Warm Steam Therapy to Increase Breast Milk Production of Post-

Partum Mothers

Rosnani, Jawiyah

and Devi Mediarti

Department of Nursing, Polytechnic of Health Palembang, Palembang, Indonesia

Keywords: Warm Stream, Therapy, Breast Milk, Post-Partum Mothers.

Abstract: One form of community independence in the vision of the Ministry of Health by building the empowerment

of women and children directed at improving the quality of life and the role of women. In the postpartum

period the mother cares for her baby with breastfeeding. To help the success in breastfeeding, warm steam

therapy is needed to stimulate milk production. The purpose of this study was to determine the effect of

warm steam therapy to increase maternal production of postpartum mothers. This research used quantitative

and qualitative approach with mixed methodology design. Sampling technique used purposive sampling and

obtained 32 people in treatment and 32 in control group. Quantitative analysis used independent and

dependent samples test paired t-test and qualitative used non-statistical analysis through logical inference

based on actual considerations and conditions. Result showed the average breast milk production before

treatment was 97.19 with SD=15.077 and after treatment was 103.59 with SD=11,447. Treatment with

warm steam therapy gave affects for the production of breast milk (p=0.017). Conclusions: treatment with

warm steam therapy was very beneficial for the health of post-partum mothers. Therefore, warm steam

therapy should be used as a model of post-partum maternal care at home.

1 BACKGROUND

Efforts to build self-reliance was to instill a

proactive and not reactive or defensive.

Independence was a dynamic concept because it

recognizes that life and conditions of

interdependence are constantly changing, both in

terms of their constellation, their equilibrium, and

their underlying and influencing values (RPJPN

2005-2025). The vision in line with the vision of the

Ministry of Health is the realization of a healthy

society that was independent and fair. Smooth public

health, through community empowerment, including

private (Depkes 2012).

The form of community independence is one of

them by developing the empowerment of women

and children directed at improving the quality of life

and the role of women, welfare, and child protection

in various fields of development (UU RI No.17,

2007). Improving the quality of children life was the

improvement of the quality of Human Resources

(HR). The basic capital of quality human resource

formation begins since the baby is in the womb and

from an early age. One of the things that can be done

in optimizing the quality of human resources is the

provision of breast milk (breast milk) (Depkes

2012). WHO, UNICEF and the Ministry of Health

support the government program in Global Strategy

for infant and Young Child Feeding (GSIYCF) and

Kepmenkes RI No 450 / MENKES / SK / IV / 2004

and Health Act No. 36 Year 2009 article 128

recommends breastfeeding.

Although the support and efficacy of breast milk

was great but realizing breastfeeding by the mother

to her baby was not always easy because many

women have problems applied. Basic Health

Research in 2010 noted that in Indonesia babies

given breast milk by their mothers for 6 months only

15.3%, this figure was below the global exclusive

figure breastfeeding that was 32.6%. The low rate of

breast feeding prevalence by the mother to her baby

one of them caused by the production of mother's

milk was less.

Tasya (2010) stated that mother's mental and

psychological factors have a big role in influencing

milk production. Stress experienced by the mother

will inhibit the release of the hormone oxytocin, if

there was stress from breastfeeding mothers there

will be a blockade of the reflux of oxytocin due to

the release of adrenaline by stress hormones that

Rosnani, ., Jawiyah, . and Mediarti, D.

Warm Steam Therapy to Increase Breast Milk Production of Post-Partum Mothers.

DOI: 10.5220/0008325503730378

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 373-378

ISBN: 978-989-758-336-0

373

cause vasoconstricts blood vessel, so that little hope

of oxytocin reaches the target organ mieopitelium

(Hegar 2012).

Nowadays a lot of research that has been

generated about the therapy can be done to obtain a

relaxation of the physical and psychological

condition of the mother post-partum. One therapy

recommended by the Minister of Health is

complementary therapy. Traditional complementary

therapies or alternatively referred to as CAM

(Complementary Alternative Medicine) were non-

conventional treatments that are shown to improve

community health status, including promotive,

preventive, curative and rehabilitative measures

obtained through structured education with quality,

safety and effectiveness which is based on

biomedical science.

Complementary therapy was strengthened in RI

Law no. 36 of 2009 on Health, outlined in article 1

point 16. Traditional health services were

medication and or treatment by means and

medications that refer to empirical experience and

hereditary skills that can be justified and applied in

accordance with the norms prevailing in the

community. This is reinforced by the Minister of

Health Regulation No: 1109 / Menkes / Per / IX /

2007 regarding the provision of alternative-

complementary medicine in health care facilities.

Steam therapies given to postpartum mothers can

have vasodilatory effects on skin exposed to warm

steam, then this provides a smooth flow of maternal

blood flow to smooth. Heat from steam causes body

heat to increase 1 - 20oC, in the presence of heating,

the body's automatic mechanism is to fight to cool

the body temperature. How to remove the sweat

through the pores of the skin. Sweat itself is actually

a mixture of water, minerals, fatty acids and toxins

in the body. Heating also makes the blood vessels in

the skin widen. As a result, the blood circulation

becomes smooth so that the provision of nutrients to

the body's cells and removal of metabolic waste

from within cells or tissues, to be better.

Dilation of blood vessels also makes blood

pressure in the body decreases slowly. Heart rate

also increases. Every 10oC body temperature rise,

the heart will work with 11 more pulses. Supplement

oxygen to the muscles of the body also more and

more. So, sweating a lot and circulating blood flow

in the body will cleanse and revitalize the skin.

Increased blood flow to the whole body of the

mother impacts on the arousal LDR (let down

reflex) is the reflex of milk expenditure. When the

baby sucks, it will push the sinus and breast milk out

through the holes in the nipple.

In Indonesia, post-partum treatment is done with

steam boiled water (daily) such as in Sangihe

Archipelago (Sulawesi), to restore body heat, give a

drink of turi leaf juice, to compress the mother's

head with leaf dregs, eat stew Ketapang tree skin

restores health, treatment lasts 2 weeks to a month or

40 days (Sutanwijaya 2014).

The results of the research on post-partum

mothers in the working area of Local Goverment

Clinic Multiwahana Palembang, got statistical test

result with p value = 0.001, it can be concluded that

there was difference of milk production between the

control group and the intervention group after the

warm steam therapy of peppermint (Mediarti 2015).

2 METHODS

2.1 Study Design

The design of this research is Quasi Experimental

pre and posttest with control group, mixed methods

with explanatory sequential type. This method is

carried out in sequence. Quantitative research

method is firstly done the pretest and posttest of

intervention, both to intervention group and control

group. Quantitative data is obtained from the scale

of clinical assessment of postpartum mother's milk

production. Then proceed with qualitative research.

Researchers use this design with the expectation of

qualitative findings to help interpret or contextualize

the results of quantitative research. Qualitative data

obtained from interviews, observations and

documentation of patient assessment regarding the

treatment of warm steam therapy.

The research was conducted in the house of the

post-partum mother in the Working Area of Local

Goverment Clinic 23 Ilir Palembang. The study was

conducted from 15 September to 28 December 2017

2.2 Study Population, Sampling,

Inclusion Criteria

The population in this study was the mother of the

partum who gave birth and domiciled in the city of

Palembang. The sampling technique in this study

used purposive sampling technique: the mother who

gave birth at the maternity clinic in Local

Goverment Clinic Area 23 Ilir Palembang. Then the

patient was discharged and the therapy was carried

out at the respondent's home. The sample in this

study amounted to 32 people for each group.

For qualitative research, participants were taken

from quantitative research samples, after data

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

374

saturation was obtained that is 10 participants,

qualitative research was discontinued.

Inclusion criteria consists of willing to be

researched, post-partum the first day, age of mother

20-35 years, no mental disorders, babies are not

given formula milk, not experiencing physical

illness or complications that accompany the mother

(mother's nipple normal) and her baby (good baby

suction reflex, BB born baby> 2500 gram)

2.3 Procedures

The data collected through interviews, participatory

observation and document analysis are presented in

fieldnote form, each of which is coded and records

related to the research question. After going through

data reduction or directly verified, the data from

each research question is interpreted and combined

with the result of analysis of research data of early

stage (quantitative method), so that can be obtained

by complete research result.

2.4 Data Analysis

Quantitative clinical assessment data and patient

assessment data in qualitative form. To analyze the

quantitative data used statistical analysis, while to

analyze the qualitative data used non-statistical

analysis through logical inference based on actual

considerations and conditions. The form of the

analysis of quantitative data with numerical use of

mean, median, standard deviation, and minimum –

maximum (Hastono & Luknis 2010). Descriptive

analysis in this research is used to analyze data about

the characteristics of respondents and research

variables.

Statistical technique used to test the hypothesis

using data difference test. The data collected is then

tabulated by the researchers using computerized

software. Furthermore, the data is tested normality to

determine the type of test used to analyze the

research. Normality test results are said to be

normally distributed if p> α (α = 0.05), so the

formula used is t test. If the normality test results are

abnormally distributed p <α (α = 0.05) then use the

test formula Wilcoxon Signed Rank Test and Mann-

Whitney U Test.

In the final stage (qualitative method), qualitative

data analysis is done by searching and arranging

data systematically from interview transcript,

observation, field notes and other materials to

improve the researcher's understanding on the case

studied and present it as research findings. Analysis

of data to be used using interactive models (Miles et

al. 2014)

2.5 Ethical Clearance

This study has passed the review and certified of

Ethical Approval with No. 656/KEPK-

PTKMKS/XII/2017, December 12, 2017 that issued

by Health Research Ethics Committee of Health

Polytechnic Makasar.

3 RESULTS

3.1 Quantitative Results

The average number of mother's milk post-partum

before treatment with warm steam therapy was

97.19 and standard deviation = 15.077. The average

amount of breast milk after warm steam therapy was

103.59 and standard deviation = 11.447.

Based on the table 1 is known the most

respondents of were multigravida respondents

62.5%.

Table 1: Distribution of Respondents Based on

Gravida of Post-Partum Mother.

Gravida

Primigravida

37.5

Multigravida

62.5

Total

100

Table 2: Distribution of Respondents Based on

Employment of Post-Partum Mother.

Employment

Not Work

43.8

Work

56.3

Total

100

Table 3: Distribution Average Number of

Breastfeeding Post-Partum mothers.

Number of Breastfeeding

Pretest

Posttest

Mean

97.19

15.077

103.59

11.447

Table 4: Distribution of Average Breastfeeding

Production Before and After Warm Steam Therapy.

Variable

Mean

Value

Breastfeeding

Production

- 6.406

14.325

2.532

0.017

Warm Steam Therapy to Increase Breast Milk Production of Post-Partum Mothers

375

Based on the table 2 is known that the number of

respondents who work and does not work almost

equal 18 (56.3%) and 14 (43.8%).

Result of statistic test got p value = 0.017, hence

can be concluded treatment action with warm steam

therapy affect to mother's milk production of post-

partum.

3.2 Qualitative Results

3.2.1 Health Benefits

The informant explained that in addition to making

the body fresh again and can restore stamina, since

the girl has often used a steam bath, can make his

skin white and clean even though he is often

exposed to heat and dust due to his work selling in

the market. In addition, it can treat rheumatism

experienced so that when rheumatism or body feels

stiff due to fatigue.

3.2.2 Get Rid of Body Toxin

The informant reveals that during pregnancy the

pores are so wide open that toxins and unnecessary

substances Mother can enter the body, and after

delivery the mother usually still bleeds like

menstruation, but even if the blood stops out in the

body still perceived dirty blood that has not

completely out of the body of the puerperal mother

so, seeing it need to do a steam shower.

The informant also re-issued the dirty blood as

usual in the form of spots or blood clots that are

solid red, while for the poison itself is expelled

through the sweat through the evaporation process.

4 DISCUSSION

The effect of steam therapy according to (Crinnion

2010) that was peripheral circulation increased 5-

10%; circulation to the muscles, kidneys and

visceral passages decreased; increased metabolic

rate; increased oxygen consumption; liquid

discharge; increased heart rate; decreased blood

pressure; increase plasma cortisol, corticosteroids,

growth hormone, TSH and prolactin;

bronchodilation; muscle relaxation and decreased

activity of the neuromuscular system; loss of water

and electrolytes (Na, K, Cl) which are compensated

by aldosterone hormone regulation in the kidney;

lipolysis.

The heat of the environmental temperature will

be accepted by the skin as a heat stimulus to the

central body temperature regulation of the

hypothalamus. Thus, the body will try to maintain

body temperature by increasing heat loss to the

environment. Dilation of blood vessels and increased

blood flow to peripheral areas attempt to get rid of

body heat (Irianto 2014). Increased ambient

temperature will reduce the heat gradient between

the environment and the surface temperature of the

skin and between the surface temperature of the skin

and the core temperature. Although it was

homoiotherm, but the human body temperature can

increase if the increase in ambient temperature

exceeds the skin temperature. Thus, the temperature

in the steam room therapy bath can increase the

body temperature of a person because the

temperature is above the normal temperature of the

human body (Indra 2011).

The increase in body temperature will stimulate

increased metabolic processes of the body.

Metabolism itself is all the chemical and energy

reactions that occur in the body. While the metabolic

rate or metabolic rate can be expressed as the rate of

heat released during the occurrence of various

chemical reactions in all body cells. Logically the

more the body releases heat, the faster the rate of

metabolism (Guyton & Hall 2014).

Increased metabolic rate due to high

temperatures during steam bath therapy leads to an

increase in blood flow in general. This is reinforced

by the vasodilation (dilation) of blood vessels that

cause the higher blood circulation. Increased blood

flow and circulation in general will be followed by a

rise in cardiac output. (Guyton & Hall 2014).

Cardiac output is an indicator of heart function.

Cardiac output is also the amount of blood pumped

by the heart in every minute. Thus, cardiac output is

strongly influenced by the frequency of the

heartbeat. Increasing the frequency of heart rate or

pulse is the body's attempt to compensate for an

increase in cardiac output (Hudak & Gallo 2010).

Increased metabolism in addition followed by an

increase in pulse frequency, also accompanied by an

increase in respiratory frequency. This is due to the

need for metabolic processes to oxygen and the

importance of removing carbon dioxide from the

body. Metabolic rate is also closely related to

respiration because respiration is the process of

energy extraction from food molecules that depend

on the presence of oxygen. This is what makes

measurements of metabolic rate can be estimated by

measuring how much oxygen is consumed by

creatures of time union. The amount of oxygen the

body needs during this metabolism is also known as

the rate of oxygen consumption (Tobin 2009).

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

376

One of the factors that influence the high rate of

metabolism followed by the rate of oxygen

consumption is the temperature or temperature of the

environment in which living are. Room temperature

steam guidance range 38OC - 520C can increase the

rate of metabolism and the rate of oxygen

consumption so that will be accompanied by an

increase in respiratory frequency (Tobin 2009).

Breastfeeding in the postpartum period requires

energy and causes fatigue because to meet the needs

of the baby, the mother must be willing to give it on

demand. The Wambach study (1998) in McGovern,

Dowd, Gjerdingen, Gross, Kenney, Ukestad, et al

(2006) reported that there was a significant

relationship between breastfeeding with fatigue (r =

0.38, p <0.05) at four measurements (3 days, 3

weeks, 6 weeks and 9 weeks post-partum).

(Aini 2015) showed that nursing mothers who

are not relaxed in the state, the mind is not calm and

feeling depressed so let down reflex will be

hampered. This occurs due to the release of

adrenaline which inhibits the oxytocin hormone

work where vasoconstriction of vessels occurs so

that oxytocin slightly reaches the organ of the

myoepithelium to squeeze out the milk.

Oukup is a traditional Karo tribe sauna that

utilizes the diversity of plant species as a herb for

postpartum health and treatment of various types of

diseases (Nasution 2009). It used to be done by

cooking water that has been mixed with various

spices to boil in a large cauldron. The steam that

arises from that process will be absorbed by the

body. Usually this is done Karo woman who gave

birth to healthy and fresh again. Today, not only is

done by Karo women who have just given birth but

also performed by men and women, teenagers to old

age and from various tribes. This steam bath can

secrete toxins through sweat, cleanse the skin and

stimulate circulation. This great public interest can

be seen from the increasing number of places of

business opened.

The results of research conducted by (Mediarti et

al. 2015) about the influence of warm water vapor

therapy of peppermint aroma to milk production in

post-partum mother, obtained statistical test result p

value = 0,084, hence can be concluded there is no

difference of milk production between control group

and group intervention before being given warm

steam therapy peppermint scent. The result of

statistical test obtained p value = 0,001, hence can be

concluded there is difference of milk production

between control group and intervention group after

given warm steam therapy of peppermint aroma.

Engkartin et al (2013) The effect of terapy steam

on the decrease of blood glucose level in patients

with Type 2 DM in the work area of Local

Government Clinic Bukateja, Purbalingga District,

was the difference between blood sugar levels in the

intervention group and control group after the

intervention group was given steam sauna therapy

(p-value = 0,000 <α = 0.05).

Increased body temperature caused by sauna

therapy leads to an increase in glucose or glucose

metabolism and more open capillary meshes

allowing more insulin receptors and more active

insulin receptors to affect the decrease in blood

glucose in people with diabetes mellitus (Aviv et al.

2010). This agrees with (Primadiati 2008) who argue

that steam sauna therapy is good for diabetics as it

can improve pancreatic function and other than that

the resulting steam can help increase glucose

metabolism in the body.

Research conducted by Kihara, et.al (2004)

proves that a steam bath (sauna) can decrease

cardiac arrhythmia in patients with chronic heart

failure. (Raisanen et al. 2010)revealed that there are

six benefits of steam baths that reduce stress,

detoxify, make good sleep, relax muscles and relieve

aches and pains in muscles and joints, improve heart

work, fight disease and relieve stress.

The results of statistical tests showed a

significant difference between mean respiratory

frequency before and after treatment (p value =

0.000). Similarly, the mean frequency of pulses per

minute, before and after treatment showed a

significant difference (p = 0,000). The average of

respiratory rate and pulse after treatment showed a

significant increase compared to before treatment

(Purnawan 2015).

The result of the analysis was obesity that a total

increase in body fat where if found overweight

>20% in men and >25% in women caused by fat. As

a result of obesity or obesity will be a problem for

health, such as coronary heart disease, diabetes.

Prevention of obesity or overweight can be done by

doing therapy or treatment. Steam therapy (saunas)

in humans is done at 82° C twice the normal body

temperature of 37° C, of course the sauna room

temperature determination for humans. The saunas

for relaxation are recommended 1-2 times in 2

weeks while for obesity therapy 1-2 times in a week,

with a steam temperature of 180oF or 82oC, for

approximately 15-20 minutes in a single treatment

(Mualianda 2017).

Warm Steam Therapy to Increase Breast Milk Production of Post-Partum Mothers

377

5 CONCLUSIONS

Treatment measures with warm steam therapy have

an effect on postpartum mother's milk production. p

value = 0.017. Treatment with warm steam therapy

was very beneficial for the health of post-partum

mothers.

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