Effectiveness of Oxytocin Massage in Spontaneous Post Partum Mothers to Increase Breast Milk Production

Objective : To determine the effectiveness of oxytocin massage on postpartum mothers to increase lactation. Method : The method used is a descriptive design in the form of a case study with a maternity nursing care process approach which includes assessment, diagnosis, planning, implementation and evaluation. The subjects used in this study were clients who had problems with ineffective breastfeeding in Lotus Room 2 BLUD Banjar City General Hospital. This data collection technique includes interviews, observations, physical examinations and documentation studies. Result : Evaluation of the administration of oxytocin massage therapy on the issue of breastfeeding is proven in clients who routinely do oxytocin massage after 4 days of increased milk production, marked by how often the baby is breastfed and how long he sleeps after being breastfed. Conclusion : Oxytocin massage therapy has been proven to be effective for smoothing and increasing the production of the hormones oxytocin and prolactin, which function to smooth out breast milk.


Introduction
The puerperium is a period in which the reproductive organs undergo changes during pregnancy. The puerperium begins after the placenta is separated and the uterus returns to its pre-pregnancy state, which lasts about 42 days or 6 weeks (Indrianita et al., 2022). During labor, perineal tears can occur in the birth canal and usually occur in the next birth (Kusbandiyah & to Increase Breast Milk Production Puspadewi, 2020). This stage can be said to be the most difficult period for mothers, both physically, psychologically, mentally and spiritually who are still not ready to face problems. problems that mothers will experience related to the return of the uterus to its pre-pregnancy state (Pramudianti, 2022). Breastfeeding starts from milk production to the process in which the baby sucks and swallows milk (Pamuji & Rumah, 2020). During the postpartum period, the breasts will experience changes such as larger, hard and dark breasts around the nipples, which indicates that breastfeeding has started (Bina & Nusantara, 2019).
According to WHO in 2018, 75% of infant deaths, around 1 million died in the first 24 hours including premature births (Suleman, 2021). Not only globally, Indonesia itself has by far the highest infant mortality rate compared to many other countries. The main causative factors were 46.2% neonatal mortality, 15.0% diarrhea. Another important factor is not being exclusively breastfed before birth, which is a major cause of premature death (Mawaddah, 2018). Exclusive breastfeeding is a nutrient that is very influential on the survival of the baby, where colostrum to the mother is given in the first 24 hours of breastfeeding (Jayanti et al., 2020). West Java Province is the region with the highest infant mortality rate (Wardhana et al., 2022). The low awareness of pregnant women about health causes newborns to have an abnormal weight. The postpartum period, lactation and immunization affect the status of the IMR (Fuadi, 2020).
Management to increase lactation is by doing oxytocin massage, which is massage from the spine to the twelfth thoracic bone which aims to stimulate the hormones prolactin and oxytocin after childbirth which can calm the mother, so that the milk comes out by itself (Yanti, 2019b). Oxytocin massage can increase milk supply by reducing blockage of the milk production ducts to facilitate milk secretion (Yanti, 2019a).
Research conducted by (Indrayani & Ph, 2019) entitled "Oxytocin Massage and Breast Care to Increase Breast Milk Production in Postpartum Mothers" proves that after oxytocin massage can help expel breast milk with the result that the milk released has increased milk production.
Based on the results of the above explanation and previous research, the authors wish to conduct a case study with the title "Effectiveness of Oxytocin Massage on Spontaneous Postpartum Mothers to Increase Breast Milk Production". The difference between this study and previous studies which stated that with the intervention of oxytocin massage to increase breast milk secretion, the authors intend to evaluate the management in the application of oxytocin massage to postpartum mothers while breastfeeding.

Objective
The purpose of this case study was to determine the effectiveness of oxytocin massage in postpartum mothers to increase lactation.

Method
The method used is descriptive analysis design in the form of case studies with a maternity nursing process approach including assessment, diagnosis, planning, implementation and evaluation.
This case study is a case study that explores the problem of nursing care in postpartum mothers on breastfeeding expenditure with a descriptive approach in the Lotus Room 2 BLUD Banjar City Hospital for 4 days on 24-29 May 2022. The research participant is a client of Ny. T, 31 years old female, said that only a little milk came out. The process of assessing and establishing to Increase Breast Milk Production a diagnosis focuses on the main problem. Objective and subjective data becomes a reference for periodic evaluation of implementation.

Result and Discussion Assessment
The client is Mrs. T is 31 years old, a Muslim woman, married, a housewife, high school education and lives in Cimerak, Pangandaran Regency with a spontaneous postpartum medical diagnosis.
Based on the assessment on May 24, 2022, only a small amount of milk came out with blood pressure 120/80 mmHg, pulse 77x/minute, respiration 20 x/minute, temperature 36.6˚C. The client has never been hospitalized and has no genetic disease and no family members have infectious diseases such as HIV/AIDS and genetic diseases that can affect the client. During pregnancy the client did not have an abortion. The client has menarche at the age of 13 years and the menstrual period is 7 days, the blood that comes out is not excessive, the menstrual cycle is 8 days regularly. HPHT August 23, 2021 and HPL May 30, 2022. In the previous delivery the client did not feel any contractions but at the time of the examination it was already opening 3 with spontaneous labor and the baby was born at 16.30 with a weight of 2 kg, male gender. G2P20 obstetric history.

Diagnosis
Nursing diagnoses are taken based on the results of Data Analysis which are adjusted to the grouping of nursing diagnoses by the Indonesian National Nurses Association (PPNI) in the Indonesian Nursing Diagnosis Standards (IDHS) second edition in 2019.

Nursing Intervention, Implementation and Evaluation
The nursing care plan used includes goals and outcome criteria that refer to the IDHS, SIKI, and SLKI which are the basis of the nursing process. Implementation and evaluation of nursing is documented with the SOAPIER model. The author adds that non-pharmacological focus actions are not contained in the nursing intervention book but exist in several previous studies, namely the administration of oxytocin massage therapy intervention carried out for 4 days, it is hoped that milk production will increase.  4. Create an agreed health education plan. 5. Support mothers increase self-confidence in breastfeeding. 6. Provide breastfeeding counselling. 7. Explain the benefits of breastfeeding for both mother and baby. 8. Teach the four positions of breastfeeding and latch correctly. 9. Teach post partum breast care (eg breast massage, oxytocin massage).
After conducting the assessment process on Mrs. T with spontaneous post partum In Lotus Room 2 BLUD Banja Banjar City General Hospital from 24-29 May 2022. During the implementation of nursing care the client is very cooperative making it easier to take actions consisting of assessment, determining nursing diagnoses, interventions, implementation, and evaluation .
The first stage is the assessment, which is the initial stage of the nursing care process, where the author collects data by approaching the client and family accompanied by the aims and objectives to be carried out. These data will later be submitted for the enforcement of nursing diagnoses. Based on the results of the assessment on May 24, 2022 at 09.00 the client said that only a little milk came out, with the results of blood pressure 120/80 mmHg, pulse 77x/minute, Respiration 20 x/minute, temperature 36.6˚C. The breasts do not feel tight, the breasts are clean, there are no lesions and redness. to Increase Breast Milk Production The second stage is the determination of nursing diagnoses which are carried out after collecting assessment data on Ny. Based on the analysis of the data obtained, the diagnosis that emerged was ineffective breastfeeding related to the inadequacy of the oxytocin reflex with subjective data, namely the client's breasts did not feel tight, the breasts were clean, there were no lesions and redness.
According to the facts in the field and existing theories, the cause of the decrease in breast milk production on the first day after giving birth can be related to the lack of stimulation of the hormones prolactin and oxytocin which play a very important role in the smooth production of breast milk (Yulia, 2018).
The third stage is nursing planning which is carried out after collecting data and establishing a diagnosis, then planning the actions to be carried out. The intervention was carried out in accordance with the SIKI book published by PPNI edition II in 2019.
In this planning stage, the author plans according to the theory regarding the problem of ineffective breastfeeding where the first thing to do is identify readiness to receive information, identify breastfeeding desires, facilitate health education materials and media, support mothers in increasing self-confidence in breastfeeding, provide breastfeeding counseling, explain the benefits of breastfeeding for mothers. and babies, teach the four positions of breastfeeding and attachment correctly, teach breast care by giving oxytocin massage therapy.
At this stage the authors focus on the intervention of oxytocin massage therapy. Oxytocin massage therapy itself is a massage along the spine (vertebrae) to the fifth and sixth costal bones in an effort to stimulate prolactin and oxytocin hormones after childbirth. In research according to (Della Arista, 2020) oxytocin massage, it can be concluded that there is an effect on milk production with the frequency of breastfeeding babies, the frequency of babies urinating and how long babies sleep after breastfeeding.
Implementation is the fourth phase where the authors carry out nursing which is carried out according to the plan that has been prepared previously and focuses on providing oxytocin massage therapy which is carried out for 4 times the intervention is proven to be effective in facilitating breast milk production.
As for some of the actions taken by the author after being carried out previously, including supporting mothers to increase self-confidence in breastfeeding, providing breastfeeding counseling, providing health education, and the authors added a focus action, namely teaching breast care to post partum mothers by providing oxytocin massage therapy.
The fifth stage is evaluation where the author can assess whether the objectives in the action plan are achieved or not. The results of the evaluation of the administration of oxytocin massage therapy are expected to increase the consistency of milk production. It was found that there was a significant difference in clients who were given therapy in launching breast milk production (Khasanah, 2020). It was proven by Mrs. T who routinely did oxytocin massage after 4 interventions. Breast milk production increased and continued independently at home with her family.

Conclusion
The author evaluates the results of nursing actions taken and is able to assess the discussions that occur with the client, especially the gap between theory and reality and find solutions to problems. Oxytocin massage therapy has been shown to be effective for smoothing