day.
Breastfeeding is the process of expelling breast milk involving the let down reflex
by oxytocin which be stimulated to produce breast milk. Breast milk which fed to
the baby can help to empty the mammary alveoli, by signaling the hypothalamus
to increase prolactin secretion. Therefore, mothers are advised to breastfeed their
babies every 2-3 hours.
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The result of this study is similar to research (Saraung et al., 2017) stated that
most of the research respondents have the latest high school education as many as
16 breastfeeding mothers (53.3%). Education is an important element that
determines the nutritional status of the family. Mothers who have a high
educational background are easier to understand the received information.
Fadlliyyah's research (2019) stated that mothers who work outside and must
leave their baby for more than 7 hours will be hindered by the time to have
breastfeed, meanwhile housewives can breastfeed their children everytime.
Working mothers also cannot give exclusive breastfeeding because apart from
working factors, which no facilities such as a special room for expressing breast
milk so that the practice of exclusive breastfeeding is not achieved.
Other factors that can affect breast milk production include regular diet, high
protein nutrition and regular consumption of water, breast care will stimulate the
mammary glands and affects the pituitary to stimulate hormones in milk
production, rest patterns that will affect because the condition of mothers who are
tired and exhausted due to work tends to affect breast milk production (Aprilia &
Krisnawati, 2018).
Table 2. Differences in Breast Milk Production in Traditional Music Groups
Test Breastfeed Production
Mean Difference p-value
Pretest 110.00 31.81 0.004
Posttest 141.81
Sumber: Data primer, 2021
The results showed that the p-value of paired t-test is 0.004. It means, there is
a significant difference in average milk production in the sape' traditional music
group. This statistical difference can be influenced by the intervention carried out
by researchers through routine activities of listening to traditional sape' music by
the respondents.
Erwin & Antoro's (2019) stated that traditional music therapy modulates pain
through the release of endorphins and enkephalins. Theory of hormonal changes
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said, it suggests the role of endorphins substances neurotransmitters resembling
morphine our body produces naturally. Increased endorphins related to reduce
pain, improve appetite, blood pressure and breathe.
Endorphins have a relaxing effect and endorphins are also an ejector of the
feeling of relaxation and calm that arises. Traditional music therapy will also
reduce muscle tension, and increase serotonin, induce calm, provide comfort,
relaxation, happiness and relieve stress so that traditional music therapy will affect
the milk production of nursing mothers.
Tabel 3. Differences in Breast Milk Production
in Classical Music Groups
Test Breastfeed Production
Mean Difference p-value
0.003
Pretest 168.90 29.54
Posttest 198.45
Sumber: Data primer, 2021
The results showed that the p-value paired t-test is 0.003. It means, there is a
significant difference in the average milk production in the Mozart classical music
group. This statistical difference could be influenced by the intervention carried
out through regular activities of listening to Mozart classical music by the
respondents.
The results of Damayanti's research (2019) in Magelang which states that
classical music has an effect on relieving postpartum wound pain and
breastfeeding mothers' milk production. Meanwhile, Dewi's research (2016) states
that there is an effect of giving Mozart classical music therapy on postpartum
mother's milk production.
Classical music therapy aims as relaxation therapy because it can affect the
system in the brain that will suppress the function of the hypothalamus, pituitary,
and adrenal glands to inhibit the release of stress hormones so that the production
of oxytocin and prolactin hormones is maximized. Classical music has the
function of calming the mind and optimizing regular tempo, rhythm, melody, and
harmony so that it provides a calming effect that will affect the increase in breast
milk production (Maryatun et al., 2019).
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Table 4. Differences in Breast Milk Production in the Two Groups at Pretest
Group Breastfeed Production
Mean p-value
Traditional 110.00 0.041
Classical 168.90
Sumber: Data primer, 2021
The results showed that p-value of independent t-test is 0.041. It means, there
is a significant difference of average milk production between the traditional
music group sape' and the group Mozart classical music. This can be influenced
by several factors that affect the milk production of a nursing mother.
The difference in milk production between the two groups can show many
things, one of which is psychological factors and mothers who do not work.
Musrifa's research (2018) explains that a good mother's psychological condition
has a good impact on breast milk production and motivates her to always
breastfeed her baby.
Syukur & Purwanti (2020) stated, factors that affect the composition of breast
milk include gestational, post-natal age, breastfeeding stage. Breastfeeding
mothers are advised to eat foods that are high in protein. Animal protein can be
obtained from meat, fish, milk, and eggs while vegetable protein can be obtained
from soybeans and their products such as tempeh and tofu. Protein is very good
for the growth and development of babies.
Table 5. Differences in Breast Milk Production
in the Two Groups at Posttest
Group Breastfeed Production
Mean p-value
Traditional 141.81 0.014
Classical 198.45
Sumber: Data primer, 2021
The results indicate p-value of the independent t-test is 0.014. It means, there
is a significant difference in the average milk production between two group at the
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posttest. This can be a measure of the effectiveness of increasing breast milk
production with classical music therapy.
The results of this study different with the research of Somoyani et al., (2017)
stated that there is no difference between traditional and classical music in
alleviating anxiety and emotions in mothers. Purba's research (2017), stated that
therapy with classical music affects the milk production of breastfeeding mothers
based on the frequency of the baby's defecation.
Music therapy can be used to relaxation for smooth breastfeeding which
known as the Hypnobreastfeeding Technique. This is a natural effort to use
subconscious energy so that the breastfeeding process runs smoothly, by positive
affirmation when the mother is relaxed or concentrated so that the mother can
produce sufficient breast milk for the baby's growth and development needs.
Table 6. Effectiveness of Breast Milk Production
in Both Groups
Group Breastfeed Production
Mean p-value
Traditional 37.27 0.626
Classical 33.18
Sumber: Data primer, 2021
Based on the results showed p-value the independent t-test on the
effectiveness of breast milk production between the two groups is 0.626. It means,
there is no significant difference in the average effectiveness of milk production
between the traditional music and the classical music group (p < 0.05).
The results of Arisdiani’s et al. (2021) research stated that Mozart's classical
music has a slow tempo, balanced high and low tones and has a low and rhythmic
sound level. The arrangement in Mozart's simple music, as well as a stable
melody can help mothers in the process of releasing endorphins in the body so
that they feel comfortable and have an effect on the prolactin hormone and milk
production.
Jesica Dwi Prananda (2020) stated traditional sape' music can produce
beautiful and serene tones so that it can make the hearts of those who hear it
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happy. It will have a good impact on milk production, because a happy heart will
send a signal to the hypothalamus to produce the hormone prolactin and will
increase milk production.
Compared to other classical music compositions, the melodies and high
frequencies in Mozart's works are able to stimulate and empower the creative and
motivational areas of the brain. No less important is the purity and simplicity of
Mozart's music itself. His compositions have succeeded in bringing back the
regularity of sounds experienced by babies both in and out of the womb.
Sape' in the daily life of the Dayak people is to mention the name of the
musical instrument itself, and to refer to the practice of playing music both solo
and in ensembles.. The art of music and musical instruments of the Dayak tribe is
one of the media needed in the implementation of traditional ceremonies in the
daily life of the Dayak tribe, besides that it also functions as a means of
entertainment (Haryanto, 2016).
CONCLUSSION
There is no significant difference related to breast milk production with the
intervention of traditional sape' music and classical mozart music. Traditional and
classical music has advantage of being soft, pleasant and soothing, who hear it.
Then this will keep the mother from anxiety, as well as other psychological
disorders that will affect the increase in breast milk production.
REFERENCES
Aprilia, D., & Krisnawati, A. M. (2018). Faktor-faktor yang Mempengaruhi
Kelancaran Pengeluaran Asi Pada Ibu Post partum. Jurnal Ilmiah
Kesehatan, 1–7.
Arisdiani, D. R., Anggorowati, A., & Naviati, E. (2021). Music Therapy as
Nursing Intervention in Improving Postpartum Mothers Comfort. Media
Keperawatan Indonesia, 4(1), 72.
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https://doi.org/10.26714/mki.4.1.2021.72-82
Asrifah. (2018). Hubungan Pengetahuan dan Usia Ibu Hamil dengan Kehamilan
Risiko Tinggi di Puskesmas Benua Kabupaten Konawe Selatan Tahun
2018.
Damayanti, R. (2019). Pengaruh Musik Klasik Terhadap Tingkat Nyeri Luka Dan
Produksi ASI Pada Pasien Pst Section Caesarea Di RST dr. Soedjono
Magelang.
Dewi, R. (2016). Efektifitas Pemberian Terapi Musik Klasik (Mozart) Terhadap
Produksi ASI.
Erwin, T., & Antoro, B. (2019). Pengaruh Terapi Musik Tradisional Terhadap
Respon Nyeri Pada Pasien Paska-Operasi Di Rumah Sakit Imanuel Bandar
Lampung. Holistik Jurnal Kesehatan, 13(02), 163–171.
http://ejurnalmalahayati.ac.id/index.php/holistik/article/view/1225
Fadlliyyah, U. R. (2019). Determinan Faktor Yang Berpengaruh Pada Pemberian
Asi Eksklusif Di Indonesia. Ikesma, 15(1), 51.
https://doi.org/10.19184/ikesma.v15i1.14415
Maryatun, M., Wardhani, D. K., & Prajayanti, E. D. (2019). Peningkatan Produksi
Asi Ibu Menyusui Pasca Melalui Pemberian Pijat Oksitosin dan Terapi
Musik Klasik (Mozart) Wilayah Kerja Puskesmas Kradenan 2. Gaster,
17(2), 188. https://doi.org/10.30787/gaster.v17i2.400
Musrifa. (2018). Faktor Faktor yang Berhubungan dengan Kelancaran
Pengeluaran ASI pada Ibu Postpartum di Rumah Sakit Umum Daerah
Kota Kendari Tahun 2018.
Prananda, D. J. (2020). Etnomatematika Pada Alat Musik Sape’ Dalam Budaya
Masyarakat Suku Dayak Kalimantan. 131.
Purba, R. (2017). Efektifitas Terapi Musik Klasik Terhadap Kecukupan Asi Pada
Bayi Usia 0-3 Bulan Di Bidan Praktek Mandiri Risma Dan Bidan Praktek
Mandiri Sri Armila Medan Tahun 2017. In Journal of Chemical
Information and Modeling (Vol. 53, Issue 9).
Saraung, mitrami widiastuti, Rompas, S., & Bataha, yolanda b. (2017). Analisis
Faktor-Faktor Yang Berhubungan Dengan Universitas Indonesia Analisis
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Faktor-Faktor Yang Berhubungan Dengan. Jurnal Keperawatan, 5(2), 1–
8.
Somoyani, N. K., Armini, N. W., & Erawati, N. L. P. S. (2017). Pengaruh Terapi
Musik Klasik dan Musik Tradisional Bali terhadap Intensitas Nyeri
Persalinan Kala I Fase Aktif. 1(1).
Syukur, N. A., & Purwanti, S. (2020). Penatalaksanaan IMD pada Ibu Postpartum
Sectio Caesarea Mempengaruhi Status Gizi dan Kecepatan Produksi ASI.
Jurnal Bidan Cerdas, 2(2), 112–120. https://doi.org/10.33860/jbc.v2i2.68
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LITERATURE REVIEW: POTENTIAL OF TRANSMISSION AND
PREVENTION OF COVID-19 DURING BREASTFEEDING
Agustiawan1*, Riri Dwianggarani2
1Magister Kesehatan Masyarakat Institut Kesehatan Helvetia, Medan, Indonesia
2Rumah Sakit Islam IbnuSina, Pekanbaru, Indonesia
3Klinik DwiMedika, Banjarbaru, Indonesia
Correspondence: [email protected]
Abstract: Introduction: COVID-19 pandemic is growing rapidly, where
pregnant women and neonates are a group that is vulnerable to being infected with
COVID-19. This raises concerns about transmission to mothers with COVID-19
who wish to breastfeed. We want to explain about the potential transmission of
COVID-19 during breastfeeding and tips to prevent it. Methods: We included ten
studies (articles) in the Pubmed journal database. The article discusses the
potential for transmission and breastfeeding tips for mothers with COVID-19.
Every article has been reviewed. Result: The mainstay of transmission of SARS-
CoV-2 is by symptomatic people to others through respiratory droplets, by direct
contact with infected persons, or by contact with contaminated objects and
surfaces. Options for infant feeding and measures for a mother with COVID-19:
Direct breastfeeding Infant cared for by mother (rooming-in) or HCP/caregiver;
Expressed human milk and than Infant cared for by HCP/caregiver; and No
breastfeeding and mother’s own milk is not provided. Conclusion: Risk of
transmission to mothers and babies during breastfeeding is to those who are
symptomatic and the possibility of breastfeeding can still be done if the mother is
asymptomatic or has mild to moderate symptoms who are not using antiviral
drugs.
Keyword: Breast-feeding, COVID-19, Transmission.
INTRODUCTION
Corona Virus Disease 2019 (COVID-19) (formerly also known as Wuhan
Novel Coronavirus) is an infectious respiratory disease caused by severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2) which is closely related to the
SARS virus.1 The number of cases of COVID-19 in the world has reached more
than 200 million cases with 4 million deaths. The number of cases of COVID-19
in Indonesia has reached 3.5 million cases, of which 114 cases died.2
This infection is spread from one person infected with COVID-19 to another
through respiratory droplets produced by the airways which are often expelled
with coughing. The time from exposure to the onset of symptoms is generally
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between 2-14 days, with an average of 5 days.3 COVID-19 pandemic has come
about in changes to perinatal and neonatal consideration, focusing on limiting
dangers of transmission to the infant and medical services staff while
guaranteeing clinical consideration isn't compromised for both mother and
newborn child.4
Many of the health-promoting effects of breastfeeding are due to the provision
of passive immunity via immunoglobulins andother bioactive factors (e.g.,
lactoferrin), and previous studies have shown that milk-borne antibodies are
produced in response to viral infection.5,6
Few studies have examined the presence of antibodies to SARS-CoV-2 in
human milk.In one recent study, milk from 12 of 15 women previously infected
with SARS-CoV-2 contained IgA that was reactive to the receptor binding
domain (RBD) of the SARS-CoV-2 spike protein.5
Current proposals on baby care and taking care of when mother has COVID-
19 territories from mother–newborn child detachment and aversion of human milk
taking care of, to inception of early skin-to skin contact and direct breastfeeding.
Medical services suppliers dreading dangers of extreme intense respiratory
disorder Covid 2 (SARS-CoV2) maternal–newborn child transmission might veer
toward limited breastfeeding rehearses.7,8
It’s critical all doctors caring the family discuss in detail about the risks and
benefits of breastfeeding with parents in order to individualize any feeding choice.
All women admitted to the hospital for delivery should be tested for SARS-Cov2
taking into account the context and the local epidemiological situation.9
We want to explain about the potential transmission of COVID-19 during
breastfeeding and tips to prevent it.
METHOD
We included ten studies (articles) in the Pubmed journal database. The article
discusses the potential for transmission and breastfeeding tips for mothers with
COVID-19. Every article has been reviewed.
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RESULT AND DISCUSSION
The mainstay of transmission of SARS-CoV-2 is by symptomatic people to
others through respiratory droplets, by direct contact with infected persons, or by
contact with contaminated objects and surfaces. Options for infant feeding and
measures for a mother with COVID-19: Direct breastfeeding Infant cared for by
mother (rooming-in) or HCP/caregiver; Expressed human milk and than Infant
cared for by HCP/caregiver; and No breastfeeding and mother’s own milk is not
provided.10–12
World Health Organization's (WHO) as of late refreshed rules suggest that
moms with suspected or affirmed COVID-19 disease ought to be urged to start
and keep breastfeeding on the grounds that advantages of breastfeeding
significantly offset the potential dangers of transmission. Therefore, we actually
face vulnerabilities in the ideal administration of infant care and breastfeeding.7,13
Pace et al did not detect SARS-CoV-2 RNA in any milk sample. In contrast,
SARS-CoV-2 RNA was detected on several breast swabs, although only one was
considered conclusive. All milk contained SARS-CoV-2-specific IgA and IgG,
and levels of anti-RBD IgA correlated with SARS-CoV-2 neutralization. Strong
correlations between levels of IgA and IgG to SARS-CoV-2 and seasonal
coronaviruses were noted.14
Many of the health-promoting effects of breastfeeding are due to the provision
of passive immunity via immunoglobulins andother bioactive factors (e.g.,
lactoferrin), and previous studies have shown that milk-borne antibodies are
produced in response to viral infection.
However, few studies have examined the presence of antibodies to SARS-
CoV-2 in human milk.In one recent study, milk from 12 of 15 women previously
infected with SARS-CoV-2 contained IgA that was reactive to the receptor
binding domain (RBD) of the SARS-CoV-2 spike protein.5
They also reported that antibodies in milk from previously infected women
and milk collected prior to December 2019 (prepandemic) exhibited low-level
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cross-reactivity to RBD. However, levels of secretory IgA with reactivity to RBD
were higher in milk from previously infected women. Cross-reactivity of
antibodies in serum samples collected from healthy individuals and those infected
with seasonal human non-SARS coronaviruses (sCoV) have also been
reported.5,14
This cross-reactivity is thought to stem from homology of the spike protein of
sCoVs and SARS-CoV-2. The extent to which milk-borne antibodies have cross-
reactivity to sCoV and whether these cross-reactive antibodies are associated with
neutralization of SARSCoV-2 is currently not known.5
Mei et al (2020) accept policymakers and HCP ought to be given a state-of-
the-art survey of the scope of care proposals fromprofessional and public bodies
(with their masters and con) to devise practical rules locally.12
In general, published guidelines for breastfeeding mirror those for maternal
influenza infection, which encourage breastfeeding, while the mother adopts
infection control precautions. This is the position taken by the WHO and many
national health authorities with few exceptions.13
The WHO concluded that mothers with suspected or confirmed COVID19
should not be separated from their infants, therefore skin-to-skin contact and
breastfeeding should be initiated from birth while taking precautions to avoid
spreading virus to her infant, primarily through contact with mother’s infectious
respiratory secretions.13
The WHO’s recommendations on Infection Prevention and Control (IPC) are
that mothers with suspected, probable, or confirmed COVID-19 should be
counseled about droplet and contact precautions during contact with their infant.13
However the decision about whether or not to separate mother and neonate
must be individualized, taking into account the parents information-consent, good
health status of both the mother and her neonate and capacity to care for her
neonate, the results of RT-PCR-RNA test for COVID-19, the context and the local
epidemiological situation of current COVID-19 pandemic.9
Option A involves direct breastfeeding with the infant being cared for by the
mother or caregiver. In option B, the infant is cared for by another caregiver and
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receives mother’s expressed milk. In the third option, the infant is not breastfed
directly and does not receive mother’s expressed milk. We recommend joint
decision making by parents and the health care team.12
This decision is also flexible as situation changes. We also provide a
framework for counseling mothers on these options using a visual aid and a
corresponding structured training program for health care providers.12
An article propose different choices that could be considered for newborn
child taking care of, and suggest choice An as the ideal mode for safe and mother-
and-child agreeable breastfeeding. In individual cases, in view of maternal
conditions, and divided dynamic among medical services suppliers (HCP) and
guardians, different alternatives might be considered with its dangers and
advantages comprehended.15
Breastfeeding practices can also be adapted to the administration of drugs
obtained by the mother. The two most questionable drugs for safety are favipiravir
and remdesivir. Favipiravir first appeared in Japan in 2014 as a new therapeutic
option for influenza because the virus showed increased resistance to
oseltamivir.7,16
This drug has a broad spectrum effect against a wide variety of influenza
viruses and has been used against other viral families, in addition to being
effective against the Ebola virus, where its use is associated with longer patient
survival. This medicine is not recommended for pregnant and lactating women.16
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Figure 1. Infographic for counseling a mother with COVID-19 on breastfeeding. COVID-19,
novel coronavirus disease 2019; HCP, health care provider12
Favipiravir can be used in combination with other antiviral drugs and shows a
synergistic effect. Favipiravir is considered a potential drug against COVID-19.
However, available studies have not provided sufficient evidence to recommend
routine use of favipiravir for the treatment of SARS-CoV-2 infection. No
information is available on the use of favipiravir during breastfeeding or its
excretion into breastmilk.16
Favipiravir is a small molecule that is about 60% protein bound in plasma, so
it would be expected to appear in breastmilk and be absorbed by the infant,
probably in small amounts. In clinical trials, favipiravir has been well tolerated,
but has caused liver enzyme abnormalities, gastrointestinal symptoms, and serum
uric acid elevations.16
Remdesivir is a drug developed in 2016 for the Ebola virus.17 Study tested the
use of remdesivir against SARS-CoV-1 and MERS-CoV in vitro with good
results. This drug is an antiviral analogue of adenosine, which is incorporated into
the RNA polymerase chain when metabolized in cells, thereby preventing viral
replication. Remdesivir is an RNA Polymerase inhibitor known to shorten
recovery time in nonpregnant women.16
Pregnant women have been excluded in most studies. Some studies show that
remdesivir does not cause side effects for pregnant women. Based on a
randomized control trial conducted during the Ebola epidemic, Remdesivir is safe
for use in pregnant women.18,19 There is no information regarding the presence of
remdesivir in breast milk, its effect on breastfed infants, or its effect on milk
production. Remdesivir is given intravenously because it is poorly absorbed
orally, so infants are not likely to absorb clinically important amounts of the drug
from milk.16
Counseling may be done through teleconversation, videoconference, or face-
to-face encounter with personal protective equipment (PPE) precautions. The first
meeting is ideally done before baby’s birth, once mother has been diagnosed with
COVID-19. However, with the widespread range of COVID-19 presentations,
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HCP may be confronted with various scenarios, ranging from a mother with
confirmed, probable, suspect, presymptomatic infection or an asymptomatic
carrier. There is even an emerging proposal for routine screening of obstetric
patients admitted for labor, regardless of maternal symptomatology. HCP should
discuss with the mother options available to her, with an appropriate visual aid for
her reference.
CONCLUSION
Risk of transmission to mothers and babies during breastfeeding is to those
who are symptomatic and the possibility of breastfeeding can still be done if the
mother is asymptomatic or has mild to moderate symptoms who are not using
antiviral drugs.
REFERENCES
1. World Health Organization (WHO). Naming the coronavirus disease
(COVID-19) and the virus that causes it. Geneva; 2020.
2. Satuan Tugas Penanganan COVID-19. Peta Sebaran [Internet]. Satuan
Tugas Penanganan COVID-19. 2021 [dikutip 7 Agustus 2021]. Tersedia
pada: https://covid19.go.id/peta-sebaran
3. Hessen MT. Novel Coronavirus Information Center: Expert guidance and
commentary. Else Connect. 2020;
4. Ciapponi A, Bardach A, Comande D, et al. COVID-19 and pregnancy: An
umbrella review of clinical presentation, vertical transmission, and
maternal and perinatal outcomes. PLoS One. 2021;16(6).
5. Dong Y, Chi X, Hai H, et al. Antibodies in the breast milk of a maternal
woman with COVID-19. Emerg Microbes Infect. 2020;9(1):1467–9.
6. Cunningham FG; Leveno KJ; Bloom SL; et al. Williams Obstetri. 25 ed.
New York: The McGraw-Hill Companies; 2020.
7. Susilo A, Rumende CM, Pitoyo CW, Santoso WD, Yulianti M,
Herikurniawan H, et al. Coronavirus Disease 2019: Tinjauan Literatur
Terkini. J Penyakit Dalam Indones. April 2020;7(1):45.
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8. Royal College of Obstetricians and Gynaecologists (RCOG), Royal
College of Midwives the RC of P and CH (RCPH), Royal College of
Anaesthetists, Obstetric Anaesthetists’ Association. Covid-19 and
pregnancy. BMJ. 2020;369:16–72.
9. Guiliani C, Volsi PL, Burn E, et al. Breastfeeding during the COVID-19
pandemic: Suggestions on behalf of woman study group of AMD.
Diabetes Res Clin Pract. 2020;165:1–7.
10. Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: A
review. Clin Immunol. 2020;215(April).
11. WHO Indonesia. Coronavirus disease (COVID-19). 2020.
12. Mei PY, Low YF, Goh XL, et al. Breastfeeding in COVID-19: A
Pragmatic Approach. Clin Opin. 2020;37:1377–84.
13. World Health Organization (WHO). Implementation guidance: Protecting,
promoting, and supporting breastfeeding in facilities providing maternity
and newborn services: the revised baby-friendly hospital initiative.
Geneva: WHO Int; 2020.
14. Pace RM, Williams JE, Jarvinen KM, et al. COVID-19 and human milk:
SARS-CoV-2, antibodies, and neutralizing capacity. Medrxiv. 2020;
15. Vintzileos WS, Muscat J, Hoffmann E, et al. Screening all pregnant
women admitted to labor and delivery for the virus responsible for
COVID-19. Am J Obs Gynecol. 2020;9387(20):30472–5.
16. Cavalcante MB, Cavalcante CTMB, Braga ACS, et al. COVID-19
Treatment: Drug Safety Prior to Conception and During Pregnancy and
Breastfeeding. Geburtshilfe Frauenheilkd. 2021;81(1):46–60.
17. Drugbank. Remdesivir. Drugbank. 2020.
18. Burwick RM, Yawetz S, Stephenson KE, et al. Compassionate Use of
Remdesivir in Pregnant Women with Severe Covid-19. Clin Infect Dis.
2020;
19. Pierce-Williams RA, Burd J, Felder L, et al. Clinical course of severe and
critical coronavirus disease 2019 in hospitalized pregnancies: A United
States cohort study. Am J Obs Gynecol. 2020;2.
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BREASTFEEDING KNOWLEDGE AND ATTITUDES DURING
COVID-19 ISOLATION AMONG MOTHERS WITH MILD
CASES
Wiyarni Pambudi1,2, Nuralisa Safitri2
1Department of Child Health, Faculty of Medicine Universitas Tarumanagara, Jakarta
2Breasfeeding Task Force Indonesian Pediatric Society
Abstract: Indonesia’s COVID-19 guidelines allowed mother with mild cases to
continue direct breastfeeding with infection prevention protocol upon family’s
preference according to clinical conditions and after receiving education. The
present study aimed to examined the impact of facility-based isolation compared
to self-isolation at home on the continuing direct breastfeeding practice. This
cross-sectional study targeted positive COVID-19 confirmed mothers who had
under-twelve-months infants during February-August 2021 period. Data was
collected through an online survey using self-administered questionnaire form to
assess impact of the pandemic on breastfeeding practices. In total, 308 women
participated and reported that before they confirmed to have tested positive for
SARS-CoV-2, their infant feeding were 43.5% exclusive breastfeeding, 41.2%
partial breastfeeding, 15.3% formula feeding. Nearly 48% mother responded that
breastfeeding is safe during COVD-19, but 65% of them raised concerns about
medicines they consumed. More than 59% mother with mild cases considered to
stop direct breastfeeding and practicing indirect feeding, using her own milk,
donor milk, or formula. About 57% women with previous breastfeeding
experience had intention to relactate after recover from isolation. Insufficient
knowledge, lack of intention, and poor breastfeeding self-efficacy reduce the
likelihood of breastfeeding during isolation.
Keywords: COVID-19, breastfeeding, knowledge, attitude
INTRODUCTION
The COVID-19 outbreak, caused by the severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2), was identified at the end of 2019. The pandemic
has been affecting every aspect of life around the world since then. Breastfeeding
mothers and infants are not excluded (Kotlar 2021). The World Health
Organization (WHO) stated breastmilk as clinical gold standard feeding for
infants because it is safe, clean and contains antibodies which help protect against
many common childhood illnesses. It provides all the nutrients that the infant
needs for the first months of life, and it continues to provide up to half or more of
a child’s nutritional needs during the second half of the first year, and up to one
137
The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia
third during the second year of life (WHO 2020). Breastfeeding also supports
healthy brain development and is associated with higher performance on
intelligence tests among children and adolescent (Kim 2020). Furthermore,
Sustainable Development Goals (SDGs) aims to reduce neonatal mortality to at
least 12 per 1000 live births, under-5 mortality to 25 per 1000 live births by 2030
(Tefera 2021). Studies have shown an inverse relationship between exclusive
breastfeeding and infant mortality rates in developing countries. Appropriate
infant feeding practices are required to achieve this goal (Azuine 2015).
The COVID-19 pandemic has also intensified the concerns of mothers
regarding breastfeeding. The fear of vertical transmission through breastfeeding is
currently a core concern of new mothers, and the evidence is still conflicting
(Kotlar 2021). In March 2020, Word Health Organization (WHO) supports the
continuation of breastfeeding as well as postpartum skin-to-skin contact following
certain recommendations and precautions. Word Health Organization (WHO)
recommend that women with COVID-19 can breastfeed based on the idea that
through breastmilk the babies would get antibodies and anti-infective factors that
help protect newborns from getting infections (WHO 2020). In addition, the
World Health Assembly (WHA) has set a global target in order to increase the
rate of exclusive breastfeeding for infants aged 0–6 months up to at least 50% in
2012–2025 (Azuine 2015). Adherence to these guideline, Indonesian National
Household Health Survey in 2020 showed that the practice of exclusive
breastfeeding was 66,06%. It still needs to be increased in order to achieve SDGs
target to reduce infant mortality (Kemenkes 2020).
Indonesia’s COVID-19 guidelines allowed mother with mild cases to continue
direct breastfeeding with infection prevention protocol and the provision of
expressed breastmilk upon family’s preference according to clinical conditions
and after receiving education. Of the various barriers to breastfeeding, limited
information is available for mothers during the COVID-19 isolation. In fact, even
though there are some guidelines available, there are still concern about
breastfeeding. Mothers’ good knowledge and positive attitude play key roles in
the process of breastfeeding (Dukuzmuremyi 2020). A study reported that mothers
138
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