Knowledge, Attitudes, and HIV/AIDS Risk Behaviors of Myanmar Migrant Workers in Thailand GHMJ (Global Health Management Journal) 2022, Vol. 5, No. 1 Indonesian Scholars’ Alliance Open Access Photo Essay POLITEKNIK KESEHATAN KEMENKES PALANGKA RAYA: HEALTH FORUM AND INTERNATIONAL SEMINAR THE NEW NORMAL : Creating a Pleasant Virtual Communication Breast massage to support the success of exclusive breastfeeding among postpartum mothers in Pekanbaru, Indonesia Elly Susilawati, Findy Hindratni, Cyntia Rahmadani Department of Midwifery, Poltekkes Kemenkes Riau, Indonesia *Corresponding author’s email: ellysusilawatiramli@gmail.com DOI: 10.35898/ghmj-51597 Selection and peer-review under responsibility of the scientific committee and the editorial board of the Annual Health Forum and International Seminar of the Politeknik Kesehatan Kemenkes Palangka Raya © Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars’ Alliance). This is an open-access following Creative Commons License Deed - Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) A lack of exclusive breastfeeding will increase the possibility of mother’s and infant’s death. High health costs, an increasing incidence of diarrhea, and other infections may also cause mortality. The global breastfeeding initiation rate was relatively high, yet only 40% of infants under 6 months are breastfed and only 45% breastfed for up to 24 months. In 2025, the World Health Assembly (WHA) aims to achieve a minimum of 50% of exclusive breastfeeding for infants under 6 months (Kemenkes RI, 2018). Figure 1 Exclusive Breastfeeding mailto:ellysusilawatiramli@gmail.com https://dx.doi.org/10.35898/ghmj-51597 37 GHMJ (Global Health Management Journal) 2022, Vol. 5, No. 1 Susilawati et al. An interview was conducted in a maternity clinic in Pekanbaru and it was found that only 2 out of 10 mothers gave breast milk without infant formula in the first three days of delivery. The rest of the postpartum mothers claim to experience breastfeeding smoothness issues in the first week of delivery. This worries the mother if her baby cannot get enough breast milk so that infant formula is given. The smoothness issue of breastfeeding in the first three days of delivery is a merely physiological problem but becomes the main cause of the failure of exclusive breastfeeding. Figure 2 Central and Local Government Support in Exclusive Breastfeeding The support of the Indonesian government in providing exclusive breastfeeding is shown by issuing the Government Regulation No.33 of 2012 regarding Exclusive Breastfeeding, specifically in Chapter III Article 6 stating that every mother who gives birth must provide exclusive breastfeeding to her baby. The same obligation is also stated in the Constitution No.36 of 2009 concerning Health, Article 200 stating that anyone who deliberately hinders the program to provide exclusive breastfeeding as referred in Article 128 paragraph (2) is imprisoned for a maximum of 1 year and a maximum fine of Rp 100,000,000 (one hundred million rupiahs). In Pekanbaru, the Mayor is also very supportive towards the program and issues the Mayor Regulation No.48 of 2015 regarding exclusive breastfeeding, in which in Chapter VIII Article 10 states that local government affords assistance and supervision of exclusive breastfeeding and infant formula. In Article 11, it is emphasized that any health officer violating the provisions of Article 10 is subject to administrative sanctions. The attempt to increase breast milk production in mothers after childbirth can be carried out using pharmacological and non-pharmacological methods. Pharmacological methods are done by giving therapy such as metoclopramide, chlorpromazine, and domperidone. Though, the effectiveness of these medicines in intensifying the production of breast milk is inseparable from some side effects such as headache, dry mouth, frequent thirst, diarrhea, stomach cramps, and redness of skin (William & Carrey, 2016). Further, non- pharmacological methods are usually completed in a natural way such as breast care, warm compress, back massage, woolwich, and endorphins massage (Bahiyatun, 2008; Rini & Kumala, 2017; Pamuji, 2014). Susilawati et al. GHMJ (Global Health Management Journal) 2022, Vol. 5, No. 1 38 Figure 3 Woolwich Massage in Postpartum Mothers to Increase Breast Milk Production Woolwich massage is performed on the lactiferous sinus area, precisely 1-1.5 cm above the breast areola, to remove the milk that is in the lactiferous sinuses. This massage can stimulate nerve cells in the breast, the stimulation is transmitted to the hypothalamus and the anterior pituitary responds to release the hormone prolactin which will be circulated by the blood to the myoepithelial cells of the breast to produce milk, increase milk volume, and prevent damages in the breast that can cause breast swollen (Pamuji, 2014). Endorphine massage is a gentle touch massage technique that can normalize heart rate and blood pressure, as well as improve a relaxed state in the mother's body by triggering a feeling of comfort on the surface of the skin. The woolwich and endorphins massage method could influence the production of prolactin hormone and oxytocin as well as give relaxation which can fulfill the need of postpartum mothers in overcoming breastfeeding problems in the first days after childbirth. This is proven by Barokah and Utami (2017) who gave woolwich massage intervention in postpartum mothers in the first to third days whose result influenced the production of breast milk. Hartono (2016) in his study also reveals that endorphins massage increases the breast milk volume. Figure 4 Endorphins Massage on Postpartum Mothers to Increase Breast Milk Production 39 GHMJ (Global Health Management Journal) 2022, Vol. 5, No. 1 Susilawati et al. A study was conducted on 20 postpartum mothers in which 10 of them were given woolwich massage intervention and the other 10 were given an intervention of endorphins massage on breast milk production. The study results show that the average breast milk production of mothers who were given endorphins massage (125.30 mL) was much more than those given woolwich massage (99.80 mL). There was a significant difference in breast milk volume between those given endorphins and woolwich massage by 25.50 mL. It is proven that the production of breast milk can be increased by giving endorphins massage; that is a massage technique done on the neck, arms, and hands of postpartum mothers. Hidayati & Hanifah (2019) affirm that when the endorphins massage is done, the spinal nerve is stimulated to release endorphins in the body which then stimulates oxytocin. For the breast nerve consists of many dorsal nerves coordinated along the spine, while being massaged, the spinal nerve will send signals to the brain to release oxytocin resulting in a contraction of myoepithelial cell that encourages the release of breast milk. Figure 5 Abundant Breast Milk Production After The Endorphins Massage is Completed References Bahiyatun. (2008). Buku ajar asuhan kebidanan nifas normal. Jakarta: Penerbit Buku Kedokteran. Barokah, L & Utami, F. (2017). Terhadap produksi ASI di BPM APPI Amelia Bibis Kasihan Bantul. Prosiding Seminar Nasional dan Call Paper, November, 243–250. Hartono. (2016). Massage endorphine terhadap volume ASI pada ibu post partum. Jurnal Kebidanan, 8(2), 209– 214. Hidayati, T.& Hanifah, I. (2019). Penerapan metode massage endorphin dan oksitosin terhadap peningkatan produksi ASI pada ibu menyusui bayi 0-6 bulan di Desa Gading Kabupaten Probolinggo. Journal of Health and Science, 12(1), 30–38. Kementerian Kesehatan RI. (2018). Hasil utama riset kesehatan dasar. Jakarta: Kemenkes RI. Pamuji, S. E. B. (2014). Pengaruh kombinasi metode pijat woolwich dan endorphine terhadap kadar hormon prolaktin dan volume ASI. Jurnal Ilmu dan Teknologi Kesehatan, 5(1), 1–14. Rini, S. & Kumala. (2017). Panduan asuhan nifas dan evidace based practic. Yogyakarta: Deepublish. William, M. & Carrey. (2016). Domperidone untuk meningkatkan produksi Air Susu Ibu (ASI). Jakarta: Cermin Dunia Kedokteran Cite this article as: Susilawati E, Hindratni F & Rahmadani C. Breast massage to support the success of exclusive breastfeeding among postpartum mother in Pekanbaru, Indonesia. GHMJ (Global Health Management Journal). 2022; 5(1): 36-39. doi:10.35898/ghmj-51597 https://dx.doi.org/10.35898/ghmj-51597