Proceeding International Webinar “The International Conference on Lactation Management (ICLM) in Covid-19 Pandemic Era"

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

with higher knowledge of EBF were 5.9 times more likely to practice EBF than
their counterparts (OR 5.9; 95% CI 2.6, 13.3; p < 0.001) and higher scores of
breastfeeding knowledge (OR 1.09; 95% CI 1.04–1.14), attitude (OR 1.04; 95%
CI 1.00, 1.09), and practice control (OR 1.11; 95% CI 1.02, 1.20) were associated
with a higher prevalence of exclusive breastfeeding.7 Based on the data above, this
descriptive study therefore set out to assess describe the knowledge and attitudes
among mothers with mild cases COVID-19 positive during isolation in Indonesia.

The present study aimed to explore the knowledge and attitudes about
breastfeeding of mother with mild cases. We examined the impact of facility-
based isolation compared to self-isolation at home on the continuing direct
breastfeeding practice.

METHODS

This cross-sectional study targeted positive COVID-19 confirmed mothers
who had under-twelve-months infants at all mode of feeding. Systematic random
sampling method was employed for selecting participants in proportion to facility-
based and self-isolation at home during February-August 2021 period. Data was
collected through an online survey using self-administered questionnaire. The
survey was anonymous and data confidentiality will be protected. A questionnaire
consisting of both closed and open-ended questions was used to collect all data on
socio-demographic factors, knowledge, attitude and practice of breastfeeding. The
respondents who didn’t complete all of the questionnaire were being excluded.
The obtained data were organized in MS excel and results were obtained in
percentage.

RESULTS AND DISCUSSION

Characteristic of mothers with mild case COVID-19

In total, 308 women participated and reported that before they confirmed to
have tested positive for SARS-CoV-2. The mean age of the respondents was 28,2
years old, 97 (31,4%) of the respondents have infant with 1-3 years old. The data
showed that 152 (49%) of the respondents graduated from university. Of the 308

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respondents, 137 (45%) were experiencing the birth of the first child
(primiparous) and 171 (55%) had two or more children (multiparous). 195 (67%)
of the respondents work from home during pandemic, majority 152 (49%) of the
respondents live in Java area (Table 1).

The result showed that the proportion of the exclusive breastfeeding (EBF)
before mother confirmed COVID-19 was 127 (61%), partial breastfeeding was
134 (43%) and formula feeding (FF) was 47 (15%) (Table 1).

Knowledge

The COVID-19 pandemic has been affecting every aspect of life around the
world since then. The data showed that of the 308 respondents, 148 (48%)
mothers responded that breastfeeding is safe during COVD-19, majority 134
(44%) of them still believe that COVID-19 medicine is not safe for breastfeeding
and 200 (65%) of the respondents also believe that vaccine give no benefit to
breastfed infant. The result showed less than 22 (7%) of them had vaccinated.

On the contrary, Word Health Organization (WHO) already give
recommendation to support the continuation of breastfeeding as well as
postpartum skin-to-skin contact following certain recommendations and
precautions (WHO 2020). Moreover, the Union of European Neonatal and
Perinatal Societies advise direct breastfeeding under strict measures of infection
control in asymptomatic COVID-19 mothers, but when the mothers are too sick,
the neonates will be managed separately with fresh expressed breastmilk
(Davanzo 2020). A series of 22 case studies of newborns to mothers with COVID-
19 infection from March 14th to April 14th, 2020 conducted by Pereira et all also
conclude that breastfeeding is safe with correct infection and control measures to
decrease the risk of contagion by droplets and by contact with the respiratory
secretions between mother and infant (Pereira 2020).

The result showed that they get about COVID-19 and breastfeeding
information from several sources. These are health care provider, webinar,
television or newspaper, social media, and also family or friends. Majority of the
respondents get the information from social media.

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This is similar to the report by Abdelhafiz et al. where social media was the
main source of information for young adults in their survey in Egypt (Abdelhafiz
2020). On the other hand, Roy et al. reported 67% of Indians felt worried after
receiving social media updates on the global burden of COVID-19 (Roy 2020).
Thus, we need to ensure that the source information given in social media can be
trusted.

Attitudes and Practices

The result showed half of the respondents 154 (50%) decide to do the isolation
at home, while 145 (47%) was facility-based isolation. We found that only 9 (3%)
of the respondents with mild case COVID-19 choose to isolation at the hospital
(Table 2).

After mother confirmed COVID-19, there was a difference of attitude and
practices in how to fed their babies. The result showed that 66 (21%) of the
respondents still choose to give Direct Breastfeeding (DBF), but mother with mild
case COVID-19 176 (57%) consider to stop direct breastfeeding and practicing
some another ways, these are 43 (14%) decide to give Indirect Breastfeeding, 17
(5,5%) using Donor Milk Feeding (DMF) as an alternative, 58 (18%) still choose
Formula Feeding (FF), while 124 (40%) choose combination between
breastfeeding and formula Of the 308 respondents, 176 (57%) women with
previous breastfeeding experience had intention to relactate after recover from
isolation, despite a higher burden in terms of reduced medical counseling and
psychosocial support during isolation (Table 2).

This is aligned to the online survey conducted by Brown and Shenker, their
study showed that breastfeeding experiences were influenced by the COVID-19
pandemic, either positively (41.8%; e.g., spending more time at home,
experiencing less social pressure, and fewer visitors), negatively (27%; e.g. less
perceived support, worries about safety of breastfeeding, and isolation), or
neutrally (29.5%). Women who perceived the breastfeeding experience during the
pandemic as more challenging were less likely to describe themselves as ready to
stop breastfeeding. These authors also found a strong significant association

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between breastfeeding perceptions and current feeding method. In terms of how
COVID-19 had affected their decision to stop breastfeeding, 70.3% attributed a
lack of face-to-face support, 20.9% worries about the safety of breastfeeding and
6.5% their symptoms of COVID-19 to stopping breastfeeding (Brown 2020). In
addition, when the time of birth was before the pandemic, 50.1% of women rated
their experience of breastfeeding as positive, and 10.7% as negative. When giving
birth after the pandemic, only 36.2% of women rated their breastfeeding
experience as positive, while 34.8% rated it as negative (Pacheco 2021).

The research does have limitations. Using online research data collection
methods is an increasingly popular approach and one that was necessary during
the pandemic. However, it would likely have excluded participants from the most
deprived groups who could not access the internet.

CONCLUSION

Insufficient knowledge, lack of intention, and poor breastfeeding self-efficacy
reduce the likelihood of breastfeeding during isolation. Facility-based was
associated with significantly lower exclusive breastfeeding practices compared
with self-isolation at home. Supportive and consistent messaging from health
professionals were very important to help mothers handle the stress and
uncertainty of the infant feeding practices in the midst of the pandemic.

ACKNOWLEDGEMENT

The authors would like to thank to the anonymous reviewers for their
contributions which helped to improve this manuscript.

SOURCE OF FUNDING
This was entirely self‐ funded research, authorship, and/or publication of this
this study or manuscript.

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DISCLOSURE AND CONFLICTS OF INTEREST

None of the authors had potential conflicts of interest related to any part of
this study or manuscript.

CONTRIBUTIONS

WP conceived, conceptualized, and designed the study, collected data, advised
in the analysis and interpretation of the results, finalized the manuscript. NS
analyzed and interpreted the data, write up of initial results, and drafted the
manuscript. Both authors have read and approved the final manuscript.

ORCID ID

Wiyarni Pambudi - https://orcid.org/0000-0001-9544-084X
Nurlisa Safitri - https://orcid.org/0000-0003-1431-3385

ETHICS

Ethical clearance has been approved by the Ethical Committee of the Faculty
of Medicine, Universitas Tarumanagara (No. 019/KEPK/UPPM/FK
UNTAR/VIII/2021)

REFERENCES
Abdelhafiz AS, Mohammed Z, Ibrahim ME, Ziady HH, Alorabi M, Ayyad M, et

al. (2020). Knowledge, Perceptions, and Attitude of Egyptians Towards
the Novel Coronavirus Disease (COVID-19). J Community Health, 1‐ 10.
Azuine RE, Murray J, Alsafi N, Singh GK. (2015). Exclusive Breastfeeding and
Under-Five Mortality, 2006-2014: A Cross-National Analysis of 57 Low-
and-Middle Income Countries. Int J MCH AIDS, 4(1), 13-21.
Brown A, Shenker N. (2020). Experiences of breastfeeding during COVID-19:
Lessons for Future Practical and Emotional Support. Matern. Child. Nutr,
17, e13088.

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Davanzo R, Moro G, Sandri F, Agosti M, Moretti C, Mosca F. (2020).
Breastfeeding and Coronavirus Disease-2019. Ad Interim Indications of
The Italian Society of Neonatology Endorsed by the Union of European
Neonatal and Perinatal Societies. Matern Child Nutr, 16(3), e13010.

Dukuzumuremyi JPC, Acheampong K, Abesig J, Luo J. (2020). Knowledge,
Attitude, and Practice of Exclusive Breastfeeding among Mothers in East
Africa: A Systematic Review. Int Breastfeed J, 15, 70.

Kementerian Kesehatan RI. (2020). Profil Kesehatan Indonesia 2020. Jakarta:

Kemenkes RI.

https://www.kemkes.go.id/downloads/resources/download/pusdatin/profil-

kesehatan-indonesia/Profil-Kesehatan-Indonesia-Tahun-2020.pdf viewed

20 September 2021.

Kim KM, Choi JW. (2020). Associations Between Breastfeeding and Cognitive
Function in Children from Early Childhood to School Age: A Prospective
Birth Cohort Study. Int Breastfeed J, 15, 83.

Kotlar B, Gerson E, Petrillo S. Langer A, Tiemeier H. (2021). The Impact of the
COVID-19 Pandemic on Maternal and Perinatal Health: A Scoping
Review. Reprod Health, 18, 10.

Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA,
& Ganho-Ávila A. (2021). Breastfeeding during COVID-19: A Narrative
Review of the Psychological Impact on Mothers. Behavior Sci, 11(3), 34.

Pereira A, Cruz-Melguizo S, Adrien M, Fuentes L, Marin E, Forti A, et al. (2020).
Breastfeeding Mothers with COVID-19 Infection: A Case Series. Int
Breastfeed J, 15, 69.

Roy D, Tripathy S, Kar S, Sharma N, Verma S, Kaushal V. (2020). Study of
Knowledge, Attitude, Anxiety and Perceived Mental Healthcare Need in
Indian Population during COVID-19 Pandemic. Asian J Psychiatr,
51:102083.

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Tefera YG, Ayele AA. (2021). Newborns and Under-5 Mortality in Ethiopia: The
Necessity to Revitalize Partnership in Post-COVID-19 Era to Meet the
SDG Targets. J Prim Care Community Health, Jan-Dec,
12:2150132721996889. https://DOI:10.1177/2150132721996889.

WHO. (2021). Breastfeeding Advice During the COVID-19.
http://www.emro.who.int/noncommunicable-
diseases/campaigns/breastfeeding-advice-during-the-covid-19-
outbreak.html viewed 20 September 2021.

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DIET TABOOS FOR BREASTFEEDING MOTHERS: AN OVERVIEW

Riri D.1, Agustiawan2,3
1Klinik Dwi Medika, Banjarbaru, Indonesia
2Magister Kesehatan Masyarakat Institut Kesehatan Helvetia, Medan, Indonesia
3Rumah Sakit Islam Ibnu Sina, Pekanbaru, Indonesia
Correspondence: [email protected]

Abstract: Introduction: Women who are breastfeeds need more nutritional
intake because they have to supply breast milk with the best content for the baby's
growth and development. Some regions in Indonesia still have certain dietary
restrictions for breastfeeding mothers. This food taboo is related to cultural,
health, and religious reasons. Methods:This study is a secondary data analysis,
sourced from Health Ethnographic Research data in 2012 which aims to
determine the nutritional fulfillment behavior of breastfeeding mothers in
Javanese and Madurese ethnic groups. The data collected includes the taboos for
breastfeeding mothers in the two ethnic groups.Results: We found that there are
several public beliefs regarding dietary restrictions for mothers during
breastfeeding. This dietary taboo is not only found in ethnic Madurese and
Javanese, but also in several ethnic groups and even other countries. Conclusion:
Dietary taboos for breastfeeding mothers, even though it has become a tradition,
are not proven in health. Women who are breastfeeds should increase their energy
and nutrient intakes since breast milk has to supply an adequate amount of all the
nutrients for an infants needs for growth and development.

Keyword: Breastfeeding, COVID-19, Dietary taboos

INTRODUCTION

Exclusive breastfeeding is recommended by the World Health Organization
(WHO) throughout the first 6 months of life. World Health Assembly resolution
65.6 in 2012 supports a plan for a more complete implementation of maternal,
infant and child nutrition and mentions 6 global nutrition targets by 2025. One of
the targets is to increase the rate of exclusive breastfeeding to at least 50%.
Currently, only 37% of infants are exclusively breastfed.1

The coverage of exclusive breastfeeding in Indonesia in 2020 is 66.06%. This
figure has exceeded the 2020 Strategic Plan target, which is 40%. The highest
percentage of exclusive breastfeeding coverage was West Nusa Tenggara
Province (87.33%), while the lowest was West Papua Province (33.96%).2

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Various obstacles are faced to be able to breastfeed optimally, one of which is
the existence of myths about breastfeeding that will affect the quality and quantity
of breast milk. In some areas in Indonesia, a mother must follow the traditions and
myths that exist during pregnancy until the postpartum period, including certain
dietary restrictions during breastfeeding.3

In terms of culture and tradition, Indonesian people both in urban and rural
areas have the obligation to follow this belief. Whereas due to wrong knowledge
and avoiding certain foods can make women do not get adequate nutrition. It is
important to maintain a balanced diet considering the increasing needs of women
during pregnancy and lactation.4

The nutritional needs of mothers need to be considered during breastfeeding
because the nutrition that comes in must not only meet their needs but also for
their babies through adequate breast milk content. Breast milk is important
because it is the main and first nutrient that is suitable for the digestion of
newborns. This study is designed to provide an overview of dietary restrictions in
several ethnic Indonesians.

METHOD

The data comes from a secondary data analysis, sourced from Health
Ethnographic Research data in 2012 and other journal databases which aims to
determine the nutritional fulfillment behavior of breastfeeding mothers in
Javanese and Madurese ethnic groups. The data collected includes the taboos for
breastfeeding mothers in the two ethnic groups. The purpose of this study was to
overview food taboos in Indonesia, Madurese and Javanese ethnic groups.

RESULT

We found that there are several public beliefs regarding dietary restrictions for
mothers during breastfeeding. This dietary taboo is not only found in Madurese
and Javaneseethnic, but also in several ethnic groups and even other countries.

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DISCUSSION
Breast milk contains colostrum which is rich in antibodies because it contains
protein for the immune system and is useful for killing high numbers of germs so
that exclusive breastfeeding can reduce the risk of death in infants. Colostrum is
yellowish in color which is produced on the first day to the third day. On the
fourth to the tenth day, breast milk contains less immunoglobulin, protein, and
lactose than colostrum but has higher fat and calories with a whiter color. In
addition to containing food substances, breast milk also contains certain enzymes
that function as substances absorbent that will not interfere with other enzymes in
the intestine. Formula milk does not contain these enzymes so the absorption of
food is completely dependent on the enzymes found in the baby's intestines.2
Nationally, the coverage of infants receiving exclusive breastfeeding in 2020
is 66.06%. This figure has exceeded the 2020 Strategic Plan target of 40%. The
highest percentage of exclusive breastfeeding coverage is in West Nusa Tenggara
Province (87.33%), while the lowest percentage is in West Papua Province
(33.96%). There are four provinces that have not reached the 2020 Strategic Plan
target, namely Maluku and West Papua. The full coverage of infants receiving
exclusive breastfeeding can be seen in Figure 1.2

Figure 1. Coverage of babies getting exclusive breast milk by province in 2020

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Breastfeeding is not optimal even though the advantages and benefits of
breastfeeding have been proven to support the survival of babies. Many mothers
have difficulties in breastfeeding. One of the factors is food intake. The quality
and quantity of breast milk produced by the mother can be influenced by the
intake of certain foods.5

There is a myth that has developed and become a tradition in some areas
related to some foods that are not good during breastfeeding. The eating pattern of
the mother after giving birth is shaped by a culture that is not in line with the diet
recommended by balanced nutrition guidelines. Although not all mothers do
dietary restrictions, there are still some who do and this can affect daily intake
such as energy, protein and other macronutrient components.6

Intake needs to be more than during pregnancy because all the nutritional
content in breast milk must be adequate enough to meet the needs of the baby for
the period of growth and development. It takes 200 more calories per day and the
source of calories should be from a nutritionally complete diet that contains
carbohydrates, protein, fat, and other micronutrients.7Lactation is the phase of
human reproduction that requires the most energy. The energy cost of breast milk
production in the first six months of exclusive breastfeeding increases the
mother's daily energy needs by 30% or 1260 kJ/day above the energy needs of
pregnant women. An additional 500 kcal for the first six months, and 400 kcal for
the next six months, are required for nursing mothers.8

Some of the reasons food is taboo are due to health, cultural, and religious
issues. The factors related to food consumption patterns such as income,
education, occupation, ethnicity, family support, and husband. Other food taboos
are related to traditions and cultural norms that have been passed down from
generation to generation. Based on data from the East Kalimantan Health Office
in 2013 which showed a figure of 106 deaths per 1000 births and an objective
assessment conducted at the hospital on the portion of food intake consumed by
mothers after giving birth. They tend not to eat certain food sources of protein
such as fish and eggs. They believe that some of these foods will affect the quality
of breast milk or the healing process after giving birth.5,7

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In the ethnic Madurese, there are several taboos for mothers while
breastfeeding their babies, among them are mothers are not allowed to eat sea fish
because they are afraid that their breast milk will smell fishy. In addition, mothers
should also not consume too much chili because breast milk will taste spicy and
cause the baby's eyes to be dirty and red. The following is the informant's
statement regarding dietary restrictions while breastfeeding, “...you can't eat fish
because it makes breast milk fishy. It's also not allowed to use chili, because later
the baby's eyes can get dirty, ma'am..".9

In Javanese, there are not only food taboos, but also drink taboos. There is a
belief about food and drink taboos that should not be done while the mother is
breastfeeding. Breastfeeding mothers should not drink ginger water because it is
feared that small blisters will appear. Ginger water is believed to have a bad effect
on baby's skin because it is hot. In addition, it is also forbidden to eat sweet in
large quantities because it can inhibit the process of drying the wound in the
baby's navel and food that smells and tastes fishy should also be avoided by
nursing mothers because it will affect the health of the baby10.

The same thing happened in Barito Kuala, South Kalimantan. There are as
many as 11 foods that are taboo for breastfeeding mothers. The list of foods and
their reasons can be seen in Table 1.11

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Table 1. List of taboo foods for breastfeeding mothers

No. Food Reasons

1 Egg Will get pregnant again

2 Fresh fish Bleeding after 40 days of
delivery and the child's
urine smells
Fever

3 Fish There will be red spots
on the child's skin

4 Sugar There will be red spots
5 Salt on the child's skin
Fever

There will be red spots
on the child's skin
Fever

6 Kalui fish Poisoned

7 Jackfruit Itchy

8 Fatty food Bleeding after 40 days of
delivery and the child's
urine smells

9 Spicy food Bleeding after 40 days of

delivery and the child's

urine smells

Mother's milk will be

sour and the child will

have diarrhea

10 Sour food Mother's milk will be

sour and the child will

have diarrhea

There will be red spots

on the child's skin

11 Coconut Mom can get sick

cream

This taboo food is not only in Indonesia, but also in other country. A cross-
sectional study was done in Guadalajara, Mexico to identify food taboos among
nursing mothers who participated in a breast-feeding programme. The study
includes 493 nursing mothers who were interviewed 10-45 days after delivery. A
chi- square test was used for finding an association among food taboos, mother’s
characteristics, and demographic variables. 50.3% of the mothers avoided at least
one food in their diet after childbirth due to beliefs that it was harmful during
breastfeeding. Forty- seven percent avoided three or more foods. Fruits and
vegetables (62%) and legumes (20%) were the most avoided foods. These food

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taboos were associated with living more than 10 years in Guadalajara city, breast
feeding experience, no prenatal information about breast feeding and other
people’s suggestion to complement breast feeding. A supportive approach and
efficient communication, taking into account mother’s characteristics, might
reduce the gap between scientific recommendations and nutritional practices of
mothers willing to nurse their infants.12

In Karnataka, South India, 110 women who have given birth in the past three
months were followed by a focus group discussion (FGD) among twelve
consenting mothers at a rural health centre. Among 110 women, more than 80%
of women have increased their food intake postpartum. Vegetables such as
eggplant and fruits such as papaya were avoided by 65.5% and 73.6% of women,
respectively. This is influenced by the socio-economic status and educational
status of the woman.13

Good nutritional intake to support the mother's stamina, patience and self-
confidence when breastfeeding her baby. It is important for us to be able to help
mothers achieve the right nutritional status for optimal breastfeeding and need to
consider energy and nutritional needs.8To get a healthy diet we need to eat many
different types of food each day including fruit and vegetables, grains, roots,
beans, nuts and animal products and other. It is not healthy to eat the same food
with the same components every day. Consumption of a wide variety of foods is
likely to increase nutrient adequacy, good nutrition is the key to good mental and
physical health.7

Among these taboos is to avoid foods that contain protein such as fish and
eggs. Though it needs adequate protein intake during the period of growth or
recovery from disease. Protein requirements during pregnancy are approximately
60g/day over a nine-month period. This is an increase of 10 to 15g/day above the
needs of a non-pregnant woman. During lactation, it is necessary to increase 15-
20 g/day above the pre-pregnancy requirement because protein is responsible for
various functions, namely cell growth, tissue repair, energy source, maintenance
of fluid and electrolyte balance, acid-base balance, and the immune system.8

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Fat is the main source of energy in breast milk. A breastfeeding woman has a
particularly higher need for docosahexaenoic acid (DHA) because her baby uses a
lot for the development of the central nervous system during pregnancy as well as
brain growth and eye development. The content of DHA in breast milk directly
reflects the mother's intake. On average, milk lipids comprise about 4% of human
milk.8

During breastfeeding, maternal status or intake of B vitamins (except folate),
vitamin A, selenium, and iodine greatly affect breast milk concentrations of these
nutrients. This can result in the baby consuming less than recommended and
further depleting the mother's nutritional reserves.The daily energy intake of
women who are breastfeeds should be increased when compared to women who
are not pregnant and who are not breastfeeding. This can be seen in Table 2.8\

Table 2. Summary of nutritional needs of pregnant and lactating women compared with non-
pregnant adult women aged 19 to 50 years.

CONCLUSION
Efforts to reduce belief in food taboos still need to be done, especially taboo
foods for pregnant and lactating women. This effort can be carried out by officers
from the Health Service and Posyandu cadres online. The approach must be
broader to the environment and must be with effective communication. Mothers

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are also expected to improve literacy so that taboos/misconceptions are expected
to be reduced.

REFERENCES

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Griswold M. Busted: 14 myths about breastfeeding [Internet]. [cited 2021 Sep
27]. Available from:https://www.unicef.org/parenting/food-nutrition/14-
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Ali U, Azim DrH. Taboos and Beliefs among Pregnant & Lactating Women.
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Ramadhani AS, Astawan M, Rahayu WP. Pola Konsumsi Pangan Ibu Pasca
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Pangan. 2015;2(2):136–43.

Barennes H, Simmala C, Odermatt P, Thaybouavone T, Vallee J, Martinez-Ussel
B, et al. Postpartum traditions and nutrition practices among urban Lao
women and their infants in Vientiane, Lao PDR. European Journal of
Clinical Nutrition. 2009;63(3):323–31.

Southalack P. Food Consumption Pattern Among Lactating Mothers During 2019
in Vientiane Capital, Lao PDR. 2019.

Ongosi AN. Nutrient Intake and Nutrition Knowledge of Lactating Women (0-6
months postpartum) in a Low Socio-Economic Area in Nairobi, Kenya.
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Widyasari R, Diana Sari I, Lailatul M. A, Haryanto S, Pramono MS. Buku Seri
Etnografi Kesehatan Ibu dan Anak 2012: Etnik Madura, Desa Jrangoan,
Kecamatan Omben, Kabupaten Sampang, Provinsi Jawa Timur. Badan

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Penelitian dan Pengembangan Kesehatan, Kementerian Kesehatan RI;
111.
Kristiana L, Murwanto T, Dwiningsih S, Sapardi H, Kasnodihardjo. Buku Seri
Etnografi Kesehatan Ibu dan Anak 2012: Etnik Jawa, Desa Gading Sari,
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Sukandar D. Makanan tabu di Barito Kuala Kalimantan Selatan. Jurnal Gizi dan
Pangan. 2007 Jul 11;2(2).
Santos-Torres MI, Vásquez-Garibay E. Food taboos among nursing mothers of
Mexico. Journal of health, population, and nutrition. 2003 Jun;21(2).
Rao, R C, SM D, K A, SB N. Assesment of cultural beliefs and practices during
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research study. Global Journal of Medicine & Public Health. 2014;3(5).

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DIFFERENCES IN OKETANI MASSAGE AND OXYTOCIN MASSAGE
ON BREAST MILK PRODUCTION IN POSTPARTUM MOTEHRS
AT UPT SEPAKU 3 PUBLIC HEALTH CENTER
PENAJAM PASER UTARA IN 2021

Ani Fitriani1, Susi Purwanti2, Nursari Abdul Syukur3
1)Student Of The Applied midwifery Program Study, Poltekkes Kaltim

2)Lecture Of Midwifery Department, Poltekkes Kaltim
3)Lecture Of Midwifery Department, Poltekkes Kaltim

E-mail : [email protected]

Abstract: Background low milk production causes babies not be able to get
breast milk completely exclusive. This causes the mother or family to often give
PASI for replace breast milk so that the baby is not fussy. Therefore, efforts were
made to massage oketani and massage oxytocin to facilitate milk production. The
purpose of this research is to analyze the difference between oketani massage and
oxytocin massage on breast milk production in postpartum mothers.
Methods quasi experiment, that is by design using the Non-equivalent control
group pretest approach and posttest. The sample studied was 16 people who were
divided into 2 intervention groups. 8 people in the oketani massage intervention
group and 8 in the oxytocin massage intervention group. Using univariate
analysis and bivariate analysis, this study used thetest Shapiro Wilk to determine
the normality of the data. This study uses a Dependent t test and Independent t test
because the data is normally distributed with the help of a computer program
SPSS 25.
Results after the oketani massage were p value 0,057 and after massage Oxytocin
p value 0,058. p (0.05) with 95% Confident Interval, then H0 is accepted, where
it can be concluded that there is no significant difference between Oketani
Massage and Oxytocin Massage on the production of breast milk.
Discussion Oxytocin massage can stimulate the release of the hormone oxytocin,
in addition to releasing hormones that can provide comfort to the mother. Oketani
massage can increase the production of the hormones prolactin and oxytocin.
Oketani massage also causes the mammary glands to become more mature and
wide so that milk production can increase.
Conclusion Oketani Massage and Oxytocin Massage are interventions that both
have success on smooth milk production.

Keywords: Oketani Massage, Oxytocin Massage, Breast Milk Production,
Postpartum Mother

INTRODUCTION

According to WHO, globally, the average rate of exclusive breastfeeding in

the world in 2017 was only 38%. This is not in accordance with the WHO target,

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namely increasing exclusive breastfeeding in the first 6 months to at least 50%.
This is the fifth target of WHO in 2025.

Breast milk is a source of life for children which is very important in a child's
first life, where in mother's milk there are many nutrients needed by children that
support the growth and development of a child ( Imam et al, 2018). Many
complaints experienced by mothers at the beginning of the breastfeeding process
include breast milk not coming out, breast milk in small quantities, blistered
nipples and so on (Macheasy. et al., 2019). Many things can be done such as
oketani massage and oxytocin massage (Kusumastuti et al., 2018).

Oketani massage is a massage around the breast from the 4th rib to the 9th rib.
Oketani massage is a method to stimulate the strength of the pectoralis muscle to
increase milk production and make the breasts softer and elastic so that it can
correct problems lactation and makes it easier for the baby to suck breast milk
besides massage can also provide comfort to the mother. According to research
(Cho et al., 2012) there are differences after the oketani massage, namely the
increase in milk production, changes in the nipples and the absence of signs of
breast milk dam symptoms after being given the oketani massage.

Source: Cho et al 2012
Figure 1. Oketani

Massage Oxytocin massage can affect the hormone prolactin which functions
as a stimulus for breast milk production in mothers during breastfeeding. This
action can also relax the mother and smooth the flow of nerves and milk channels

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in both breasts (Umbarsari, 2017). Oxytocin massage in addition to reducing
tension and stress can also increase milk production (Jannah & Widyawati,
2017).

Source: Ministry of Health RI, 2009
Figure 2. Oxytocin Massage

METHODS
Type of research is a quasi-experimental design using a non-equivalent
control group pretest and posttest approach (Notoatmodjo, 2018).
The sample studied was 16 people who were divided into 2 intervention
groups. 8 people in the oketani massage intervention group and 8 in the oxytocin
massage intervention group.
The research instrument used was SOP for oketani massage and SOP for
oxytocin massage, olive oil, observation sheets as well as cell phones and
stationery in the form of pencils, pens and notebooks.
The data that has been collected were analyzed by univariate analysis with
dependent t test and bivariate analysis using independent t test, this study used the
Shapiro Wilk test to determine the normality of the data. by using the computer
program SPSS 25.
Ethics of data collection in research Ethical clearance, Informed consent,
Confidentiality, Benefit, Justice

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Research time is 1 month, from May – June 2021
RESULTS

Table 1. Characteristics of Respondents

Mostly, 11 respondents (68.75%) are in the age range of 20-35 years, meaning
that the average age of respondents in both the oketani massage group and the
oxytocin massage group is in the healthy reproductive period and there are 9
respondents (56.25%) included in Parity (Multipara) so that in this case the
mother has have experience in terms of breastfeeding and milk production is
better.

Because the sample is less than 50, the .used test is Shapiro Wilk for normality
test which serves to determine whether the data is normally distributed or not.

From the results obtained before massage Oketani p value (0.366) and after
massage Oketani p value (0.365) while before massage oxytocin p value (0.067)
and after massage oxytocin p value (0.429) it can be concluded that the data is
normally distributed (p > 0, 05).

Table 2. Breast Milk Production Before and after Oketani Massage

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Value = 0.000 (0.05) then Ha is accepted and H0 is rejected, which means that
there is a difference in milk production before and after the Oketani massage. This
means that oketani massage can affect milk production.

Table 3. Breast Milk Production Before and After Oxytocin Massage.

The result is p = 0.001 (0.05) then Ha is accepted and H0 is rejected, which
means that there is a difference in milk production before and after oxytocin
massage. This means that oxytocin massage can affect milk production.

Table 4. Differences in Oketani Massage and Oxytocin Massage on Breast Milk Production

The results obtained after Oketani massage p value = 0.57 and after oxytocin
massage p value = 0.58 where p (0.05) then Ha is rejected and H0 is accepted,
which means that there is no difference between Oketani massage and Oxytocin
massage on production Breastfeeding for postpartum mothers at UPT Puskesmas
Sepaku 3 Penajam Paser Utara in 2021.

DISCUSSION
Identifying the characteristics of maternal age and parity in breast milk
production

The results showed that the majority, namely 11 respondents (68.75%) were
between the ages of 20-35 years, this age was included in healthy reproduction.
And there are 9 respondents (56.25%) with Parity (Multipara), where in this parity

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the mother already has experience in breastfeeding and breast milk production is
better.

The healthy reproductive age range is at the age of 20-35 years, this period is
the best period for pregnancy, childbirth and breastfeeding. In a healthy
reproductive period, breast milk production will be sufficient because the function
of the reproductive organs can still work optimally according to research
(Leiwakabessy & Azriani, 2020).

The experience gained by multiparous mothers in caring for children affects
knowledge about breastfeeding (Soetjiningsih, 2014).

According to research by Frieska, et al (2018) in research (Leiwakabessy &
Azriani, 2020) explaining that parity is related to early lactation. The beginning of
this lactation will determine the success of the next breastfeeding.

From the results of observations, the age of 20-35 years is a mature age both
in terms of thinking, physically, mentally and psychologically in readiness to face
pregnancy, childbirth and breastfeeding. Multipara parity has more knowledge
and experience about the breastfeeding process so that it can be applied properly.

Identifying breast milk production before and after the oketani massage

Based on the results of the study, thevalue of p value = 0.000 (0.05) then Ha is
accepted and H0 is rejected, which means that there is a difference in breast milk
production before and after the oketani massage. This means that oketani massage
can affect milk production.

Oketani massage is a massage around the breast from the 4th rib to the 9th rib.
Oketani massage can provide stimulation to the lactiferous canal.

In accordance with research (Kusumastuti et al, 2018) oketani massage is very
helpful for launching breast milk production and milk secretion so that it can
prevent the occurrence of breast milk dams. The research of Yuliati, et al (2017)
also explains that oketani massage will cause the mammary glands to become
more mature and wide so that milk production can increase. And according to
research by Macheasy et al (2018) that with oketani massage can increase the
production of the hormones prolactin and oxytocin.

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From the observations that oketani massage is very helpful in milk production
and prevents and can treat breast milk dams.

Identifying breast milk production before and after oxytocin massage

Based on the results of the study, it was found that p value = 0.001 (0.05) then
Ha was accepted and H0 was rejected, which means that there was a difference in
milk production before and after oxytocin massage. This means that oxytocin
massage can affect milk production.

Oxytocin massage is a massage along the spine (vertebrae) to the 5th and 6th
ribs in the mother's body.

According to research (Jannah & Widyawati, 2017) that Oxytocin massage
has been proven significantly through several studies to stimulate the release of
the hormone oxytocin, in addition to the release of hormones that can provide
comfort to the mother. The research (Sulaeman et al., 2016) also said that
oxytocin massage was effective for increasing breast milk production in
postpartum mothers. Likewise with research (Isnaini and Diyanti, 2015) oxytocin
massage can stimulate the anterior and posterior pituitary to secrete the hormone
oxytocin. Thus frequent breastfeeding is good and it is important to empty the
breasts so that breast engorgement does not occur, but on the contrary accelerates
the release of milk.

From the results of the interview, it was found that oxytocin massage can
make the body relax and provide a sense of comfort and reduce fatigue after
giving birth.

Analyzing differences in milk production after oketani massage and oxytocin
massage

Based on the research results, breast milk production was obtained after
Oketani massage p value = 0.57 and after oxytocin massage p value = 0.58 where
p (0.05) with Confident Interval 95%, then Ha is rejected and H0 is accepted, that
there is no significant difference between Oketani massage and Oxytocin massage

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on milk production. This means that Oketani massage and Oxytocin massage can
both facilitate milk production.

According to research (Buhari et al, 2018) there is a difference in the increase
in the frequency of breastfeeding in mothers who received oketani massage
compared to mothers who received oxytocin massage.

There is a difference in the effectiveness of oxytocin massage with oketani
massage with an average of 102.35 ml of oxytocin massage and an average of
78.35 ml of oketani massage with a difference of 24 ml on milk production in
postpartum mothers (Andani, 2019)

According to research (Sihotang et al, 2020) there is a difference breast
massage with oxytocin massage. Where oxytocin massage produces more milk
than breast massage.

From the discussion above and the results obtained through observations made
that Oketani massage and oxytocin massage are equally effective in smooth milk
production and prevent breast milk damming.

CONCLUSION

There is no significant difference between Oketani massage and Oxytocin
massage on milk production. This means that Oketani massage and Oxytocin
massage can both facilitate milk production.

The difference between the two is that after the oketani massage is performed
on the mother with the nipples pulled inward (inverted) and stretched (flat) for 3
consecutive days, the nipples that are pulled inward become stretched and the
nipples that are stretched become prominent. Oketani massage can also treat
breast milk dams so that milk becomes smooth.
While Oxytocin Massage can provide a sense of comfort so that the body
becomes relaxed.

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REFERENCE

Andani, NV (2019). Differences in the Effectiveness of Oxytocin Massage and
Oketani Massage on breast milk production in postpartum mothers in the
working area of the East Metro Yosodadi Health Center.

Buhari, S., Jafar, N., & Multazam, M. (2018). Comparison of Oketani Massage
and Oxytocin on Breast Milk Production on First Day Post Partum
Mothers to Third Days at TK II Pelamonia Hospital Makassar. pelamonia
pomegranate health journal, 2(2), 159–169.
https://doi.org/10.37337/jkdp.v2i2.84

Cho, J., Ahn, HY, Ahn, S., Lee, MS, & Hur, M.-H. (2012). Effects of Oketani
Breast Massage on Breast Pain, the Breast Milk pH of Mothers, and the
Sucking Speed of Neonates. Korean Journal of Women Health Nursing,
18(2), 149. https://doi.org/10.4069/kjwhn.2012.18.2.149

Isnaini N, & Diyanti R. (2015). The relationship between oxytocin massage in
postpartum mothers and breast milk production in the working area of the
Raja Basa Indah Public Health Center in Bandar Lampung. Journal of
Midwifery.

Jannah, SR, & Widyawati, MN (2017). Comparing Effectiveness Of Palm Dates
And Oxytocin Massage In Stimulating Breastmilk Production Of Post
Partum Mother. 2nd International Conference on Applied Science and
Health.

Jauhari Imam et al. (2018). "Protection of Children's Rights Against
Breastfeeding". Yogyakarta: CV Budi Utama

Kusumastuti, Qomar, U. laelatul, & Pratiwi. (2018). The effectiveness of oketani
massage on the prevention of breast milk dams in postpartum mothers.
University Research Colloquium.

Leiwakabessy, A., & Azriani, D. (2020). Relationship of age, parity and
frequency of breastfeeding with breast milk production. Journal of
Midwifery Science and Women's Health.
https://doi.org/10.36082/jmswh.v1i1.162

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Macheasy et.al. (2018). Oketani massage reduces cortisol hormone levels in

nursing mothers in the city of Semarang. Journal of Nursing And Scientific

Thinking.

Macheasy. J., . NK, . SW, . EDH, & . FH (2019). Increasing Oxytocin Hormone

Levels In PostPartum Mothers Receiving Oketani Message and Pressure in

the GB-21 Acupressure Point. International Journal of Advancement in
Life Sciences Research, 2(1), 22–27.

Notoatmodjo, (2012). Health Research Methods. Jakarta: Rineka Cipta

Sihotang, PC, Situmorang, TH, Hutagaol, IO, & Setyawati, E. (2020). The

effectiveness difference between breast massage and oxytocin massage

towards the smoothness of breast milk production at Matahari Room of

Undata Public Hospital Central Sulawesi Province. International Journal

of Advanced Science and Technology.

Soetjiningsih. (2014). Child Development. Jakarta: EGC.

Sulaeman, ES, Yunita, FA, Yuneta, HAEN, Khotijah, Wijayanti, YRAR,

Setyawan, H., Rinawati, S., & Utari, CS (2016). The effect of oxytocin

massage on the postpartum mother on breastmilk production in Surakarta

Indonesia. International Conference on Health and Well-Being.

Yahya, FD, Ahmad, M., Usman, AN, Sinrang, AW, Alasiry, E., & Bahar, B.

(2020). Potential combination of back massage therapy and acupressure as

complementary therapy in postpartum women for the increase in the

hormone oxytocin. Enfermeria Clinica.

https://doi.org/10.1016/j.enfcli.2019.07.163

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EFFECTIVENESS OF OXYTOCINE MASSAGE AND MARMET
MASSAGE ON BREAST MILK PRODUCTION IN POST PARTUM
MOTHERS AT MUTIA CLINIC, PENAJAM PASER NORTH DISTRICT

IN 2021

Suprapti1), Inda Corniawati Politics2), Elisa Goretti Sinaga3)
1)Student Midwifery Study Program,Applied
2) Department ofPoltekkes Kaltim

3) Lecturer in the Department of Midwifery, Poltekkes Kaltim

Introduction : Breast milk is the main food for babies containing all the
substances needed by babies. The problem that is often faced by post partum
mothers is that breastfeeding has not come out, this causes the failure of exclusive
breastfeeding. For this reason, efforts are needed in the form of interventions to
help accelerate the release of breast milk and increase milk production, namely
through oxytocin massage and marmet massage.
Methods : aresearch method quasi-experimental with a randomized two group
pre-test post-test design, the population of all healthy postpartum mothers and
their babies. The number of samples is 20 people.sampling technique of sampling
Totalg. The research instrument is SOP and observation sheet. Univariate data
analysis technique used the value of central tendency and bivariate analysis used
dependenttest,test tindependent t.
The results of the study : The milk production before oxytocin massage was
obtained (mean) 1.890 and after oxytocin massage the value (mean) was 7.920.
The milk production before the marbled massage was obtained (mean) 1,920 and
after the marmet massage the value (mean) was 7,760. There are differences in
breast milk production before and after oxytocin massage in maternity with p
value 0.000 with a difference of 6.030. There are differences in milk production
before and after marmet massage in maternity mothers with p value 0.000 with a
difference of 5,840. There is no difference in milk production between oxytocin
massage and marmet massage in maternity mothers at Bunda Mutia Clinic, North
Penajam Paser Regency in 2021 with a p value 0.379.
Conclusion: oxytocin massage and marmet massage are interventions that can
increase milk production in postpartum mothers.

Keywords: Oxytocin Massage, Marmet Massage, Breast Milk Production

INTRODUCTION

Referring to the 2025 Strategic Plan target of 60%, nationally the coverage of

exclusive breastfeeding for infants aged less than 6 months of 54.8% has not

reached the target. Of the 34 provinces, only 3 provinces have not reached the

target, namely Gorontalo 34.2%, Riau 41.5% and Central Kalimantan 50.6%,

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while in East Kalimantan province ASI coverage is 53.4% in 2019 (Ministry of
Health RI, 2019) . Exclusive breastfeeding coverage in North Penajam Paser
Regency in 2018 was 73.07% and in 2019 it was 73.60%, an increase of 0.53%.
Exclusive breastfeeding coverage even though there was an increase, namely in
2019 by 73.6% but this value is still below the national target of 80%. (East
Kalimantan Provincial Health Office, 2019).

Efforts to facilitate breast milk production can be done with oxytocin massage
(WHO, 2011). Oxytocin massage can reduce swelling (engorgement), reduce
breast milk blockage, stimulate the release of the hormone oxytocin, maintain
milk production when mothers and babies are sick (Kemenkes RI, 2012). The
oxytocin reflex can be stimulated by expressing and pumping breast milk for 10-
20 minutes until the baby can suckle.

In addition to oxytocin massage, it can also be done with a marmet massage
technique which is a combination of blushing and massaging techniques (Roesli,
2012). Marmet massage causes the milk secretion reflex to be optimal. The
principle aims to empty the breast milk from the lactiferous sinus which is under
the areola so that it is hoped that emptying the breast milk in the lactiferous sinus
area will stimulate the release of the hormone prolactin and will further stimulate
the mammary alveoli to produce breast milk.

Research conducted by Delima et al. (2016) with the title the effect of
oxytocin massage on increasing breast milk production of breastfeeding mothers
at the Plus Mandiangin Health Center showed that there was an effect of oxytocin
massage to increase the milk production of breastfeeding mothers at the Plus
Mandiangin Public Health Center Bukittinggi 2016, with a p-value of 0.000.

Based on this description, the researcher is interested in the Differences in the
Effectiveness of Oxytocin Massage and Marmet Massage on Smooth Breast Milk
Production in Post Partum Mothers at Bunda Mutia Penajam Paser Utara Clinic

RESEARCH METHODS

The design of this study used a research method quasi-experimental with a
randomized two group pre-test post-test design. The population in this study were

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all postpartum mothers on the first and second days who gave birth at Bunda
Mutia Penajam Paser Utara Clinic. The average number of deliveries per month is
20 deliveries, the number of samples is 20 respondents with total sampling
technique. The instruments used are SOPs and observation sheets. The analysis
used univariate analysis with central tendency and bivariate analysis using
independent t test.

RESULTS AND DISCUSSION

Table 1. Characteristics by Age of Respondents at Bunda Mutia Clinic, North Penajam Paser
Regency in 2021

No. Oxytocin Massage Marmet Massage
Frequency

Age (n) % Frequency %
(n)

1 < 20 years 4 40.0 3 30.0
2 20-35 years 5 50.0 6 60.0
1 10.0 1 10.0
3 > 35 years
Parity 5 50.0 6 60.0
5 50.0 4 40.0
1 Primiparity 4 40.0 2 20.0
2 Multiparity
1 Low 5 50.0 6 60.0

(SD/SMP) 1 10.0 2 20.0
2 Medium 4 40.0 2 20.0

(SMA) 8 80.0 7
2 20.0 3
3 High (PT)
1 Low

(SD/SMP)
Employment

1 Not working
(IRT)

2 Work
(PNS/Traders)

Based on the table above shows that most of the respondents in the oxytocin
massage group were mostly aged between 20-35 years, namely 5 people (50%) as
well as in Most of the marmet massage groups were also aged between 20-35
years as many as 6 people (60%), most of the respondents in the oxytocin
massage group were mostly multiparous, namely 5 people (50%). as many as 6

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people (60%), most of the respondents in the oxytocin massage group were mostly
SMA as many as 5 people (50%) as well as in the marmet massage group, most of
them also SMA as many as 6 people (60%), most of the respondents in the
oxytocin massage group mostly IRT as many as 8 people (80%) as well as in the
massage group Marmet mostly also IRT as many as 7 people (70%).arity is as
many as 22 people (68.8%).
Univariate Analysis

Table 2. Results of Breast Milk Production in the Group PerformedOxytocin
Massage

Based on the results of collecting data on milk production before doing
oxytocin massage, the data obtained an average value (mean) of 1,890 after doing
oxytocin massage, the data obtained an average value (mean) of 7,920.

Table 3. Results of Data on Breast Milk Production in the Group Performed by
Marmet Massage.

Breast milk production before doing massage marmet obtained an
average value (mean) of 1.920, after doing massage the average value of
data (mean) was 7.760.

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Bivariate Analysis of the
The Effect of Oxytocin Massage on Breast Milk Production

Table 4. The Effect of Oxytocin Massage on Breast Milk Production

Statistical test results obtained p value 0.000 < 0.05 and tcount>15.865 t table
(n-1)(1/2α) = 2.262. which shows the effect of oxytocin massage intervention on
breast milk production in post partum mothers at Bunda Mutia Clinic, Penajam
Paser Utara Regency in 2021.
Effect of Marmet Massage on Breast Milk Production

Table 5. Effect of Marmet Massage on Breast Milk Production

Statistical test results obtained p value 0.000< α 0.05 and value t 21.240> t
table (n-1)(1/2α) = 2.262. which shows that there is an effect of giving oxytocin
massage intervention on breast milk production in post partum mothers at Bunda
Mutia Clinic, North Penajam Paser Regency in 2021.
Effect of Marmet Massage on Breast Milk Production

Table 6. Differences in milk production between Oxytocin Massage and Massage Marmet

Statistical test result obtained resultvalue p 0,000 <α 0.05 and valuet 0.379
<ttable (n-2)(1/2α) = 2.101. which showed that Ho is rejected, which means there
is no difference between massage milk production of oxytocin and maternal post

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Marmet Massage Clinic Mother partumdi Mutia Penajam Paser Utara 2021.
Discussion
Characteristics of Respondents

Based on the findings that most of the age 20-35 years old in both the mothers
who received oxytocin massage and those who received marmet massage.
Maritalia (2017) also said that a healthy reproductive age will affect breast milk
production because in addition to a healthy age, the psychological condition of
mothers at the age of 20-35 years is better prepared so that it affects the release of
hormones that stimulate milk production.

Based on the results of the study, the most parity was multiparity, both in
mothers who received oxytocin massage and those who received marmet
massage. It is clear that the majority of respondents are in parity groups are not at
risk as proposed in Manuaba (2010) parity is good for pregnancy and maternity
and breastfeeding is the parity of 2 to 3.

Based on the results of educational research that most of the good high school
education in the mother oxytocin massage and marmet massage. According to
Notoatmodjo (2003), a higher level of education will make a person's knowledge
better.

Respondents with higher education are more likely to breastfeed because they
have good knowledge about nutritious food.

Based on the results of the research, the most occupations were housewives,
both for mothers who received oxytocin massage and those who did marmet
massage. This explains that most of the respondents do not work.

There is a relationship between mother's work and breastfeeding practice.
According to Roesli (2013), working mothers tend to not pay too much attention
to the care of their babies and are less patient in breastfeeding their babies so that
they fail in the breastfeeding process (Trianita, 2018).

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Milk production before and after Oxytocin Massage

The results showed that the average milk production before the intervention
was 1.890 ml with a minimum milk production of 1.2 and a maximum milk
production of 2.7, thevalue was standard deviation 0.5065. The results showed
that in the group that received oxytocin massage before the intervention, there was
still a small amount of milk coming out.

Differences in milk production masing each different respondents from 1.2
ml to 2.7 ml, these differences seen in the different characteristics, wherein the
new mothers breastfed their first child very small amount compared with mothers
who already have children over 1. this difference is also evident from the age of
the mother where the mother's age <20 years banyak whose supply out very little
because milk production is also affected by maternal age.

Based on the results of this study, it was shown that before the oxytocin
massage on the first day 6 hours postpartum, the mother's milk production was
still low. After that, an intervention in the form of oxytocin massage was carried
out to the mother where the results of breast milk production increased where the
milk production measured on day 2 increased on average to 7,920 with a minimum
milk production of 6.4 ml and a maximum milk production of 9.3 ml. Thus, it was
seen that there was an increase in breast milk production before and after the
intervention.

Breast Milk Production Before and After Marmet Massage

The results showed that the average milk production before the intervention
was 1.920 ml with a minimum milk production amount of 1.4 and a maximum
milk production of 2.4, thevalue was standard deviation 0.3048. The results
showed that in the group that received marmet massage before the intervention,
there was still little milk coming out.

The difference in the milk production of each respondent differs between 1.4
ml to 2.4 ml, this difference can be seen in different characteristics, where in
mothers who have just given birth to their first child the amount of breast milk is
very little compared to mothers who already have more than 1. this difference is

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also evident from the age of the mother where the mother's age <20 years banyak
whose supply out very little because milk production is also affected by maternal
age.

Effect of Oxytocin Massage on Breast Milk Production

The results showed that there was an effect of oxytocin massage on breast
milk production, seen from the significant difference in milk production before
and after oxytocin massage, seen from p value 0.000 < 0.05. This proves that
oxytocin massage is effective in increasing breast milk production in postpartum
mothers, this can be seen from the milk production before the intervention has an
average of 1.898 ml and after the intervention for 2 days and measured milk
production increases to 7.920 ml or there is an increase in the amount of
production Breast milk is 6.030 ml.

Oxytocin massage is a massage carried out along the spine (vertebrae) to the
fifth - sixth costae bone and is an effort to increase the production of the
hormones prolactin and oxytocin after childbirth which aims to increase milk
production (Rahayu et al., 2015). This oxytocin massage action is able to increase
the production of the hormone oxytocin which can increase comfort for
breastfeeding mothers. In addition, the production of the hormone oxytocin is also
able to increase myoepithelial contractions of the mammary glands so that the
production of breast milk is more and more smoothly. When breastfeeding
mothers experience stress or discomfort, there will be an inhibition of thereflex let
down so that it will reduce milk production. This is because there is a release of
the hormone adrenaline which causes vasoconstriction of theblood vessels
alveolar, so that only a small amount of oxytocin is able to reach the target organ
of the myoepithelium of the mammary gland. In addition, there will also be the
release of the hormone noradrenaline in the central nervous system so that in
accordance with the mechanism of action of these two chemical substances, it will
cause thebe inhibited milk ejection reflex to and eventually breast milk production
will decrease (Riordan & Auerbach, 2010).

The results showed that oxytocin massage affects milk production, this is in

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accordance with the theory put forward by Widyani (2015) that the working
oxytocin hormone will stimulate smooth muscles to squeeze out the breast milk in
the alveoli, lobes, and ducts containing breast milk and then expel it. through the
nipple. One of the alternative actions taken to increase milk production is oxytocin
massage (Lestari, 2017). Another benefit of oxytocin massage is that it can
stimulate let-down reflexes ininfants, provide comfort to mothers, reduce swelling
in the breasts, reduce blockage of breast milk, stimulate the release of the
hormone oxytocin, and maintain milk production when mothers and babies are
sick (Delima et al., 2016).

Effect of Marmet Massage on Breast Milk Production

The results showed that there was an effect of Marmet massage on breast milk
production seen from the significant difference in milk production before and
after Marmet massage seen from the p value 0.000 < 0.05.

The use of the marmet method is one of the efforts made to increase milk
production. This method is often referred to as back to nature because it is simple
and does not cost money and effectively stimulates the breasts to produce more
breast milk (Norlita, 2017).

Differences in the effectiveness of Oxytocin Massage and Marmet Massage
Against Breast Milk Production

The results of the research conducted to determine the effectiveness of
differences in breast milk production between oxytocin massage and marmet
massage were analyzed by independent t-test and the results showedvalue p =
0.709 0.05 whereanalysis independent t-testshowed no significant difference.
There is a significant difference between oxytocin massage and marmet massage
where the results of breast milk production in the group given oxytocin massage,
which is 7.920, does not show a significant difference with the group receiving
marmet massage, which is 7.780 or there is a difference of 0.1600 ml.

Oxytocin massage and guinea pig massage are equally useful interventions in
the lactation process, especially in the first days after birth because these two

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interventions help maximize the release of lactation hormones such as prolactin
and oxytocin (Guyton, 2015).

CONCLUSION

The characteristics of post partum mothers at the Bidan Mutia Clinic are
mostly between 20-35 years old in the oxytocin massage group as many as 5
people (50%) and the marmet massage group 6 people (60%), mostly multiparity
in the oxytocin massage group as many as 5 people. (50%) and the marmet
massage group were 4 people (40%), the education level of most of the senior
high school students in the oxytocin massage group was 5 people (50%) and the
marmet massage group was 6 people (60%) and most of the occupations did not
work or IRT at the oxytocin massage group was 8 people (80%) and the marmet
massage group was 7 people (70%).

Breast milk production before oxytocin massage obtained an average value
(mean) of 1.890 and after oxytocin massage the data obtained an average value
(mean) of 7.920.

The production of breast milk before the marbled massage obtained the
average value (mean) 1,920 and after the marmet massage the average value data
(mean) was 7,760.

There is an effect of oxytocin massage on breast milk production in maternity
with a p value of 0.000 with an average difference of 6.030.

There is an effect of marmet massage on breast milk production in maternity
with a p value of 0.000 with an average difference of 5,840.

There is no difference in the effectiveness of oxytocin massage and marmet
massage on milk production in maternity mothers at Bunda Mutia Clinic, North
Penajam Paser Regency in 2021 with a p value of 0.379.

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Widya Ningrum. (2017). Characteristics and Support of Breastfeeding Mothers
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THE EFFECT OF MORINGA LEAF ON BREASTFEEDING MOTHERS
ON INCREASING BABY WEIGHT IN PUSKESMAS LOAKULU

Dewi Wahyuni 1), Jasmawati 2), Rizky Setiadi 3)
1)Student of Applied Midwifery Study Program, Poltekkes Kaltim

2)Lecturer of the Department of Midwifery, Poltekkes Kaltim
3)Lecturer of the Department of Nursing, Poltekkes Kaltim

Abstract: Preliminary: Scope breast milk Exclusively in Indonesia at 68%,
while the target according to SPM 80%. In East Kalimantanbreast milkExclusive
rates are at 70%, while Kutai Kartanegara Regency is 53% in 2019. Moringa
leaves are a super food that contains phytosterols that function as lagtogogums,
which are substances that trigger the production of breast milk. to increase breast
milk production.
Methods:This study uses the Quasy Experiment method with a pretest and
posttest group design. The population in this study were all mothers who breastfed
babies aged less than 6 months in the working area of the Loa Kulu Health Center.
The sample using the Porposive Sampling technique was 32 respondents who
were divided into 2 consisting of 16 control groups and 16 treatment groups.
Results : From calculations using the Mann Withney test, the p value of 0.00 is
smaller than 0.05, meaning that giving Moringa leaf vegetables to breastfeeding
mothers has an effect on increasing baby weight. Meanwhile, in the Paired T test,
the results of measuring the weight of infants included in the treatment group
obtained p value of 0.00 <0.05, meaning that there was a significant difference
before and after treatment.
Conclusion: In this study, it was shown that there was a significant effect on
giving Moringa leaf vegetables to breastfeeding mothers on increasing infant
weight. It is recommended for breastfeeding mothers that is very good to consume
Moringa leaf vegetables with nutrient-rich content, it will support the success of
exclusive breastfeeding.

Keyword : Moringa leaf, ASI, increasing infant weight.

INTRODUCTION

Breastfeeding is a time when a mother feels closer and intimate with her baby.

During breastfeeding, there are many factors that can make the breastfeeding

process successful or not. The mother's focus on caring for the baby during

breastfeeding is also supported by nutritional intake as well as socio-

psychological support. There are many factors that can affect the productivity of

breast milk. The factors that most influence the success of mothers in giving

breast milk to their babies include insufficient milk production.(Jeniawaty et al.,

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2016) .
Referring to the Sustainable Development Goals (SDGs) or the 2030

Sustainable Development Goals, breastfeeding is one of the first steps for a
human being to get a healthy and prosperous life. In Indonesia, almost 9 out of 10
mothers have given breast milk, but the IDAI study found that only 49.8% gave
exclusive breastfeeding for 6 months according to WHO recommendations.

The coverage of infants receiving exclusive breastfeeding in Indonesia in 2018
was 68.74%. This figure has exceeded the 2018 Strategic Plan target of 47%. The
highest percentage of coverage of exclusive breastfeeding is in West Java
Province (90.79%), while the lowest percentage is in Gorontalo Province
(30.71%). A total of six provinces have not reached the 2018 Strategic Plan
target(Ministry of Health RI, 2018). However, the same data source also shows
that the percentage of exclusive breastfeedingdecreases with increasing age of the
child. For children under one month the percentage is quite high, 67%. This figure
decreases to 55% in children aged 2-3 months, and falls again to only 38% in
children aged 4-5 months. This means that the exclusive breastfeeding rate of
67% is actually a false achievement because it does not describe the percentage of
babies who actually get only breast milk during the first 6 months of life, without
other intakes such as formula milk (factory-made milk substitute), bananas, starch
water, and food. /other drinks.

Based on the Basic Health Research in East Kalimantan Province in 2018,
exclusive breastfeeding was not significantly increased, in 2013 by 69% to 70% in
2018 (Kemenkes RI, 2018). As for the Kutai Kartanegara Regency, exclusive
breastfeeding in 2018 was only 59% and decreased to 53% in 2019 (Kukar Health
Office, 2019).

When a Consuming foods that contain laktagogum is one of the efforts to
increase milk production. Moringa leaves contain phytosterol compounds
including campesterol, stigmasterol, and B-sitosterol which are laktagogums
which can increase breast milk production.(Mutiara, 2011).

Preliminary study was conducted in the working area of the Loa Kulu Health
Center, out of 10 acceptors to mothers who visited the KB Poly, 3 of them

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dropped out of breast milk in the second and third months. One of the reasons is
the lack of milk production in the second and third months, so mothers switch to
formula milk. There alot of Moringa leaf plants in Loa Kulu sub-district makes
researchers interested in researching Moringa leaf vegetables to increase breast
milk production. In addition to overcoming the production of breast milk, the
utilization of natural resources and local wisdom is also carried out.

This study aims to determine the effect of giving Moringa Leaf vegetables to
breastfeeding mothers on increasing infant weight.

RESEARCH METHODS

The type of research used is Quasy Experimental research method with pretest
and posttest design with control group design. The research location was
conducted in the Loa Kulu Health Center Working Area in March-May 2021. The
target population was all mothers breastfeeding babies under 6 months in the
LoaKulu Health Center area. The affordable population in this study were
breastfeeding mothers and infants under 6 months of age who gave birth normally
in the working area of the Loa Kulu Health Center. In this study, respondents
were divided into 2 groups: the experimental group was treated with 1 serving of
Moringa leaf vegetable per day (1x100 gr) for 7 days and the control group was
only treated with regular food without treatment. The day before the study, all
respondents (babies) were weighed,

The number of research samples using Federer's formula so that each group
contains 16 people, and the division of groups is done by using purposive
sampling technique. Respondents in this study were breastfeeding mothers aged
20-35 years, mothers and babies were in good health, babies born with normal
weight, babies aged less than 6 months, babies had never received food other than
breast milk, babies were given breast milk 6 times or more in a day, living in the
working area of the Loa Kulu Health Center. In order to avoid bias in this study,
the researchers excluded respondents from breastfeeding mothers with sunken/flat
nipples, mothers who consumed milk or breast-feeding pills, and infants with
congenital abnormalities (labio/labiopalatokisis). Mothers who use hormonal

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contraception Pill / Combination Injection.
The instruments used in this study were observation sheets, characteristic

questionnaires, and baby scales. Baby scales have been tested and calibrated by
comparing them with similar scales.

Bivariate analysis was conducted to examine the relationship between 2
variables, namely each independent variable and the dependent variable. That is to
assess the difference in the average treatment group before and after the
intervention using the Paired T Test. Meanwhile, to assess the difference in the
average increase in infant weight gain between the two treatment groups and the
control group, the Mann Withney test was used.

RESEARCH RESULT

Univariate Analysis

The data in this section describe the characteristics of mothers who are

respondents in the study.

Table 1. Respondent Characteristics

Age Characteristics n %
Education ️ 30 years 21 65.6
️ 31 years 11 34.4
Work 22 68.75
parity High (High School- 10 31.25
baby age Bachelor)
8 25
Baby Gender Low (SMP-SD) 24 75
14 43.75
Work 18 56.25
Does not work 12 37.5
20 62.5
Primigravida 0 0
Multigravida 14 43.75
18 56.25
1-2 months
3-4 months
5-6 months

Man
Woman

From table 1 above, a description of the age in this study, the majority is
dominated by age ️30 years old, namely 21 people (65.6%). As for age️31 Years
old totaled 11 people (34.4%). Respondents' education reported that most of the
mothers involved in this study had high education (SMA-Bachelor), 22 people
(68.75%), with low education (SMP-SD) 10 people (31.25%) College education

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12 people (20.0%).
The description of mothers about work was obtained as many as 8 people

(25%) working mothers, and mothers who did not work or only took care of the
household as many as 24 people (75%). According to parity, there were 14
(43.75%) Primigravida mothers and 18 (56.25%) Multigravida mothers.

Based on the baby's age, of the 32 babies studied, 12 babies (37.5%) were 1-2
months old, and 20 babies (62.5%) were 3-4 months old. Meanwhile, based on
gender, 14 babies were male (43.75%), while 18 babies were female (56.25%).

Bivariate Analysis

Normality test

Prior to the test using the formula, the normality test was previously carried
out to test whether the data to be calculated was data that was normally distributed
or not.

The following are the results of the Normality test using the Kolmogorov-
Smirnov formula.

Table 2. Normality test

BB before Kolmogorov-Smirnov Note:

BB after Statistics df Sig Normal
,101 32 ,200* Normal
BB ,107 32 ,200* Abnormal
difference ,204 32 ,002

Based on the results of the Normality Test, the value of the difference between
the BB of the Treatment group and the Control group, it was found that the p
value = 0.02 is smaller than 0.05, so the data is not normally distributed so that
using the Mann Withney test. Meanwhile, for the treatment group, BB before and
after treatment, the p value = 0.200 is greater than 0.05, so it can be concluded

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that the data is normally distributed. Then the test that is used is the Paired T Test.

Differences in the weight gain of infants in the treatment group and the weight
in the control group with the Mann Withney test.

Table 3. Analysis of differences in the weight gain of infants in the treatment group and the
weight in the control group

Group N Sum rank P Value

increase in bb
Treatment group 16 365.50

Control Group 16 159.50 0.00

Difference 206

From the different test with the Mann Withney T test, it can be seen that the
results of the p value = 0.00 < 0.05, thus there is a difference in the average
weight gain of infants whose mothers received treatment with Moringa leaf
vegetables (treatment group) with infants whose mothers were not treated (group).
controls). The increase in body weight in the group that was given the treatment
had a difference of 206 grams higher than the group that was not given the
treatment. This means that breastfeeding mothers who are given Moringa leaf
vegetables increase their breast milk so that they can increase the baby's weight.

Increase in baby weight before and after treatment in the treatment group with
paired t test .

Table 4. Analysis of the baby's weight gain before and after treatment

P (values)
N mean

BB after BB Before 16 5850, 0.00
treatment -
BB before BB After 16 6118,
treatment Average
increase
268

From the Paired T test, it can be seen that the p value = 0.00 <0.05 p is smaller
than 0.05, meaning that there is a significant difference in the weight of the baby

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before and after the mother received the treatment with Moringa leaf vegetables.
In the treatment group, the average body weight before treatment was 5850 grams,
while after treatment it was 6118 grams. The group that was given the treatment
with Moringa leaf vegetables showed an average increase in body weight of 268
grams after being treated.

DISCUSSION

Analysis of the effect of giving Moringa leaf vegetables to breastfeeding
mothers on increasing infant weight.

Increase in the weight of the babies in the treatment group with the weight of
the babies in the control group

Exclusive breastfeeding makes babies grow well. Because breast milk can
meet all the baby's needs for the nutrients needed for the baby's growth and
development, so that the ideal body weight can be achieved(Mutiara, 2011).
Moringa is a nutritional super plant. Nutrient content is spread in all parts of the Moringa
plant and all parts of the plant can be consumed, from the leaves, bark, flowers, fruit, to
the roots like radishes. These compounds include nutrients, minerals, vitamins, and amino
acids(Septadina & Murti, 2018).

The treatment group that received Moringa leaf vegetables showed a higher
weight gain of 206 grams compared to the control group. According to Weni
(2009) there are several factors that affect the increase in breast milk production,
one of which is the food consumed by the mother. Moringa leaf vegetables affect
breast milk production because they contain phytosterol compounds that function
to increase and facilitate breast milk(Mutiara, 2011). In addition, Moringa leaves
also have very good nutritional content, so that the production of breast milk in
the treatment group contains high nutritional value. This is in line with research
conducted by Johan (2018), which obtained p value of 0.038 <0.05 whereThe
results showed that there were differences in breast milk production as seen from
the increase in infant weight, frequency of urination and defecation, and frequency
of breastfeeding in the intervention group which were more significant than the

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control group.
The results of this study indicate that there is a significant weight gain when

the mother is given additional nutritional intake in the form of Moringa leaves.
This is in line with research conducted by Zakaria (2016) which stated that the
increase in breast milk volume before and after the intervention in the two groups
was significantly different after being given Moringa leaf extract, namely p value
0.001 <0.05.

With the complex content of Moringa leaves, breastfeeding mothers who are
given Moringa leaf vegetables will produce more milk and of course sufficient
nutrition for the baby, so that it can increase the baby's weight significantly.This
shows that Moringa leaf as a super food is very good to be given to nursing
mothers because it contains lagtogogum as a breast milk stimulant. The results of
this study are also in line with research from(Purnanto et al., 2020)which indicates
that the milk production at the post test stage has a mean value greater than the pre
test stage, which is 6.50. This means that the consumption of Moringa leaves has
been shown to be able to increase the amount of milk production in breastfeeding
mothers.

Infant weight gain before and after treatment

Efforts to increase breast milk according to Mansyur (2014) include
breastfeeding the baby every 2 hours day and night for 10-15 minutes at a time.
Mother should increase rest and drinking. Consumption of balanced nutrition such
as consuming additional calories at least 500 calories a day. By consuming
Moringa leaves, the calories and nutrition of breastfeeding mothers can be met.
With the fulfillment of nutrition for breastfeeding mothers, milk production will
increase. This increase in milk production is expected to significantly increase the
baby's weight.

From the results of measuring the weight of infants who were included in the
treatment group, the p value of 0.00 < 0.05 was obtained, so there was a
significant difference before the mother was given treatment and after the
treatment. According to Wong (2009), the weight gain of infants 0-6 months is

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140-200 grams per week. From the results of the analysis, the average increase in
infant weight before and after treatment was 268 grams. This means that there is a
very significant effect on the increase in the average weight of babies, which is as
much as 268 grams in the group given the Moringa leaf vegetable treatment.
Mother's nutritional status It will increase the quality and quantity of breast milk
which will have a direct effect on the baby's weight.

According to the Ministry of Health (2013) the increase in infant weight is
influenced by internal and external factors. One of the external factors is nutrition
during pregnancy and nutrition during infancy. One of the nutrients that babies get
is from breast milk which contains all the nutrients that babies need. Breast milk
production is strongly influenced by the food consumed by the mother on a
regular basis.

This is in line with research conducted (Aliyanto & Rosmadewi, 2019)which
compared Moringa leaf vegetables with unripe papaya on breast milk production,
the increase in infant weight in the group given Moringa leaf vegetables was
higher than those given unripe papaya. While research byPutri & Fitria (2021) the
results of the analysis of the group giving Moringa leaf extract and the group
giving katuk leaf extract effectively were both able to increase breast milk
production with an increase in baby weight.

This is different from the results of Mia & Pratiwi's (2020) study which stated
that there was no significant difference in the weight gain of babies whose
mothers received moringa leaf pudding with the control group with p value
0.317> 0.05. The difference in these results can be influenced by how often the
mother gives her breast milk, psychological factors and family support that are not
examined as disturbing factors.(Pratiwi & srimiati, 2020).

In this study, the treatment group was given Moringa leaf vegetables as much
as 100 grams per day, by including protein and carbohydrates into the Moringa
leaf vegetable menu in the form of eggs and sugar. Moringa leaves contain
calories, protein, carbohydrates, minerals, iron, vitamins and many more,
including phytosterols that can increase breast milk production. By giving
Moringa leaf vegetables regularly for 7 days, it can add nutrients needed by the

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