The Role of Midwives in Motivating Mothers to Initiate Early Breastfeeding at Pertiwi Mother and Child Hospital in Makassar City

Early Initiation of Breastfeeding is a process of letting the baby crawl on its own looking for its mother's nipple immediately in the first hour after birth along with skin contact between the baby and the mother. The aim of the study was to analyze the role of midwives in motivating mothers to initiate early breastfeeding at the Makassar City Mother and Child Hospital. The research used is qualitative research. The method of data collection used is data obtained through in-depth interviews using interview guidelines and observations of the object to be studied. From the results of research conducted for approximately one month, it was found that midwives' authority in motivating mothers to carry out Early Breastfeeding Initiation is still not optimal. The implementation of exclusive breastfeeding cannot be monitored, in terms of action and motivation it is quite good because at work midwives carry out their duties with full responsibility in accordance with the midwifery code of ethics. The conclusion from the results of this study is that the role of midwives in initiating early breastfeeding still needs to be improved, because the community, especially pregnant women, are still unfamiliar with the program, so effective socialization and education is needed so that babies born can be initiated on early breastfeeding.


Introduction
A midwife is someone who has completed a state-recognized midwifery education program and has obtained qualifications and been granted permission to practice midwifery.A midwife must provide supervision of care, and provide the necessary advice to women during pregnancy, childbirth and postpartum (post partum period) lead deliveries on their own responsibility and care for newborns and children (Christine, 2006).
Midwives are recognized as responsible and accountable professionals who work as women's partners to provide support, care and advice during pregnancy, labor and the postpartum period, lead deliveries on their own responsibility and provide care to newborns and infants.This care includes prevention efforts, promotion of normal delivery, detection of complications in mother and child, and access to medical assistance or other appropriate assistance, as well as carrying out emergency measures.
The main task of midwives is to foster community participation through fostering posyandu and other health development, in addition to providing direct services at posyandu and delivery assistance at home, also receiving referrals for health problems to be provided with services as needed or rationally referred to health centers or service facilities better health.Early Breastfeeding Initiation (IMD) is a series of activities in which a newborn baby instinctively carries out activities that end with finding his mother's nipple and immediately suckling from her mother's nipple (Hartati, 2008).

1) Stages of Early Breastfeeding Initiation
Babies born are immediately dried and placed on the mother's abdomen with skin-toskin contact and are not separated from the mother for at least an hour, all babies will go through five behavioral stages before they can successfully breastfeed.Here are the five stages of infant behavior (Roesli,2008).a) The first 30 minutes: The resting or quiet stage of alertness.The baby does not move, this special quiet period is a transitional adjustment from the situation in the womb to the situation outside the womb.This bonding (affectionate relationship) is the basis of the baby's growth in a safe atmosphere.This increases the mother's confidence in her ability to breastfeed and educate her baby.b) 30-40 minutes: making sounds, mouth movements such as wanting to drink, kissing and licking hands.The baby smells and feels the amniotic fluid in his/her hand.This odor is the same as the odor of the fluid secreted by the mother's breast.This smell and taste will guide the baby to find the mother's breast and nipple.

c) Salivating
On realizing that there is food around, the baby starts salivating.d) The baby starts to move towards the breast.Areola (breast) as a target, with legs pressing on the mother's abdomen.He licks the mother's skin stomps his head against the mother's chest, turns his head right and left, and touches and squeezes the nipple area and its surroundings with his tiny hands.Finding, licking, rolling the nipple, opening the mouth wide and clinging well.
Steps for Early Breastfeeding Initiation 2) Perform the recommended early breastfeeding initiation, namely.(Roesli,2008)a) Once born, the baby is placed on the mother's stomach which has been covered with a dry cloth b) Dry the baby's entire body including the head as soon as possible, except for the hands.c) The umbilical cord is cut and then tied d) Vernix (white fatty substance) attached to the baby's body should not be cleaned because this substance makes the baby's skin uncomfortable.e) Without swaddling, the infant is placed directly on the mother's chest or abdomen with skin-to-skin contact between the infant and the mother.If necessary, the baby is given a hat to reduce heat loss from the head.
3) The benefits of early initiation of breastfeeding are: a) Children who are able to breastfeed early can easily breastfeed later, so breastfeeding failure will be greatly reduced.In addition to getting colostrum which is beneficial for the baby, exclusive breastfeeding will reduce mortality.b) Breast milk is the liquid of life, which contains not only food but also absorbents.
Formula milk has no enzymes, so its absorption depends on the enzymes in the child's gut.Therefore, breast milk does not 'take away' the child's enzymes.c) Insufficient milk supply is often complained about by mothers, even though breast milk is produced based on demand (the demand of the baby), if taken a lot, a lot will be given, while babies who are given formula milk need one week to remove substances that are not needed.The baby's sucking on the breast stimulates the release of the hormone oxytocin, which aids uterine involution and helps control bleeding.
The point of all this is that exclusive breastfeeding is the best food for babies.However, due to the lack of information on breastfeeding, we have unknowingly disrupted the process of human life as a mammalian creature.Early Breastfeeding Initiation is only 1 hour, but it affects the baby's whole life.(Riksani,2010)

Research Method
The type of research used is qualitative research using a purposive sampling technique, namely selecting a sample that has essential characteristics of the population so that it is considered quite representative of the population it represents.This research was conducted for one month, starting from March 22 to April 17.The informants in this study were midwives who worked at the hospital and mothers who checked their wombs and mothers who were about to give birth.The number of informants was 10 people.From the results of the interviews during the research it was found that the midwives' authority in carrying out Early Breastfeeding Initiation was still not optimal.This was evident from the answers of the informants who still varied when asked about what information was given to pregnant women who came to check their womb.This was revealed from the results of in-depth interview excerpts as follows:

Results
"...as usual, for example counseling, cleaning breast milk, giving immunizations..." (RK, 53 years) "... if you were examined, you were also asked about nutrition, the dangers of pregnancy, place of delivery, forms of assistance and so on..." (EL, 22 years) "... in the anamnesis, the data is completed, such as name and origin..

." (NH, 21 years) (in-depth interview).
However, when asked further about patients or pregnant women, the informants' answers were as follows: This is because the informants have not fully implemented the importance of information to pregnant women who come to check their pregnancies as knowledge for pregnant women to apply the rules in pregnancy.In the form of services provided to pregnant women and the form of their implementation is quite good, as stated by the following informants: The informants' explanations stated that they were ready to assist deliveries to patients who were about to give birth, most of the informants also knew the importance of early initiation of breastfeeding.This was revealed from the results of in-depth interview excerpts as follows: Furthermore, when the informant was asked whether the mother knew the steps in carrying out early initiation of breastfeeding, the informant answered that: Based on the analysis of the informants' answers, it can be interpreted that so far midwives have tried to provide information about the implementation of IMD but not systematically, information, especially early initiation of breastfeeding, still needs to be improved because they think that this knowledge is common in the community, but assistance is still needed to pregnant women so that they understand more about the importance of maintaining their pregnancy until delivery.

d. Application of exclusive breastfeeding
Based on the results of interviews with informants in this study, when the researchers asked a number of informants about government regulations regarding exclusive breastfeeding, the informants said that: "....So far it's been running but it depends on the mother, she's also given counseling about breastfeeding..."(EL, 22 years) "... there is socialization, given a kind of education and counseling as well..

." (PW, 39 years) (in-depth interview).
When the researcher asked whether the mother socialized pregnant women about the importance of breastfeeding.The following is the informant's statement: From the informants' answers, it can be said that midwives consider that socialization has been carried out so far, while according to pregnant women they are not given a complete understanding of the importance of a mother providing breast milk to her baby.In the interviews conducted regarding the extent of implementation of breastfeeding to infants, the following was expressed by the informant as follows: "... still needs to be improved because breastfeeding is better, babies rarely get sick ..." (ST, 29 years) "... there was a gift but we couldn't monitor the continuity of the problem because they sometimes just went to the puskesmas..

." (EL, 22 years)(deep interview).
The implementation of breastfeeding for infants still needs to be increased in monitoring so that babies can breastfeed exclusively, so collaboration with other health centers is needed.During the research it was rare to find breastfeeding mothers coming back to the hospital to give immunizations to their babies, more pregnant women were found only to have their womb checked.After the informant was further asked about what was the obstacle to the non-implementation of exclusive breastfeeding for infants as told by the informant as follows: "...There is no or not enough breast milk, it's also common because the mother is lazy to breastfeed because of her appearance (EL, 22 years) From the answers or explanations given by the informants, it was quite complete about the reasons why babies could not breastfeed exclusively.When the researcher asked the informant about the monitoring process carried out on the mother so that exclusive breastfeeding could run well, the informant's answers were as follows: "... not all of them because they usually don't check it out anymore, they usually go straight to the puskesmas near their house..." (JH, 40 years) "... controlled so that exclusive breastfeeding..

." (PW, 39 years) (in-depth interview).
e. Action Based on the informant's answer when asked about the extent of the preparations made for the mother who is about to give birth, the informant gave the answer that:

"... Preparation of tools, of course, birth attendants and baby equipment..." (EL, 22 years) "... Equipment such as masks, hand guards, the patient has been prepared both physically and mentally ..." (SC, 26 years) (in-depth interview)
When researchers asked informants about what mothers do after the baby is born.Following are the results of interviews with informants: "... if the baby's condition is really good, IMD will be carried out, then baby care..." (PW, 39 years) "... well weighed, injected like babies in general..

." (RK, 53 years) (in-depth interview)
In carrying out early initiation of breastfeeding, they first look at the condition of the baby, whether it can be done or not.Furthermore, when the researcher asked the informant whether after carrying out IMD on the baby, the baby's movements were followed until he found his mother's nipple.The results of in-depth interviews with informants are as follows: "... followed up so that if there is a problem, for example, it was thought that he was breastfeeding with his mother but it turns out that his nose is blocked.. From the informant's answer, it can be analyzed that in performing IMD, midwives make various considerations both from the mother's condition and the condition of the newborn baby.Furthermore, when the researcher asked the informant about the steps taken so that the baby can grow healthy, the informant answered as follows: "... memberi ASI eksklusif kepada bayi, ibu banyak makan makanan bergizi sperti sayur-sayuran, kacang, daun katuk, pemberian vitosin, oh ya cara menyusui ibu penting diketahui supaya ASI lancar...."(PW,39 th) "... dijaga kebersihannya, makan bergizi serta cukup ASI..."(EL,22 th) (wawancara mendalam).

f. Motivation
Carrying out duties and responsibilities requires a sacrifice for good results, including in providing health services to the community.When the researcher asked the informant what to expect in providing services, the informant's answers were as follows: "… we really hope that you will follow what is said…"(EL, 22 years) "... the best service we can do, sincere in work, no burden...

" (JH, 40 years) (in-depth interview)
When the informant was asked further about whether he got satisfaction in helping the community and how he felt.Following are the informants' answers as follows: Furthermore, when the researcher asked the informant what the criteria were for becoming an exemplary midwife and whether they had the desire to get an award from the government, the informant answered as follows: To find out more about the role of midwives in IMD, the researchers asked about the forms of health promotion given to the community about early initiation of breastfeeding, so the informants answered: "...In an effort to promote health to the community, we explain that if you want to give birth, you should go to a health worker, Mrs.
"... Yes, for health promotion, we as midwives always recommend mothers to always come to check their pregnancies, because then it's easy to monitor the health of the fetus...

.(RK, 53 years) (in-depth interview)
Based on the analysis of the informant's answers, it can be interpreted that the informant is trying to provide good service to the community.They work responsibly and carry out health promotion efforts for pregnant women so that the condition of the mother and baby is healthy, giving full appreciation is not a prerequisite for providing assistance, but they work as best they can in providing quality services.Based on the results of research that has been conducted within a period of approximately one month, regarding the role of midwives in motivating early initiation of breastfeeding at Pertiwi Mother and Child Hospital, each variable will be discussed as follows:

International
1. Midwives Authority Authority is defined as the right to rule or regulate.Power refers to the ability to influence others, while authority refers to the right to exercise that power.Based on in-depth interviews with informants about whether the mother provided information to pregnant women during pregnancy checks, the usual answers were obtained, for example counseling, breastfeeding hygiene, immunization.
In accordance with the observations that the researchers made, it was found that when the patient was admitted to the obstetric polyclinic, an ultrasound examination was immediately carried out to find out the condition of her pregnancy and after that she was immediately given a prescription for drugs/vitamins if the womb was in normal condition, but if there was a patient with problems with the fetus, he was only informed about efforts -Efforts to maintain its content.This is also due to the fact that there are quite a number of patients who come to do the examination, so that the time available is not enough to explain thoroughly.Furthermore, when the informant was asked about the importance of early initiation of breastfeeding, the informant replied that the baby is protected from disease, breast milk also comes out quickly and is good because it contains antibodies besides increasing the baby's body immunity, and can reduce bleeding in the mother, the baby's temperature is good so that hypothermia does not occur.From the explanation of the informant, it can be interpreted that the understanding of IMD is quite good based on the explanation given, whereas when the researcher asked about the steps for implementing early breastfeeding initiation, the informant stated that the baby was laid on his stomach on his mother's chest, allowed to look for the mother's nipple, while other informants said that when the baby Newborns clean the body, head and feet except for the hands, if the baby's condition is good, do the IMD immediately for 1 hour, as well as the other midwives who answered, cut the umbilical cord, then clean it anyway, except for the hands, skin to skin, wear a hat, leave it for half to an hour to find mother's nipples.
From the results of the discussion, it can be analyzed that part of the midwife's authority has been implemented, but not all of the midwife's duties have been Of course, this is a problem that must be handled by all related institutions.

Conclusion
Based on the results of research on the Role of Midwives in Motivating Mothers to Initiate Early Breastfeeding at Pertiwi Mother and Child Hospital in Makassar City, it can be concluded as follows: 1) The authority of midwives in Early Breastfeeding Initiation is still not optimal.Information given to pregnant women during pregnancy checks, only explains counseling, breastfeeding hygiene, immunization, nutrition, dangers of pregnancy, place of delivery and so on without socializing early initiation of breastfeeding.
2) The implementation of exclusive breastfeeding has not been effective, because the monitoring has not been carried out properly.3) Midwives' Actions in Early Breastfeeding Initiation, midwives see the condition of the baby first whether IMD can be done or not.Preparation of tools, physical and mental in providing birth assistance has been provided in accordance with their responsibilities.4) Midwives' motivation in IMD is quite good because in providing assistance it must be based on full responsibility, sincerity in work and sincerity in helping the community.

1 | 3 |
Journal of Health Sciences is licensed under a Creative Commons Attribution 4.0 International License Publish : Association of Indonesian Teachers and Lecturers International Journal of Health Sciences (IJHS) Journal Homepage : https://jurnal.agdosi.com/index.php/IJHS/indexVolume Number September 2023 | Health Sciences is licensed under a Creative Commons Attribution 4.0 International License "... while being examined here about 4 times, but only being examined immediately, later for example we ask questions and the midwife will be told..." (AW, 25 years) "... when I was told to eat nutritious food in the polyclinic for pregnancy, exercise and immunization..." (ST, 29 years) (in-depth interview).
"... Babies are protected from disease, breast milk also comes out quickly and that's good because it contains antibodies..."(EL, 22 years) International Journal of Health Sciences is licensed under a Creative Commons Attribution 4.0 International License "... Increases the baby's body immunity, and can reduce bleeding in the mother, the baby's temperature is good so that hypothermia does not occur..." (SC, 26 years) (in-depth interview).
"... Yes, we usually do two-way communication or directly, we have also collaborated with the Polytechnic to conduct seminars..." (JH, 40 years) (indepth interview) International Journal of Health Sciences is licensed under a Creative Commons Attribution 4.0 International License However, when the researchers further asked pregnant women whether exclusive breastfeeding was socialized, the following were informant's statements: "...If the obstetric polyclinic just explains it, tug on the mother's nipples..." (ST, 29 years)."...It was never socialized because it might have been considered as information, for example conveyed on television..."(AW, 25 years) (in-depth interview)

"
...Mother's malnourishment, lack of knowledge, maybe because of her mother's ignorance...(SC, 26 years) "... Hepatitis B is active so mothers are prohibited from breastfeeding because the baby can be moved, the nipple does not come out (JH, 40 years) (in-depth interview) International Journal of Health Sciences is licensed under a Creative Commons Attribution 4.0 International License ." (JH, 40 years) International Journal of Health Sciences is licensed under a Creative Commons Attribution 4.0 International License "... Sometimes yes but sometimes not because there are more patients who want help with their deliveries..."(NH, 21 years) (in-depth interview) Midwives try to participate in the implementation of early initiation of breastfeeding so that the baby's movement smoothly looking for the mother's nipple, but sometimes they are constrained at the same time when they have to help other mothers who are about to give birth.When the researcher asked the informant about what hindered early initiation of breastfeeding, the informant said the following: "... Mother is bleeding and hepatitis, baby or mother is not healthy,..."(SC, 26 years) "....lack of oxygen, the condition of mother and baby is not good..(EL, 22 years) (deep interview).
Journal of Health Sciences is licensed under a Creative Commons Attribution 4.0 International License "...Satisfied, feeling relieved because I can help mothers give birth..."(SC, 26 years) (in-depth interview) Journal of Health Sciences is licensed under a Creative Commons Attribution 4.0 International License b. Discussion Journal of Health Sciences is licensed under a Creative Commons Attribution 4.0 International License fully implemented because the socialization of early breastfeeding initiation has not gone smoothly according to the Government Regulation of the Republic of Indonesia of 2012 in article 9 paragraph 1 which reads "Health Workers and Health Care Providers Health Service Facilities are required to carry out early initiation of breastfeeding for newborns to their mothers for at least 1 (one) hour.
The baby is laid on his stomach on his mother's chest, left to look for his mother's nipple..."(NH, 21 years).
"...When a newborn baby is cleaned the body, head and legs except for the hands, if the condition of the baby is good, do the IMD immediately for 1 hour..." (PW, 39 years)."... Cut the umbilical cord, then clean it except for the hands, skin to skin wearing a hat, leave it for half to an hour to look for the mother's nipples...(SC, 26 years old) (in-depth interview) In carrying out their duties they try their best, work sincerely in helping the community, but if they are given appreciation they are also happy, then when the researcher asked the informant about what steps were taken to serve the nation and state, the informant gave the same answer as stated, namely: