IMPROVING BREASTFEEDING SELF-EFFICACY IN POSTPARTUM MOTHERS THROUGH HYPNOBREASTFEEDING

Keywords Exclusive breast milk is breast milk given to infants from birth for 6 months, without adding from/or replacing other foods and drinks (except medicine, vitamins, and minerals). Breastfeeding Self-Efficacy is the biggest factor that can influence the process of breastfeeding and the success of exclusive breastfeeding. One of the solutions that can help improve breastfeeding self-efficacy is to apply Hypnobreastfeeding. The type of research is quantitative with a pre-experimental research design in the form of a one-group pretest and posttest design, which assesses the effect of Hypnobreastfeeding on Breastfeeding Self-Efficacy on postpartum mothers in the postpartum room of RSUD Kudungga. The sampling technique was taken using consecutive sampling of 23 people. Based on the results of data analysis using the Wilcoxon test, a p value of 0.000 was obtained. Thus p = 0.000 is smaller than the error rate used at the α = 0.05 level. Mothers who breastfeed When they have the belief that their milk is lacking and not enough for the baby, then this belief will be embedded in the subconscious, and the mother will experience what she believes. Hypnobreastfeeding can neutralize these negative recordings for reprogramming by incorporating a positive intention or attitude towards self-confidence to be able to provide breast milk to their babies and believe that milk production is sufficient according to the needs of the baby. It can be concluded that Hypnobreastfeeding does affect the breastfeeding self-efficacy for postpartum mothers in the postpartum room at RSUD Kudungga.


INTRODUCTION
The Sustainable Development Goals (SDGs) target for 2030 is to end preventable deaths of infants and children, with all countries striving to reduce the Neonatal Mortality Rate to at least 12 per 1000 live births through exclusive breastfeeding (Ministry of Health, Indonesia, 2021).Data from the World Health Organization (WHO) in 2016 showed that the global average for exclusive breastfeeding was around 38%.In Indonesia, 96% of women have breastfed their children, but only 42% exclusively breastfeed (National Population and Family Planning Board, 2018).
The United Nations Children's Emergency Fund (UNICEF) recommends exclusive breastfeeding for a minimum of 6 months, and UNICEF also targets 80% by 2025 for each country to achieve exclusive breastfeeding.In 2016, less than 10 countries achieved this target, with Timor-Leste at 93.6%, Rwanda in Africa at 81%, while Somalia had the lowest rate at 5.3%, and Korea at 18%.This indicates that exclusive breastfeeding rates are still low, while non-exclusive breastfeeding practices remain high in various countries (UNICEF, 2017).
According to the Central Statistics Agency, the percentage of infants under 6 months exclusively breastfed in East Kalimantan Province in 2019 was 71.08%, in 2020 it was 71.13%, and in 2021 it reached 75.87% (Health Office, 2021).In Kutai Timur itself, the achievement of exclusive breastfeeding in 2016 was 56.34%, and there were fluctuations in achievement until 2020 when it reached 56.8% (Kutai Timur District, 2021).
Breastfeeding Self-Efficacy (BSE) refers to a mother's confidence and belief in breastfeeding her baby (Agustin, 2018).BSE is the most influential factor that can affect the breastfeeding process and the success of exclusive breastfeeding (Gonzales, 2020).
Mothers with low breastfeeding self-efficacy tend to resort to alternative techniques when facing breastfeeding challenges (Pakseresht et al., 2017).One solution that can help improve breastfeeding self-efficacy is through hypnobreastfeeding.
This research is conducted to determine the impact of Hypnobreastfeeding on Breastfeeding Self-Efficacy in postpartum mothers in the maternity ward of RSUD Kudungga, Kutai Timur Regency, with the hope that the research results can contribute to the field of midwifery by adding knowledge about the influence of Hypnobreastfeeding on breastfeeding selfefficacy in postpartum mothers at RSUD Kudungga, Kutai Timur Regency.

METHOD
This research is a quantitative study with a pre-experimental research design in the form of a one-group pretest and posttest design.The research was conducted in the postpartum ward of RSUD Kudungga, Kutai Timur Regency.The population in this study consisted of postpartum mothers in the postpartum ward of RSUD Kudungga in February -March 2023.The sample was selected using consecutive sampling techniques, totaling 23 individuals who met the inclusion criteria, namely postpartum mothers (both Cesarean section and normal delivery) whose babies were cared for together, physically and mentally healthy, and willing to participate as respondents.Exclusion criteria included mothers with psychological disorders, mothers unable to breastfeed their babies, and babies not cared for together.
Data were collected using the BSES-SF (Breastfeeding Self-Efficacy Scale-Short Form) questionnaire to assess Breastfeeding Self-Efficacy before and after a 30-minute hypnobreastfeeding intervention.The dependent variable was Breastfeeding Self-Efficacy, and the independent variable was hypnobreastfeeding.Data were analyzed univariately to describe the characteristics of each research variable.Bivariate analysis was performed to determine the relationship between the two variables.Univariate data analysis in this study used frequency and percentage, while bivariate data analysis used the Wilcoxon signed-rank test.Source: Primary Data Based on the table above, the total number of respondents is 23 postpartum mothers.The majority of them are aged 20-35 years, with 14 individuals (60.9%).Nearly half of the respondents, which is 10 individuals (43.5%), have more than 2 children.A small portion have a college education, with 8 individuals (34.8%), and the majority of all respondents, totaling 13 individuals (56.5%), are homemakers.Source: Primary Data Based on Table 2, the total number of respondents is 23 postpartum mothers before the intervention.The majority of the respondents, which is 15 individuals (65.2%), have a moderate level of BSE.Source: Primary Data

RESULTS
In Table 4, out of 23 respondents, 15 individuals experienced an increase in Breastfeeding Self-Efficacy (BSE).Based on the data analysis using the Wilcoxon test, a p-value of 0.000 was obtained.Therefore, with the statistical test decision where the pvalue is ≤ α (0.05), Ha can be accepted.Thus, it can be concluded that there is an influence of hypnobreastfeeding on Breastfeeding Self-Efficacy in postpartum mothers in the maternity ward of RSUD Kudungga.

DISCUSSION
Based on the characteristics of respondents by age, it was found that very few respondents were <20 years old, totaling 2 individuals (8.7%), who had a moderate and high level of Breastfeeding Self-Efficacy (BSE).The majority were aged 20-35 years, with 14 individuals (60.9%) having low (3 individuals), moderate (8 individuals), and high (3 individuals) BSE levels.A small portion were >35 years old, totaling 7 individuals (30.4%), with 1 individual having a low BSE level, and the others having a moderate BSE level.
In the study conducted by Moneca Diah L (2022), it was concluded that maternal age showed no significant relationship with postpartum breastfeeding self-efficacy.In the research by Melinda Widyamukti (2020), there was no correlation between the age of breastfeeding mothers and self-efficacy in breastfeeding (p=0.448,p > 0.05).Based on this research, low BSE levels were found in those above 20 years old, and high BSE levels were found in those under 35 years old, indicating that age does not have a significant impact on breastfeeding self-efficacy.
Regarding the characteristics of respondents based on parity, it was found that mothers with 1 child, a small portion of 8 individuals (34.8%), had low, moderate, and high BSE levels.Those with 2 children were very few, only 5 individuals (21.7%), and they had moderate and high BSE levels.Nearly half of the respondents (>2 children) totaled 10 individuals (43.5%), also had low, moderate, and high BSE levels.
Research that aligns with this study suggests that the breastfeeding self-efficacy score of mothers with breastfeeding experience is 1.93 times higher than that of mothers without experience (Poorshaban et al., 2017).In the study by Moneca Diah L (2022), it was concluded that parity showed a significant relationship with postpartum breastfeeding self-efficacy.
Based on this research, it was found that low BSE scores were present in mothers with 1 child and more than 2 children but not in mothers with 2 children.Therefore, the researcher concludes that parity does not have a significant impact on breastfeeding self-efficacy.
Regarding the characteristics of respondents based on education, it was found that very few, only 1 individual (4.3%) with elementary school/no schooling, had a moderate BSE level.A small portion with junior high school and senior high school education, 7 individuals each (30.4%), had low, high, and moderate BSE levels.A small portion with college/university education, 8 individuals (34.8%), had moderate and low BSE levels.
According to the research by Sri Riyana (2018), the multivariate test results show that external variables do not have a significant effect on breastfeeding selfefficacy.Factors such as age, education, occupation, number of children, breastfeeding experience, hypnotherapy class, and delivery do not significantly affect breastfeeding self-efficacy.According to N. Kadek Sri Eka Putri (2019), there is a relationship between maternal education level and breastfeeding self-efficacy, but in this study, low BSE levels were found among mothers with junior high school, senior high school, and college education, so the researcher concludes that there is no significant relationship between education level and breastfeeding self-efficacy.
Regarding the characteristics of respondents based on occupation, it was found that the majority, 13 individuals (56.5%), were homemakers, while nearly half, 10 individuals (43.5%), were employed.BSE levels were found to be moderate and low in employed mothers and low, moderate, and high in homemakers.
In the study by Melinda Widyamukti (2020), there was no correlation between self-efficacy in breastfeeding and educational status, previous experience in breastfeeding, receiving education (information) about breastfeeding, occupation, and parity.According to the research by Diah Ayu Tri Wartami (2020), there is a relationship between occupation and breastfeeding selfefficacy in breastfeeding mothers at Posyandu Mawar II, Dusun Trowangsan Colomadu.Risma Aliani Putri's research (2022) concluded that working mothers mostly have low breastfeeding self-efficacy.Mothers who return to work after childbirth have lower self-efficacy compared to mothers who stay at home.Working mothers have two roles: as mothers and as workers.Both roles are a challenge for breastfeeding mothers, requiring patience, attitude, and a very high level of self-efficacy to facilitate continued breastfeeding.
After a 30-minute hypnobreastfeeding intervention in postpartum mothers in the maternity ward of RSUD Kudungga, the average level of breastfeeding self-efficacy increased from moderate to high.Before the intervention, a small portion had low and high BSE levels, each with 4 individuals (17.4%), and the majority had a moderate BSE level, with 15 individuals (65.2%).After the intervention, a small portion had a moderate BSE level, with 6 individuals (26.1%), while the majority had a high BSE level, with 17 individuals (73.9%), and none had low or very low BSE levels.
Hypnobreastfeeding is performed by directly contacting the subconscious mind.When in a relaxed and stable state, it can implant a new program or concept that will automatically influence daily life and actions without conscious awareness.When a breastfeeding mother believes that her breast milk is insufficient for her baby, this belief is embedded in the subconscious, and the mother will experience what she believes.Hypnobreastfeeding can neutralize these negative recordings and reprogram them by instilling positive intentions or suggestions regarding her confidence in providing breast milk to her baby and believing that breast milk production is sufficient for the baby's needs (Sari, 2017).
The brain waves that influence the hypnosis process include beta, alpha, theta, and delta brainwaves.Alpha brainwaves have a frequency of 8-13.9Hz and are dominant when we daydream, daydream, or when we are in a state where our thoughts are focused on one goal.Alpha waves are the gateway to the subconscious mind, allowing the brain to work more optimally.In the alpha wave state, the brain and pituitary gland produce serotonin and endorphins, creating feelings of comfort, relaxation, calmness, and happiness, and natural amnesia occurs.Hypnosis can access the subconscious mind to provide new suggestions and concepts in life and record them effectively (Sari, 2017).
Based on this research, providing hypnobreastfeeding for 30 minutes significantly increased the level of breastfeeding self-efficacy.This increase occurred because hypnosis accesses the subconscious mind and reprograms negative beliefs into positive ones.In this case, hypnobreastfeeding convinces mothers that the breastfeeding process is comfortable, and are capable of providing exclusive breastfeeding to their babies.
According to Lutfiana Sari (2019), Hypnobreastfeeding is a relaxation technique that helps facilitate the breastfeeding process.It involves inserting positive affirmations that assist in the breastfeeding process while the mother is in a relaxed state or highly concentrated on a specific aspect.According to Ni Wayan Armini (2016), breastfeeding self-efficacy (BSE) is a mother's self-belief or confidence in her ability to breastfeed her baby.Putri Wulandari (2021) also stated that breastfeeding self-efficacy has a significant impact on breastfeeding and is the strongest factor influencing the breastfeeding process and the achievement of exclusive breastfeeding in the future.
These research results align with the findings of Sri Riyana (2018), indicating a significant effect of hypnobreastfeeding on breastfeeding self-efficacy between before and after treatment.Repeated ANOVA and independent t-tests showed that self-efficacy scores in breastfeeding for the hypnobreastfeeding group significantly increased in measurements from pretest to posttest 1 and posttest 2, with p=0.000.Hypnobreastfeeding was more effective in increasing breastfeeding self-efficacy compared to standard education, with p<0.05.The multivariate test results showed that external variables did not have a significant effect on self-efficacy in breastfeeding, with p>0.05.
Another study that aligns with this research is by Vidya Arianti (2017), which found a relationship between hypnobreastfeeding and breast milk production.The statistical test results showed a significant difference in body weight before and after the intervention.The paired t-test results showed a p-value <α (0.05) of 0.000 (95% Confidence ).Based on this value, it can be concluded that at a 95% confidence level, there is a significant difference in body weight after hypnobreastfeeding.This research indicates that hypnobreastfeeding has an effect on increasing breastfeeding self-efficacy.

CONCLUSIONS
Based on the analysis results using the Wilcoxon Signed Rank Test, a p-value of 0.000 was obtained, which is ≤ α (0.05).Therefore, it can be concluded that there is an influence of hypnobreastfeeding on breastfeeding self-efficacy in postpartum mothers in the maternity ward of RSUD Kudungga, Kutai Timur Regency in 2023.