175
Ulfa Farrah Lisa, Erda Mutiara Halida, Yulizawati, Aldina Ayunda Insani
THE RELATIONSHIP OF MIDWIVES' KNOWLEDGE ABOUT
HYPNOBREASTFEEDING AND LACTATION MASSAGE WITH THE
MOTIVATION OF PROVIDING INFORMATION BY MIDWIVES TO
MOTHERS FOR BREASTFEEDING
Ulfa Farrah Lisa, Erda Mutiara Halida, Yulizawati, Aldina Ayunda Insani
Universitas Andalas, Indonesia
Email: ulfa.feliz@gmail.com
Abstract
The breastfeeding support is crucial for nursing mothers, and one aspect of this support is the motivation
provided by healthcare professionals in delivering maternity services to breastfeeding mothers, particularly
regarding hypnobreastfeeding and lactation massage. An individual's motivation is significantly influenced
by their knowledge of specific subjects. This quantitative research employed an analytical method, utilizing
a cross-sectional design. The study was conducted in the Maternal and Child Health Center of Padang City
from September to October 2023. The research sample consisted of 40 midwives working in the Maternal and
Child Health Center in Padang. The analysis used the chi-square test with a confidence interval of 95%. The
research findings indicate that the majority of participants with insufficient knowledge about
hypnobreastfeeding had low motivation (41.17%), compared to those with high motivation (8.70%). The
statistical test result using the chi-square test yielded a p-value of 0.035 (p≤0.05). Meanwhile, in terms of
knowledge about lactation massage, the majority with insufficient knowledge had low motivation (23.53%),
while those with high motivation had no insufficient knowledge (0%). The statistical test result using the chi-
square test yielded a p-value of 0.046 (p≤0.05). Therefore, it can be concluded that there is a significant
relationship between knowledge about hypnobreastfeeding and lactation massage and the motivation of
midwives to provide information
Keywords: Knowledge, Hypnobreastfeeding, Lactation Massage, Motivation
INTRODUCTION
Postpartum care is one of the important components in preventing complications in mothers
and improving the health of mothers and newborns. There are still mothers who have less
knowledge and have poor practices regarding puerperal care practices. The lack of information
regarding postpartum care is due to the lack of postpartum information during pregnancy checks
and the short period of stay of mothers and babies after childbirth in health facilities. This suggests
that women who receive puerperal care are lower than women who receive care during pregnancy
(Eldawati, 2017)
One form of government support in reducing the Maternal Mortality Rate (MMR) is the role
of midwives in providing care during the postpartum period which is guided by the Minister of
Health Regulation Number 97 of 2014, which consists of postpartum health services including
Health services for mothers and newborn health services. Health services for mothers at least 3
(three) times during the postpartum period (Peraturan Menteri Kesehatan Republik Indonesia
Nomor 97 Tahun 2014, 2014; Nurdahniar, 2022).
The Sustainable Development Goals (SDGs) target by 2030, ending preventable infant and
under-five deaths, with all countries seeking to reduce Neonatal Mortality Rates to at least 12 per
1,000 Live Births with exclusive breastfeeding. The World Health Organization (WHO) and the
United Nations Children Foundation (UNICEF) have recommended exclusive breastfeeding for
infants aged 0-6 months. This is in line with the Decree of the Minister of Health of the Republic
of Indonesia No.450 / Menkes / IV / 2004 which stipulates that breast milk is the best food for
babies, to achieve optimal growth and development breast milk needs to be given for 6 months and
continued until the child is 2 years old. The promotion of the implementation of the exclusive
breastfeeding program is carried out in an integrated manner in the community after the existence
of Government Regulation Number 33 concerning Exclusive Breastfeeding (Kemenkes RI, 2015).
The amount of use of breast milk is very influential on the development of babies if balanced
Jurnal Sosial dan Teknologi (SOSTECH)
Volume 4, Number 3, Maret 2024
p-ISSN 2774-5147 ; e-ISSN 2774-5155
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Ulfa Farrah Lisa, Erda Mutiara Halida, Yulizawati, Aldina Ayunda Insani
with an increase in breastfeeding behavior. But some problems hinder exclusive breastfeeding,
namely some mothers often complain of lack of milk production, chafed nipples, babies have
difficulty sucking nipples and mothers think babies need more milk. Many mothers stop
breastfeeding because they assume that the amount of their milk is insufficient to meet the needs
of their babies (Romadhoni et al., 2023). Breastfeeding support is needed by mothers, one of which
is support from health workers so that breastfeeding mothers can always try to create positive
conditions for themselves to continue to be able to breastfeed. One way to increase motivation in
providing services to clients is by the brilliance of one's knowledge in the context of the activity.
According to Notoatmodjo (2012), Knowledge is acquired through understanding after the
individual observes a particular object. Knowledge or cognitive aspects have a very significant role
in shaping a person's real behavior.
Hypnobreastfeeding is a relaxation technique to help smooth the breastfeeding process.
Inserting positive sentences that help the breastfeeding process when the mother is relaxed or very
concentrated on something (Ruslinawati et al., 2020). Hypnobreastfeeding is one of the mother's
preparations in terms of mind (mind) including peace of mind, so that the mother is confident that
she can produce enough milk to meet the baby's growth and development needs. Preparation in
terms of soul (soul) includes sincere intentions to provide the best for the baby (Handayani et al.,
2021). Based on the results of the study by Aprilyadi, DKK (2022), There was an increase in the
average volume of breast milk in breastfeeding mothers in the intervention group after
hypnotherapy. Results obtained the volume of breast milk before measurement with a median of
50.00 (SD 35.329). In post-measurement with a median of 120.00 (SD 60.062). The Wilcoxon test
result was p = 0.000, where hypnobreastfeeding was significantly effective in increasing the
amount of breast milk.
Lactation Massage is a massage technique for the head or neck, back, spine and breasts,
which is useful for stimulating the hormone oxytocin and prolactin hormones that can increase milk
production. This effort is done because there are still many babies who are not exclusively breastfed
by their mothers who reason that breast milk is not smooth. Lack of guidance related to factors that
can increase milk production will greatly affect the breastfeeding process and breastfeeding of
babies. Because not all mothers who after giving birth directly produce and secrete milk because
milk production is a very close relationship between mechanical stimuli, nerves and various kinds
of hormones that have an impact ond the production of the hormone oxytocin (Romadhoni et al.,
2023).
RESEARCH METHODS
This research is quantitative with analytical methods, using crossectional design. This
research was conducted at PMB Kota Padang from September to October 2023. The population in
this study is PMB midwives in Padang City. The research instrument used a knowledge
questionnaire on Hypnobreastfeeding and Lactation Massage containing 20 assessment items, and
a midwife motivation questionnaire on information by midwives to mothers for breastfeeding. The
analysis used to test the hypothesis is the chi squere test using a computer application with a level
of meaning (CI = 95%) and a value of α 5% or 0.05.
RESULTS AND DISCUSSION
Table 1. Characteristics of the Respondent's Education Level
Education Level
Frekuensi (n=40)
Persentase
D-III
D-IV/S1
Midwife
S2
S3
19
10
9
2
0
47,5
25
22,5
5
0
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Ulfa Farrah Lisa, Erda Mutiara Halida, Yulizawati, Aldina Ayunda Insani
Based on table 1, it can be seen that the majority of the education level of midwifery D-III
levels is 19 respondents (47.5%)
Univariate Analysis
Table 2. Frequency Distribution of Hypnobreastfeeding Knowledge Level, Lactation
Massage Knowledge Level and Information Motivation
Variabel
Frekuensi (n=40)
Persentase
Knowledge Level of Hypnobreastfeeding
Less
9
9
22
22,5
22,5
55
Enough
Good
Knowledge Level of Lactation Massage
Less
Enough
Good
4
15
21
10
37,5
52,5
Motivation
Low
17
42,5
Tall
23
57,5
Based on table 2, it can be seen that the level of knowledge of the majority of respondents
about hypnobreastfeeding is good, namely 22 respondents (55%), the level of knowledge of the
majority of respondents about lactation massage is good, namely 21 respondents (52.5%), and the
motivation for providing information to the majority of respondents is high, namely 23 respondents
(57.5%).
Bivariate Analysis
The relationship between the level of knowledge of hypnobreastfeeding and the motivation
of information provision by midwives
Table 3. The relationship between the level of knowledge of hypnobreastfeeding and the
motivation of information provision by midwives
Knowledge of Hypnobreastfeeding
Total
Motivation
Less
Enough
Good
ρvalue
f
%
f
%
f
%
f
%
Low
7
41,17
4
23,53
6
35,30
17
100
0,035
Tall
2
8,70
5
21,74
16
9,56
23
100
Based on table 3, it shows that those who know about hypnobreastfeeding with less
categories have a low motivation of 41.17% compared to high motivation of only 8.70%. The
results of statistical tests using chi square obtained p-value = 0.035 (p≤0.05). So it can be concluded
that there is a meaningful relationship between knowledge and motivation for providing
information by midwives.
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Ulfa Farrah Lisa, Erda Mutiara Halida, Yulizawati, Aldina Ayunda Insani
The relationship between the level of knowledge of lactation massage and the motivation to
provide information by midwives
Table 4. The relationship between the level of knowledge of lactation massage and the
motivation to provide information by midwives
Knowledge of Lactation Massage
Total
Motivasi
Less
Enough
Good
ρvalue
f
%
f
%
f
%
f
%
Low
4
23,53
6
35,30
7
41,17
17
100
0,046
Tall
0
0
9
39,13
14
60,87
23
100
Based on table 4, it shows that those who know lactation massage with less categories have
a low motivation of 23.53% compared to those with high motivation there is no less knowledge
(0%). The results of statistical tests using chi square obtained p-value = 0.046 (p≤0.05). So it can
be concluded that there is a meaningful relationship between knowledge and motivation for
providing information by midwives.
Analysis
The results showed that those who knew about hypnobreastfeeding with less categories had
a low motivation of 41.17% compared to high motivation of only 8.70%. The results of statistical
tests using chi square obtained p-value = 0.035 (p≤0.05). While knowledge about lactation
massage with less categories the majority have low motivation at 23.53% compared to those with
high motivation there is no less knowledge (0%). The results of statistical tests using chi square
obtained p-value = 0.046 (p ≤ 0.05). So it can be concluded that there is a significant relationship
between knowledge about hypnobreastfeeding and lactation massage with the motivation to
provide information by midwives.
This research is in line with Wijaya, (2021) research that there are 12 (75.0%) respondents
with a good level of knowledge with good motivation, while those with good knowledge and less
motivation are 4 (24.0%) respondents, the results of other studies from 35 respondents there are 3
(15.8%) respondents with less knowledge with good motivation respondents, while those with less
knowledge and less motivation 16 (84.2%) Respondents. The results of the statistical chi-square
test with fisher'sexact test were found p = 0.001 which means that there is a relationship between
knowledge and motivation in preventing complications.
As a health worker, in providing services is needed motivation in implementing practices
according to evidence-based, one of the goals of good service is to get recognition from clients for
the satisfaction they get. Individuals with high motivation for achievement, will be characterized
by having a strong desire to determine and achieve goals, calculating every risk to achieve goals,
happy to get feedback on progress and achievement, and happy to work alone or work with
individuals who have the same achievement motivation. One way to increase motivation is to better
one's knowledge in what to do, according to Notoatmodjo, (2012) states that knowledge is the result
of knowing, and this occurs after people sense a certain object. Knowledge or cognitive is a very
important domain in the formation of one's actions (overt behavior).
With good knowledge about hypnobreastfeeding and lactation massage , it will increase the
motivation of health workers in providing services to breastfeeding mothers. Hypnobreasfeeding
can help increase the motivation of breastfeeding mothers. Hypnobreastfeeding is a good new
method to build positive intentions and motivation in breastfeeding, if applied properly will be able
to maximize the quantity and quality of breast milk (Armini, 2016).
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Ulfa Farrah Lisa, Erda Mutiara Halida, Yulizawati, Aldina Ayunda Insani
Research Sofiyanti et al., (2019) that the results of the Wilcoxon test obtained a p value =
0.018, so it was concluded that there were differences in prolactin hormone levels before and after
the application of hypnobreastfeeding to breastfeeding mothers in the Ungar Health Center Work
Area, in his research said that the way hypnobreastfeeding works is an increase in milk production
if anxiety and stress in breastfeeding mothers decrease. Hypnobreastfeeding can eliminate anxiety
and fear so that the mother can focus her mind on positive things and can increase the mother's
confidence and motivation. Hypnobreastfeeding can make breastfeeding mothers feel better and
confident in carrying out their role.
The advantages and benefits that can be obtained from the use of hypnosis in
hypnobreastfeeding is as a means of relaxation, the cost is relatively low because without the use
of drugs, the method used is relatively simple so that it is easily understood and practiced by many
people, including the subject, can be done alone by the subject (nursing mother) and is sufficiently
assisted by one therapist (midwife), can nourish elements of action, behavior, desire, passion,
motivation, initiative, bad habits, etc., as well as preparing mothers to succeed in breastfeeding and
preparing babies to become a healthy, intelligent and creative generation (Armini, 2016)
Likewise, with the application of lactation massage in nursing mothers, stimulation at an
acupoint point on a meridian pathway will be continued by large diameter A-Beta nerve fibers to
the spinal nerves which then in the spinal modulla there is a gelatinose substance working as a gate
control before being forwarded by efferent nerve fibers to transmission cells, transmission cells
channel to the central nervous system by decreasing taste Discomfort. This acupressure technique
stimulates the production of the hormone prolactin from the brain. This hormone affects a lot to
say the least ASI (Rahayu et al., 2015).
Based on the results of research by Vitriani, et al (2022), it was found that the average
increase in breast milk production with acupressure was 0.290 (SD = 0.5763), this method is one
of the recommendations for postpartum mothers who want to increase their milk production. The
same thing was also obtained from the results of Rahayu's research (2015) found that the volume
of breast milk in mothers who were given acupressure therapy and oxytocin massage was 250-400
ml, while those who were not given therapy were only <250 ml.
In this study, respondents also obtained knowledge about hypnobreastfeeding both with low
motivation as much as 35.3% and knowledge about lactation massage well with low motivation as
much as 41.17%. This shows that good knowledge with less motivation is influenced by several
factors, one of which is the level of education, where the majority of respondents are still educated
D-III Midwifery which is 47.5%, other factors that influence are physical factors and mental
processes where the level of education is high and has good knowledge compared to low education
but there is no encouragement from within him to apply it and is very influential to the actions he
will take (Tombokan & Purwandari, 2017). Previous research revealed that in people who did not
have motivation in themselves before, despite having good knowledge, there are still patients who
ignore taking medication regularly and never carry out the recommendations of doctors (Bertalina
& Purnama, 2016).
A person's knowledge is influenced by factors such as education level, experience, sources
of information, occupation, age and culture. Education is needed to get information such as things
that support health so that it can improve the health of life, the higher one's education the easier it
is to receive information so that the better the knowledge possessed, on the contrary less knowledge
will hinder the development of one's attitude towards newly introduced values because someone
with low education will find it difficult to receive messages, digest messages and information that
delivered so that the knowledge gained becomes less (Notoatmodjo, 2012). According to Jayasman,
(2013) a person's education level can affect his work motivation, meaning that the higher the
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Ulfa Farrah Lisa, Erda Mutiara Halida, Yulizawati, Aldina Ayunda Insani
education level of an employee, his abilities, knowledge, and attitudes also increase, as a result
motivation in work also increases.
Based on this research, knowledge is closely related to the motivation of health workers,
especially midwives, in providing midwifery services, including providing information about
hypnobreastfeeding and lactation massage. By providing information about hypnobreastfeeding
and lactation massage to clients, clients will know the benefits and importance of
hypnobreastfeeding and lactation massage in producing their breast milk. Not only that, clients
will also overcome stress during breastfeeding with positive affirmations given during
hypnobreastfeeding. By getting lactation massage clients will feel relaxed and comfortable. This
sense of relaxation and comfort will affect the hypothalamus in producing the hormone prolactin,
so that breast milk can be produced optimally. With sufficient breastfeeding production, the
exclusive breastfeeding program and continuing breastfeeding for duan (2) years to the baby will
be achieved to the maximum.
CONCLUSION
Based on the results of research that has been conducted, there is a significant relationship
between knowledge of hypnobreastfeeding and lactation massage with the motivation of providing
information by midwives. It is recommended to further examine the relationship of knowledge of
hypnobreastfeeding and lactation massage with the last education and its application in midwifery
practice.
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