HOW TO INCREASE MILK PRODUCTION
FROM MOTHER WITH INFANT LOW BIRTH WEIGHT (LBW)
Umi Solikhah
1, Indri Wisudawati Anggraeni
2, Sodikin
3 1Lecturer Faculty of Health Science University of Muhammadiyah Purwokerto
2Nurse
3
Lecturer Faculty of Health Science University of Muhammadiyah Purwokerto
Abstract
Background: Kangaroo care method aims to keep the body temperature stabilization, reducing the risk of infection, increasing the frequency of breastfeeding can have an impact on increasing milk production.
Objective: To examine the effectiveness of kangaroo care method to increase milk production in low birth weight infants
Methods: This research is a quasi$ experimental, with design non equivalent control group and the sampling technique using purposive sampling technique.
Results: The mean weight of LBW infants before kangaroo method 1678.42 grams in the intervention group, performed after 1775.00 grams kangaroo method, the results of statistical tests indicate paired t$test p$value 0.000 and the mean weight LBW baby kangaroo that no treatment method before done treatment 1597.24 grams, 1629.61 grams after treatment performed, the results of statistical tests indicate paired t$test p$ value 0.001. The mean increase in weight infants in the intervention group was 96.58 grams, in the control group was 32.37 grams. The mean increase in breastfeeding in the control group was 94.13 cc. So every 1 cc of milk production in the control group with 0.34 grams weight gain, so it is expected to increase milk production in the intervention group at 284.06 cc for 5 days. The results of independent statistical tests showed p$ value (0.000) <0.05.
Conclusion: Kangaroo care method to increase milk production.
Keywords: milk production, low birth weight (LBW)
BACKGROUND
The main problem in Indonesia is a health problem that occurred of mothers and children, which marked the high maternal mortality rate (MMR) and infant mortality rate (IMR). That’s
reflects the ability of the state to provide health services to the public yet either. Low birth weight (LBW) is a major cause of mortality in neonatus.1
LBW neonate from January to May (2012) in Margono Soekarjo Purwokerto Hospital, obtained an average of 61 cases with an average of 13 deaths a baby. There are still many cases of LBW and referral is a very fundamental issue that requires special attention related to the proper handling and care.
The success rate is exclusively breastfeeding particularly clearly increased in developed countries, but this has not occurred in developing countries such as Indonesia. Edmond (2006) 3, revealed when the baby is given the opportunity to suckle within the first hour to let the mother skin to skin contact for at least an hour, it will simplify the process of breastfeeding, and 22% lower the infant mortality rate in under 28 days.7
Mothers can successfully breastfeed if the mother is more contact with their baby. Breastfeeding stimulates the production of prolactin, thereby increasing the volume of breast milk and stimulate reflex expenditure. The closest contact occurs when the mother kangaroo method (skin contact directly to the skin baby’s mother or surrogate mother). LBW with kangaroo care method, is an excellent means to support the success of exclusive breastfeeding in LBW, because the baby is attached to the mother, the baby will be easier to suck every baby wants it. The key to success is not breastfeeding an infant on the pacifier or bottle8.
the stress hormones will go back down, so the baby becomes more calm, not stress, as well as respiratory and heart rates more stable9.
METHODE
This study uses a quantitative method to research the type of quasi,experiment. The design of this study used a non,equivalent control group10. first treatment group using the kangaroo method, whereas the comparison group without treatment method kangaroo. Sampling is used way that all LBW infants treated that meet the inclusion criteria. Samples were needed in each group totaled 38 respondents in the intervention group and 38 respondents in the control group.
Univariate analysis to describe the characteristics of the respondent (infant birth weight, sex, and gestational age). While bivariate analysis is used to determine whether there is any effect of kangaroo care method to the increase in milk production in LBW infants using independent t,test and to determine the weight gain before and after the study is done using a paired t,test.
RESULT AND DISCUSSION 1. Infant Characteristics
Univariate analysis of this study can be seen in table 1.1 below:
Table 1. Neonatal characteristics:
Most of gestational age on the incidence of low birth weight of less than 37 weeks old both in the intervention and control groups. Gestational age less than 37 weeks in the intervention group 68.4%, gestational age in the control group 81.6%. For gestational age more than or equal to 37 weeks in the intervention
group 31.6%, gestational age in the control group 18.4%.
Graha (2006)11 showed no significant association between gestational age with LBW, low birth weight can be caused due to premature and dismatur. This suggests intrauterine growth retarded infants. The circumstances associated with impaired circulation and efficiency plasenta12.
Sex
The sex of the baby is not absolutely dominated by a particular sex because the percentage of female sex with men in the intervention group relative to the control group equally. Gender male infants in the intervention group 52.6%, sex baby girl 47.4%, while the boys and girls in the control group 50.0%.
Including the sex of the baby is not one of the factors that influence LBW infants. Based
Infant birth weight between 1000,1500 grams in the intervention group and 21.1% in dismatur. Premature infants whose pregnancies are less than 37 weeks and weight according to weight for gestational age, and dismatur itself is a baby born weighing less than weight for age pregnancy should. Johnston et al (2009)13 says, infants with birth weights less to get special treatment after birth, special care after birth, for example with the incubator. By using the incubator babies separated from their mothers, this would preclude direct skin contact between mother and baby are very necessary for the
Table 2. Tabel mean before and after weighing infants ( n = 38/group )
Group Pre Post p "alue
Mean SD Mean SD
Intervention 1678,42 211,207 1775,00 230,59 0,000 Control 1597,24 266,102 1629,61 249,44 0,001
There are still many cases of low birth weight are born either in hospital or referral is a very fundamental issue that requires special attention. It comes to the proper handling and carefully aimed at the case of LBW. Because infants with low birth weight is a risk factor that has contributed to the infant’s death, especially in the perinatal period.
Shiau (1997)14, the majority of mothers
in the developing world is less attention to the handling of infants with low birth weight. Suradi (2000) 7 states, use the incubator to care for low birth weight (LBW) requires a high cost. Due to the limited incubator facility, not infrequently one incubator occupied more than one baby. This increases the risk of occurrence of nosocomial infections in hospitals.
Research of Margaretha (2006)15 showed that the kangaroo care method is an alternative for the treatment of premature infants. For small premature infants, health care continually is something very important. Treatment with the kangaroo method is an effective way, safe, comfortable and able to meet the basic needs of newborns in the form of warmth, breastfeeding, affection and protection from infection.
Effectiveness kangaroo care method LBW infants to increased milk production
There are differences in the effectiveness of kangaroo care method to increased milk production in LBW infants.
Table 3. Table weight gain intervention and control groups
Variable Mean SD t p@value Intervention 96,58 67,083 4,470 0,000 Control 32,37 57,794 4,470 0,000
Kangaroo method is effective against the increase in milk production are shown in the results of the independent t test with p value of 0.000.
Kangaroo care method is a simple way to increase milk production. Kangaroo care method is ideal for breastfeeding. Mothers can feel when the baby starts hungry mouth movement, suction,small suction and movement
kangaroo is placed between the second breast in an upright position, the baby’s chest attached to the mother’s chest, skin to skin contact between the baby and the mother creates a feeling of warm and sweat easily so baby will feel thirsty. In this condition the baby will try to find the mother’s nipple and suckling. With the baby sucking at the breast will cause stimulation and if the baby more often disusukan then milk production will increase. Increased milk production can occur with the stronger bond of love the mother and the baby so happens letdown reflex is important for breastfeeding spending. In addition, the stress that usually occurs in mothers whose babies are admitted to the hospital will be reduced if the mother is given the chance would an infant in the kangaroo method, it has a positive effect on milk production 7.
Nizmawardini and Yaman (1997)16 provides that during wear kangaroo mother care method to increase breast milk production feel, baby drinking breast milk, body weight and increased infant immune system, perceived kangaroo care method more practical, better growth of infants.
There are significant differences in weight infants receiving kangaroo care method with no kangaroo care method. Kangaroo care method is a way to put the baby in the care of the mother’s chest, causing skin contact between the baby and the baby’s mother’s skin naturally resulting in frequent disusukan. Powered by opinion (Roesli, 2009)17 which states the more breast milk removed from the breast, the more milk production. The more often breastfeed, the more milk production. Amount of prolactin secreted and the amount of milk produced relating to puff stimulus, namely the frequency, intensity and duration of infant sucking.
Shiau (1997)14 found that most mothers do not breast,feed attachment correctly. The weakness of the method of breastfeeding can be overcome with the kangaroo method because the baby’s nipples with lip contact is strong thus strengthening suction the baby.
important step to achieve normal development in the future. Psychological reasons stated Agudelo, et al (2011)18 the kangaroo method will create an inner relationship with the baby’s mother is getting stronger so that milk production is much more driven by the feeling of a stronger bond between the baby’s mother. This psychological bond causes a more intense pattern of breastfeeding. Hamilton says (1995)19, the mother who was anxious to experience the baby blues tend not to breastfeed her baby. One function of the kangaroo method is to strengthen the parent, infant interaction which in turn can reduce maternal anxiety.
Comparison of weight infants with breast milk production
Table 1.4. Comparison of mean weight gain of infants with average milk production
Variabel Intervention Control p@" Weight
Milk mother Production
96,58 284,06
32,37 94,13 0,000 Weight gain in the intervention group 96.58 grams for 5 days and body weight in the control group 32.37 grams for 5 days. To find out 1 cc of milk production to increase in body weight that is by dividing the mean number of the control group increased weight infants during 5 days (32.37 grams) with a mean milk production during the 5,day control group (94.13 cc) to obtain the results of any 1 cc of milk production in the control group equal to 0.34 grams. To determine the increase in milk production in the intervention group by dividing the mean weight gain intervention group (96.58 cc) with weight gain in each 1 cc of breast milk (0.34 grams). So the expected increase in milk production in the intervention group was 284.06 cc for 5 days. Based on the above results it can be concluded that there is kangaroo method to the increasing influence of milk production. With the results of the independent t,test p value of 0.000.
CONCLUSSION
Based on the description and discussion of research results can be concluded as follows: 1. Largely gestation less than 37 weeks of either
the intervention group or the control group. Sex men in the intervention group were more likely than women, while male gender and women in the control group was relatively similar. Birth
weight between 1501,2000 grams tend to be much more than the weight between 1000,1500 grams.
2. Increased milk production in mothers who received kangaroo care method can be determined by weighing the baby before and after treatment, showed a mean weight gain of LBW babies before the kangaroo care method in the intervention group was 1678.42 grams and the weight after the baby is done kangaroo care method is 1775.00 grams. Statistical test results obtained p,value = 0.000.
3. Increased milk production in women who do not get treatment kangaroo method can be determined by weighing the baby before and after treatment, the mean body weight showed that LBW infants without treatment prior to treatment kangaroo method is 1597.24 grams and weight after baby done treatment is 1629.61 grams. Statistical test results obtained p,value = 0.001.
4. The mean increase in weight infants in the intervention group was 96.58 grams, the control group was 32.37 grams. The mean increase in breastfeeding in the control group was 94.13 cc. So every 1 cc of milk production in the control group equal to 0.34 grams of weight gain, it is estimated that the increase in milk production in the intervention group was 284.06 cc for 5 days. With the results of the independent t,test p , value of 0.000.
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