IMPROVEMENT OF MOTHER'S BREAST MILK PRODUCTION THROUGH PAPAYA FRUIT DESSERT

ABSTRACT


INTRODUCTION
Breast Milk (ASI) is the first gift in a newborn's life.For newborns, breast milk is the essential and natural source of nourishment.Providing breast milk offers benefits for both the baby and the mother.
Breast milk serves as the primary source of nutrition for infants, supplying essential proteins, fats, sugars, and calcium in appropriate proportions.Breast milk also contains antibodies that shield the baby from diseases during breastfeeding.Babies who receive breast milk are 3.9 times less likely to succumb to the risk of diarrhea and 2.4 times less likely to contract Acute Respiratory Infections (ARIs) (Arifeen, 2018).Other studies indicate that breastfed infants also face reduced risks of ear infections, food allergies, anemia, and obesity in the future (Haryono, 2018).
Various efforts have been made to enhance breast milk production, including traditional methods.These efforts involve early and regular breast care, improving breastfeeding techniques, or adjusting dietary intake.Natural potential from beneficial plant sources, such as papaya fruit, can also be harnessed for this purpose (Istiqomah & Wulandari, 2019).Nataria & Oktiarini (2018) state that papaya fruit contains lactagogue compounds with the potential to stimulate hormones like oxytocin and prolactin, including alkaloids, polyphenols, steroid flavonoids, and other substances.These compounds are most effective at increasing and facilitating breast milk production.The hormonal prolactin reflex, essential for milk production, occurs when a baby suckles on the mother's nipple, stimulating neurohormonal responses in the nipple and areola.This stimulation is transmitted to the pituitary gland through the vagus nerve, then to the anterior lobe.The anterior lobe releases the hormone prolactin, which enters the bloodstream and reaches the milk-producing glands.These glands are then stimulated to produce breast milk.
The increase in breast milk production is influenced by the presence of polyphenols and steroids in papaya fruit, which affect the prolactin reflex and stimulate active alveolar function in milk production.Oxytocin hormone also plays a role in increasing milk production; its elevation is influenced by the polyphenols found in young papaya fruit.This results in a more forceful milk flow after papaya consumption.Oxytocin is responsible for prompting milk letdown.It works by stimulating the contraction of myoepithelial cells surrounding the alveoli, pushing milk into the milk ducts.As a result, alveoli become empty, encouraging the synthesis of the next batch of breast milk (Nataria & Oktiarini, 2018).In a preliminary study involving interviews with 10 breastfeeding mothers of one-month-old babies, 6 mothers combined breast milk with formula due to perceived low milk supply.Among these, some mothers did not use supplements or foods known to boost breast milk production.Four mothers continued breastfeeding while providing supplemental foods.Building upon the background described above, the researcher aims to investigate the impact of papaya fruit dessert consumption on breast milk production among postpartum mothers in the Sungai Merdeka Community Health Center's working area in 2023.

METHOD
This type of research employs a quasi-experimental design known as the Pretest-Posttest, Control Group Design.The population for this study consists of all postpartum mothers who have had normal deliveries in the Working Area of Sungai Merdeka Community Health Center, with an average of 30 deliveries per month.The sampling technique was determined using the Lemeshow formula, resulting in a sample size of 26 individuals.The instruments for breast milk production assessment include observation sheets and measurements obtained using the Real Bubee electric breast pump.The dependent variable is breast milk production, while the independent variable is papaya fruit dessert consumption.Data were analyzed using univariate analysis to describe the characteristics of each researched variable.Univariate analysis presents mean, median, standard deviation, and minimum-maximum values.Furthermore, bivariate analysis was conducted to test the effectiveness of papaya fruit dessert on breast milk production using the Wilcoxon test.  1, it is shown that in the group given papaya fruit dessert, the majority are aged between 20-35 years, which is 7 individuals (53.8%).The majority have multiparous parity, with 7 individuals (53.8%).Their education level is mostly high school (SMA), with 7 individuals (53.8%), and the majority are homemakers (IRT), totaling 7 individuals (63.6%).Normal nipple shape is observed in 10 individuals (76.9%), while breastfeeding frequency is ≥ 8 times for 10 individuals (76.9%), and strong infant sucking strength is noted in 11 individuals (84.6%).In the control group not given papaya fruit dessert, the majority are aged between 20-35 years, with 8 individuals (61.5%).Most have multiparous parity, with 7 individuals (53.8%).High school (SMA) is the predominant education level, with 8 individuals (61.5%), and the majority are homemakers (IRT), totaling 9 individuals (69.2%).Normal nipple shape is observed in 11 individuals (84.6%), while breastfeeding frequency is mostly ≥ 8 times for 11 individuals (76.9%), and strong infant sucking strength is noted in 11 individuals (84.6%).

Source: Primary Data
Based on Table 2, before being given papaya fruit dessert, the data reveals a mean value of 7.38 ml, a standard deviation of 3.070 ml, a standard error of 0.851 ml, a minimum value of 3 ml, and a maximum value of 15 ml.Meanwhile, after being given papaya fruit dessert, the breast milk production data shows a mean value of 101.54 ml, a standard deviation of 16.631 ml, a standard error of 4.613 ml, a minimum value of 70 ml, and a maximum value of 130 ml.

Source: Primary Data
Based on the collected breast milk production data, before not being given papaya fruit dessert, the data reveals a mean value of 8.15 ml, a standard deviation of 3.412 ml, a standard error of 2.011 ml, a minimum value of 3 ml, and a maximum value of 15 ml.Meanwhile, after not being given papaya fruit dessert, the breast milk production data shows a mean value of 62.31 ml, a standard deviation of 7.250 ml, a standard error of 2.011 ml, a minimum value of 50 ml, and a maximum value of 75 ml.Source: Primary Data Based on the analysis results using an independent t-test to observe the difference in breast milk production between those given papaya fruit dessert and those without papaya fruit dessert, a difference of 39.231 ml was observed.The statistical test yielded a p-value of 0.000, which is less than α (alpha) of 0.05, and a calculated t-value of 7.796, which is greater than the t-table value (n-2)(1/2α) = 2.091.This indicates that the null hypothesis (Ho) is rejected, meaning that there is an influence of papaya fruit dessert consumption on the enhancement of breast milk production among postpartum mothers in the working area of Sungai Merdeka Community Health Center in 2023.The research findings indicate that papaya fruit dessert has a more significant effect compared to not consuming papaya fruit dessert.

DISCUSSION
The research findings indicate that the average breast milk production before the intervention was 7.38 ml, with a minimum production of 3 ml and a maximum production of 150 ml.After being given papaya fruit dessert, the breast milk production increased to 101.54 ml, with a minimum production of 70 ml and a maximum production of 130 ml.The results show that in the group given papaya fruit dessert, the initial breast milk output was minimal, but after consuming the papaya fruit dessert, the breast milk production increased to 130 ml.This study supports the research conducted by Abdullah et al. (2020), where the analysis showed that the average breast milk production before consuming papaya fruit dessert was 91.833 cc, with a minimum score of 60 cc and a maximum of 120 cc.After consuming the papaya fruit dessert, the average breast milk production increased to 112.500 cc, with a minimum value of 80 cc and a maximum of 145 cc.
After consuming papaya fruit dessert, postpartum mothers appeared more enthusiastic about breastfeeding their infants.The increased flow of breast milk was visible, and after nursing, babies fell into deep sleep.Babies didn't wake up frequently during sleep and didn't cry upon waking, indicating that their breast milk needs were being met.
The research results indicate that the average breast milk production was 8.15 ml, with a minimum production of 3 ml and a maximum production of 15 ml.After 7 days, the breast milk production was measured again, and it increased to 62.31 ml, with a minimum production of 50 ml and a maximum production of 75 ml.The results show that in the group not given papaya fruit dessert, the initial breast milk production was minimal, but after 7 days without consuming the papaya fruit dessert, the breast milk production increased to 62.31 ml.These findings demonstrate that in the group not given papaya fruit dessert, initially, the breast milk production was low.After 7 days without consuming the papaya fruit dessert, the breast milk production increased, with an average of 62.31 ml, a minimum of 50 ml, and a maximum of 75 ml during home visits.Therefore, an increase in breast milk production was observed after 7 days of research.
The process of postpartum breast milk production is a natural occurrence due to the lactation phase.Lactation or breastfeeding is the process of forming breast milk involving hormones such as prolactin and oxytocin.During pregnancy, prolactin levels increase, but breast milk does not yet flow due to the inhibitory effect of high estrogen levels.After childbirth, estrogen and progesterone levels decrease, and prolactin becomes dominant, leading to milk secretion (Astutik, 2018).
The research results show a significant difference between those given papaya fruit dessert and those not given papaya fruit dessert, with a p-value of 0.000.This indicates that consuming papaya fruit dessert can significantly increase breast milk production, as seen from the increase in production before and after the intervention, with a difference of 39.231 ml.These findings align with the study conducted by The research results show a significant difference before and after without papaya fruit dessert consumption on breast milk production in breastfeeding mothers at the Sungai Merdeka Community Health Center, with a p-value of 0.000.This indicates that even without papaya fruit dessert consumption, breast milk production can increase significantly.The difference in breast milk production before and after the intervention was 54.154 ml.This study indicates that breast milk production in postpartum mothers experienced enhancement, both in those who produced less and those who produced more milk.The change was influenced by the age and parity of the mothers.In the group not given papaya fruit dessert, the increase in breast milk production was attributed to the mothers' consumption of nutrient-rich foods, such as vegetables and protein sources, which influenced breastfeeding outcomes.
The research findings show a significant difference in breast milk production between those who consumed papaya fruit dessert and those who didn't among breastfeeding mothers at Sungai Merdeka Community Health Center, with a p-value of 0.000.This indicates that the average breast milk production in the group given papaya fruit dessert is higher compared to the average breast milk production in the group without papaya fruit dessert, with a difference of 39.231 ml.The study conducted by Elly Wahyuni in 2018, titled "The Influence of Papaya Fruit Dessert Consumption on Breast Milk Production Enhancement in the Community Health Center Area, Central Bengkulu," yielded similar results.The study showed an increase in average frequency of breast milk production from 5.7 times before consuming papaya fruit dessert to 9.75 times after consuming it.

CONCLUSIONS
Based on the analysis results using the Wilcoxon test, a p-value of 0.000 ≤ α (0.05) was obtained.Thus, it can be concluded that there is a difference in breast milk production before and after giving papaya fruit dessert to postpartum mothers in the working area of Sungai Merdeka Community Health Center.
Fitriah et al. (2022), titled "The Effect of Papaya Fruit Dessert Consumption on Breast Milk Production Enhancement in the Srikuncoro Community Health Center Area, Pondok Kelapa Subdistrict, Central Bengkulu, 2022."The study demonstrated a difference in average breast milk production enhancement of 5.458 with a significance level of 0.000.