The Effects of Early Breastfeeding Initiation on the Uterine
Involutional Process in Post Partum Mothers
Raisha Octavariny, Sri Tri Dwi, Sri Melda Br. Bangun, and Dwi Handayani
Faculty of Midwifery, Institut kesehatan medistra lubuk pakam, Deli serdang, Sumatera utara, Indonesia
Keywords: Early breastfeeding initiation, involuntary uteri, post partum mother
Abstract: One of the causes of high bleeding rate is involute uterine process which is not running properly. Mothers
who initiate breastfeeding early will accelerate uterine involution due to the influence of the hormone oxytocin
which can increase uterine contractions. The type of research is Quasi Experimental. The population are all
post partum mothers with a total sample of 20 people with accidental sampling technique using the
independent sample t-test. The results of this study indicate that the mean height of uterine fundus mothers
who have an EBI is 9.70 cm and those who do not do an EBI 11.20 cm, thus the EBI is effective in accelerating
the process of uterine involution. Furthermore, it is expected for health workers to implement early
breastfeeding initiation as a permanent procedure in the management of post partum mothers.
1 INTRODUCTION
The puerperium (post partum) is literally defined as
the period immediately after birth, this period also
includes the following weeks when the reproductive
tract returns to a normal nonpregnant state, generally
lasting 6 weeks or shortly thereafter. During the
puerperium, the reproductive organs gradually return
to the state before pregnancy. One of the changes in
the reproductive organs is involution. Uterine
involution is the process of returning the uterus to its
original state or state before pregnancy where in the
process of uterine involution the contraction of the
uterus can be marked by a decrease in the height of
the uterine fundus (Maryunani, 2017).
The puerperium (post partum) is literally defined
as the period immediately after birth, this period also
includes the following weeks when the reproductive
tract returns to a normal nonpregnant state, generally
lasting 6 weeks or shortly thereafter. During the
puerperium, the reproductive organs gradually return
to the state before pregnancy. One of the changes in
the reproductive organs is involution. Uterine
involution or contraction of the uterus is a process in
which the uterus returns to its pre-pregnancy
condition. Uterine revolution can also be said to be
the process of returning the uterus to its original state
or the state before pregnancy (Maryunani. 2017).
If uterine involution goes normally, it can reduce
the incidence of bleeding, especially post partum
hemorrhage which is one of the direct causes of
maternal death. If uterine involution goes normally, it
can reduce the incidence of bleeding, especially post
partum hemorrhage which is one of the direct causes
of maternal death. The factors influence the process
of involution, namely: puerperal exercise, early
mobilization, early breastfeeding initiation, nutrition,
age, and parity. Early breastfeeding initiation is one
of the factors that influence uterine involution
because during breastfeeding stimulation and
hormone release include oxytocin which functions in
addition to stimulating the contraction of smooth
muscles of the breast, also causing contractions and
retraction of uterine muscles (Nelwatri, 2017).
This problem has been carried out research in
which the study stated that mothers who initiate early
breastfeeding will accelerate uterine involution due to
the influence of the hormone oxytocin which can
increase uterine contractions. The uterus will
naturally contract slowly and return to its original
shape for approximately 14 days (Gibert et al, 2018)
In Figure 1 can be seen the ongoing process of
early breastfeeding in which a baby looks for its
mother's nipples. important step to facilitate the baby
in starting the process of breastfeeding. Newborns
who are placed on the mother's chest or stomach,
naturally can find their own source of breast milk and
suckle.
Octavariny, R., Dwi, S., Bangun, S. and Handayani, D.
The Effects of Early Breastfeeding Initiation on the Uterine Involutional Process in Post Partum Mothers.
DOI: 10.5220/0009466501050111
In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 105-111
ISBN: 978-989-758-460-2
Copyright
c
 2020 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
105

Figure 1: Early Breastfeeding Initiation.
Rahayu's research (2018), explained that the use
of curves and octopus was not effective in helping in
uterine involution, but used of these curves and
octopus was allowed with the condition that they
must be used with the right technique but in reality
there are still many women who believe that use of
curved and octopus can help the process of
involutional uteri, the obstacle that is often faced is
the belief that has been believed in society for
generations that is difficult to change (Rahayu, 2018)
Rosyidah's research (2017) entitled The effect of
early breastfeeding incision to the high rate of
decrease in uterine fundus also found that there was
an effect of early breastfeeding initiation on the rate
of high loss of uterine fundus in post partum mothers
where uterine involusio process in mothers who
breastfeed their babies early on would have a time
span which is shorter than mothers who do not
breastfeed their babies (Rosyidah, 2017)
Wulan's research (2018) explains that there are
differences in uterine involution in post partum
mothers day 1 who are given hypnobirthing
relaxation therapy and who are not given
hypnobirthing relaxation therapy. Hypnobirthing
relaxation therapy is 2 times faster making a decrease
in uterine involution in normal post partum mothers,
this is can be seen from the average obtained in the
group of mothers who were given treatment
amounting to 6 people, amounting to 2.50 while in the
group of mothers who were not given treatment
amounting to 12 people obtained an average of 1.25
(Wulan, 2018)
Martini's research (2018) states that the average
time a baby takes for EBI is 61.1 minutes. The results
of multivariate analysis showed that mothers who
gave exclusive breastfeeding for up to 7 days had a
29.8 times higher chance of experiencing normal
uterine fundus height, compared to those who did not
exclusively breastfeed.
In Figure 2 By giving exclusive breastfeeding
requires mothers to breastfeed routinely, when
mothers naturally breastfeed their bodies will produce
the hormone oxytocin which helps the uterus to
contract slowly so that the process of uterine
involution in mothers who give exclusive
breastfeeding will be faster (Martini, 2018)
Figure 2: Uterine Involutional Process.
Research Cyril et al (2019) in his research on
dairy cows states that ecbolic therapy carried out in
the post partum period can improve uterine involution
and reproductive tract health in cattle by giving
intramuscular injections twice a day by 50 IU
oxytocin, or 25 mg dinoprost (Cyril et al, 2019)
Permata’ Research (2018), states that there is a
correlation between abstinence with the process of
uterine involution. This research shows that the
majority of respondents have elementary school
education, do not work and are primitive mothers so
that they do not have enough experience and
knowledge in the culture of abstinence from
postpartum mothers. The process of uterine
involution is influenced by the mother's attitude
towards abstinence from food. It is recommended that
mothers further increase knowledge about the effects
of abstinence from food by reading books, asking
health workers. Health Workers increase education
and provide motivation about the impact of
abstinence on postpartum mothers and families so
that mothers can change their abstinence habits
(Permata, 2018)
From the results of a preliminary study at the
Marisa Lorena maternity clinic in a month the
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average mother who gave birth as many as 30 people.
From the observation results obtained uterine
involutional speed in puerperal mothers on average
10-12 days until the uterus can not be touched again.
Early breastfeeding initiation has been carried out in
this clinic but it has not been maximized because
although it has been given ASI shortly after giving
birth but it has not been done for an hour and skin
contact between mother and baby is still rarely done.
Rahma’ Research (2019) explained that after
initiation of early breastfeeding there was 17 patients
who experienced a condition of hard uterine
involution, strong contractions and there was 2
patients who experienced conditions of soft uterine
involution, contractions were weak. While those who
did not initiate early breastfeeding there was 9
patients who experienced a condition of hard uterine
involution, strong contractions and 2 patients
experienced conditions of soft involution, weak
contractions (Rahma, 2019)
Liliana’ Research (2019) There was no influence
between EBI behavior and uterine involution in
postpartum mothers. Because the process of
involution is not only influenced by EBI, but there are
several other factors such as age, number of parity, and
early mobilization of the mother. This is caused
between EBI behavior and uterine involution is that
there are still some respondents who even though EBI
did not experience normal uterine involution (Liliana,
2019)
Elis’ Research (2017) states that there is a cynical
effect of the puerperium on involuntary uterine
processes. The data taken are primary data obtained at
the time of study. For monitoring involuntary uteri
both those who do puerperal exercises and do not do
puerperal exercises carried out during the post partum
mother was treated at the Tobadak Health Center.
Middle Mamuju District with a total sample of 20
thousand post partum, where 10 thousand were treated
post partum exercises and 10 mothers were not given
postpartum gymnastics treatment ( Elis, 2017)
Kartinazahri's research (2019) explains that there
is a significant correlation between oxytocin massage
and uterine involution with a p value <0.05. It can be
concluded that the post partum group of mothers who
did not do oxytocin massage had a 3 times greater risk
of experiencing abnormal uterine involution than the
group with oxytocin massage. Decreased uterine
fundal height does not occur at once but gradually.
Uterus fundal height decreases every day around 1 to
2cm, so that on the 10th day no longer palpated when
palpated. The occurrence of contractions and
retractions in the smooth muscle of the uterus causes
disruption of blood circulation in the uterus resulting
in uterine muscle tissue lacking the necessary
substances, so that the size of the muscle tissue
becomes small, eventually the size of the uterus
returns to its state before pregnancy (Kartinazahri,
2019)
However, knowing the effect alone is not
enough, for this reason it is necessary to know the
difference in the process of involuntary uteri to post
partum mothers by giving EBI and those not given
EBI, this study will discuss the differences in the
process of involuntary uteri in post partum mothers in
the two groups (Goiuri, 2019)
In Figure 3 is to explain the process of initiating
the stages of early breastfeeding. after birth the baby
is placed on the mother's stomach and left looking for
her mother's nipples. after finding the mother's
nipples, the baby will suckle for the first time. do not
rush to initiate breastfeeding early and let the baby
suckle and recognize the scent of the mother's body
Figure 3: Early Breastfeeding Initiation Process.
2 RESEARCH METHODS
2.1 Research Locations and Samples
The location of this research was at the Marisa Lorena
Maternity Clinic Lubuk Pakam. The Popoluation of
this research was post partum mothers. Samples of 10
people were divided into two groups: intervention
group and control group with the criterias of not
having other disease complications.
2.2 Research Design
The type of this research was a quasi-experiment with
a case control study design which the sample is
The Effects of Early Breastfeeding Initiation on the Uterine Involutional Process in Post Partum Mothers
107

divided into a control group p and a case group (which
was done early breastfeeding initiation) and then
compared to the length of involuntary uteri in each
group. Mothers gave birth in centimeters (cm) then
the average of the fundus decreased, then the
difference in mean height of uterine fundus in the
intervention group and the control group used paired
sample t test at a 95% confidence level with p value
≤ α (0.05 ).
2.3 Systematic Research
2.3.1 Tool/Equipment
The tool used in this research is the centipede tape.
Figure 4: centimeter ribbon.
2.3.2 Research Process
This research was conducted by measuring the height
of the fundus of uterine women early post partum
immediately after giving EBI using pitasenti, then
measured again the height of the fundus 10 days later,
then see how much the decrease in the fundus of the
mother in centi units.
2.3.3 Data Collection Techniques
1 Administrative Procedures
Data collection was carried out after
obtaining permission from the research location
and the Research Ethics Commission
2 Technical Procedures
The researcher meets with related parties
at the research location through the
following procedures:
Intervention Group:
a) Determine the subject based on
inclusion and exclusion criteria
b) Introduce yourself and explain research
covering the objectives, rights and
obligations of the subject as well as the
benefits of research to the subject.
c) Provide an informed consent sheet or
consent sheet to be signed by the
subject, if the subject is willing to
participate in the study
d) Explain the procedure of the series of
checks to be carried out
e) Measuring the height of the fundus
before the EBI
f) Shortly after the baby is born do early
breastfeeding initiation in one group
while the other group is not done.
g) Wait until the EBI process is completed,
marked by the baby being able to suck
the mother's nipples
h) Pay attention to the position of the
mother and baby when the baby suckles
(position must be correct)
i) After doing EBI, allow the mother to
continue breastfeeding her baby
j) Monitor the breastfeeding process for
10 days, giving exclusive breastfeeding
k) Measure the fundus height again for the
mother 10 days later
l) Record all data on an observation sheet
Control Group:
a) Determine the subject based on
inclusion and exclusion criteria
b) Introduce yourself and explain research
covering the objectives, rights and
obligations of the subject as well as the
benefits of research to the subject.
c) Provide an informed consent sheet or
consent sheet to be signed by the
subject, if the subject is willing to
participate in the study
d) Explain the procedure of the series of
checks to be carried out
e) Measuring the fundal height of the
mother
f) Measure the fundus height again for the
mother 10 days later
g) Record all data on an observation sheet
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Figure 5: Fundal height.
3 RESULT AND DISCUSSION
EBI is one of the factors that influence uterine
involution. In this EBI the baby is left in the mother's
chest 1 hour after birth. In this process the baby will
look for the mother's own nipples.) Mothers who
initiate early breastfeeding will accelerate uterine
involution due to the influence of the hormone
oxytocin which can increase uterine contractions.
Oxytocin is a substance that can stimulate the
uterus myometrium so that it can contract. Uterine
contraction is a complex process and occurs because
of the presence of actin and myosin. Thus actin and
myosin are components of contraction. The meeting
of actin and myosin is caused by the presence of
myocin light chine kinase (MLCK) and dependent
myosin ATP ase, this process can be accelerated by
the number of calcium ions entering the cell, while
oxytocin is a hormone that increases the entry of
calcium ions into the intra-cell. So that the presence
of oxytocin will strengthen uterine contractions.
In Tabel 1 dan Tabel 2 From the results of the
study conducted 10 days after post partum in the
intervention group (carried out EBI), the average
height of the fundus uteri was 9.70 cm. In the control
group (no EBI was performed) the average height of
the uterine fundus was 11.20 cm.
Table 1: The mean height of fundal uteri in post partum
mothers.
No
Respondent
Group Involutional Uterus
(cm)
1 With EBI 10
2 With EBI 9
3 With EBI 10
4 With EBI 11
5 With EBI 9
6 With EBI 9
7 With EBI 10
8 With EBI 10
9 With EBI 9
10 With EBI 10
Average 9,70
Table 2: The mean height of fundal uteri in post partum
mothers.
No
Respondent
Group Involutional
Uterus
(cm)
1 without EBI 11
2 without EBI 12
3 without EBI 10
4 without EBI 11
5 without EBI 11
6 without EBI 10
7 without EBI 12
8 without EBI 12
9 without EBI 11
10 without EBI 12
Average 11,20
After doing statistical tests it was found that there
were differences in the average height of the fundus
of the uteri in the involuntary process of the uterus in
post partum mothers who did EBI and those who did
not do EBI of 1.50 with a p value of 0.001
Early initiation (the best crawl) or the beginning
of early breastfeeding is a baby after birth from the
mother's womb can suckle by itself. Meanwhile,
according to the Ministry of Health (2012), Early
Breastfeeding Initiation (EBI) defined an opportunity
given to the baby immediately after birth by putting
the baby in the mother's stomach, then allowing the
baby to find the mother's nipples and suckle until
satisfied. This process is done at least 60 minutes (1
hour) first after the baby is born.
The results showed that the mean involution of
uterus in post partum mothers who performed early
breastfeeding initiation was 9.70 with a standard
deviation of 0.675 and a mean standard error of 0.213.
The results of this research are in accordance with
research conducted by Sahetapy (2016) who found
that in the group that carried out early breastfeeding,
uterine involution of fast categories were 13
postpartum mothers (86.7%) and normal categories of
uterine involution were 2 postpartum mothers (13,
3%).
EBI was one of the factors that influence uterine
involution. In this EBI the baby is left in the mother's
chest 1 hour after birth. In this process the baby will
The Effects of Early Breastfeeding Initiation on the Uterine Involutional Process in Post Partum Mothers
109

find its own mother's nipples. Mothers who initiate
early breastfeeding will accelerate uterine involution
due to the influence of the hormone oxytocin which
can increase uterine contractions.
Oxytocin is a substance that can stimulate the
uterus myometrium so that it can contract. Uterine
contraction is a complex process and occurs because
of the presence of actin and myosin. Thus actin and
myosin are components of contraction. The meeting
of actin and myosin is caused by the presence of
myocin light chine kinase (MLCK) and dependent
myosin ATP ase, this process can be accelerated by
the number of calcium ions entering the cell, while
oxytocin is a hormone that increases the entry of
calcium ions into the intra-cell. So that the presence
of oxytocin will strengthen uterine contractions.
Uteric Involvement in Post Partum Mothers not
Early Initiated Breastfeeding
The results showed that the mean involutional
involution of post partum mothers who did not initiate
early breastfeeding was 11.20 with a standard
deviation of 0.789 and a mean standard error of 0.249.
The results of this research are in accordance with
research conducted by Sahetapy (2016) who found
that in the group without early breastfeeding
initiation, rapid category uterine involution were 3
postpartum mothers (20%) and normal uterine
involution were 12 normal postpartum mothers (80%)
.
Uterine involution begins after delivery, that is
after the placenta is born. The involution process lasts
for about 6 weeks. After the placenta is released from
the uterus, the uterine fundus can be palpated and is
in the middle of the center and symphysis pubis or
slightly higher. The height of the fundus after delivery
is estimated to be one centimeter or 1 cm below the
center.
In this research still found mothers who did not
initiate early breastfeeding which was then used as a
control group in this study. According to UNICEF
(2016), there are many problems that can hinder the
implementation of EBI, among others: lack of
concern for the importance of EBI, lack of counseling
by health workers and lack of EBI practice, there is
an opinion that injection of vitamin K and eye drops
to prevent gonorrhea disease should be given
immediately after birth, when in fact this action can
be postponed for at least one hour until the baby
suckles on its own, strong family belief that mothers
need adequate rest after giving birth and
breastfeeding is difficult, public belief stating that
colostrum that comes out on the first day is not good
for the baby, public trust that does not allow mothers
to breastfeed early before her breasts are cleaned.
The Effect of Early Breastfeeding Initiation on
Uteric Involvement in Post Partum Mothers
The result of this research it was found that the mean
difference of uterine involution in post partum
mothers who did and did not initiate early
breastfeeding was 1,500. Based on statistical tests
found that the value of p value 0,000. Means p value
<0.05, then there is the effect of early breastfeeding
initiation on involutional uteri in post partum
mothers.
The results of this research in line with
Sahetapy's (2016) study entitled, the efffect of Early
Breastfeeding Initiation (EBI) on the speed of uterine
involution in puerperal mothers at BPM Dwi Inggrini
Samarinda, where this study found
Effect of EBI on uterine involutional speed in
postpartum mothers (p value = 0.001). The results of
this research are also relevant to the study of
Rosyidah & Sulistyorimi (2017) that there is an effect
of EBI on the speed of TFU reduction. Likewise, the
results of a study conducted by Nelwatri (2013)
entitled the effect of early breas
tfeeding initiation (EBI) on uterine involution in
maternal in BPS Padang City found that there were
significant differences in the height of the uterine
fundus between those carried out by EBI and not
carried out by EBI to maternity mothers at BPS Kota
Padang.
EBI is one of the factors that influence involution
because in the lactation process there is a prolactin
reflex and an oxytocin reflex (Let Down Reflex).
Nipple stimulation is passed on to the anterior
pituitary which then secretes the hormone prolactin,
then continues again until the posterior pituitary so
that the hormone oxytocin will come out. Through
blood circulation, the hormone oxytocin will go to the
uterus so that it triggers contractions.
Breastfeeding will speed up the process of
involution. The Efforts to improve maternal and
infant health can be done by giving ASI. Likewise,
the results of a study by Pratiwi (2014) found that
mothers who had EBI experienced rapid uterine
involution and mothers who did not do EBI
experienced involution of respondents who were
given EBI treatment which experienced a faster TFU
decline. This is due to the touch of the baby's hands,
mouth, and head and sucking on the breast stimulates
the production of oxytocin which causes uterine
contractions so that it can accelerate uterine
involution in post partum mothers.
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4 CONCLUSION
The means of involusio uteri in post partum mothers
who performed early breastfeeding initiation was
9.70. The means of involusio uteri in post partum
mothers who did not initiate early breastfeeding was
11.20 and the difference in mean height of uterine
fundus in post partum mothers with early
breastfeeding initiation and not early breastfeeding
initiation was 1.50 so there was a difference in the
process of involuntary uteri in post partum mothers
with the initiation of early breastfeeding and those
who are not initiating early breastfeeding with p value
= 0.00.
5 SUGESTION
5.1 Related Health Workers
Especially midwives must be more patient in
accompanying post partum mothers in conducting
EBI.
5.2 Maternity Clinic
Maternity Clinic is expected to make Early
Breastfeeding Initiation a permanent procedure that
must be done after the mother gives birth.
5.3 Patient
The results of this study can be a source of knowledge
for patients that early breastfeeding is very influential
in accelerating the return of the uterus to its original
form.
ACKNOWLEDGMENT
Thank you to Health Institute Medistra Lubuk Pakam
for giving researcher the opportunity to carry out this
research and also being willing to provide funding so
that this research can be carried out well from start to
finish.
REFERENCES
Debra L, Wagner et al. 2019. Retrospective chart review of
skin-to-skin contact in the operating room and
administration of analgesic and anxiolytic medication
to women after cesarean birth.
Elis, Andi dkk. 2017. Pengaruh senam nifas terhadap
involusio uteridi puskesmas tobadak kab.mamuju
tengah tahun 2017.
Ellaene, Webber et al. 2019. Postpartum depression: a
multi-disciplinary approach to screening, management
and breastfeeding support.
Gilbert, J.G et al. 2018. Epidural analgesia to facilitate
breastfeeding in a grand multipara.
Goiuri, Alberdhi et al. 2019. A feasibility study of a
multidimensional breastfeeding-support intervention
in Ireland.
Kartinazahri. 2019. The effect of oxycin massage on uterus
involution in post partum mother in working areas of
health center ingin jaya aceh besar.
Liliana, Anita. 2019. Pengaruh paritas dan perilaku EBI
dengan involusi uteri pada ibu postpartum di RSUD
panembahan senopati bantul.
Martini. 2018. Hubungan inisiasi menyusu dini dengan
tinggi fundus uteri ibu postpartum hari ke-tujuh.
Maryunani, Anik. 2017. Inisiasi menyusu dini, asi eksklusif
dan manajemen laktasi. Jakarta : CV. Trans Info
Media.
Nelwatri, Helpi. 2017. Pengaruh inisiasi menyusu dini
(EBI) terhadap involusi uterus pada ibu bersalin di bps
kota padang. Jurnal Ipteks Terapan Research of
Applied Science and Education V8.I3 (83-87).
P.I. Opara et al. 2018. Prelacteal feeding practices of
mothers attending infant welfare clinic in a tertiary
hospital in port harcourt, nigeria.
Permata, Sari Dyah. 2018. Hubungan sikap pantang
makanan ibu nifas dengan proses involusi uteri di
puskesmas sooko kecamatan sooko kabupaten
mojokerto.
Rahayu, Dewi Taurisiawati. 2018. Efektivitas bengkung
dan gurita terhadap involusi uterus dan pengeluaran
lochea di puskesmas keling kabupaten kediri.
Rahma, Arwiyantasari Wida dkk. 2019. Hubungan antara
inisiasi menyusu dini dengan involusi uterus pada ibu
post partum normal di poskesdes melati desa garon
kab. madiun.
Rosyidah, R & Sulistyorimi. 2017. Pengaruh inisiasi
menyusu dini terhadap kecepatan penurunan tinggi
fundus uteri. Prosiding Seminar Nasional Hasil
Penelitian dan Pengabdian Masyarakat Seri ke-1.
Sahetapy, Sonya Yulia. 2016. Pengaruh inisiasi menyusu
dini (EBI) terhadap kecepatan involusio uterus pada
ibu nifas di BPM dwi inggrini samarinda. Mahakam
Midwifery Journal Vol 1 No 1, Mei 2016, hal 1-9.
Stiphen Cyril P., et al. 2019. The impact of ecbolic therapy
in the early postpartum period on uterine involution
and reproductive health in dairy cows.
Wulan, Sari Novi. 2018. Perbedaan Involusi Uteri Pada Ibu
Post Partum Normal Yang Diberi Dan tidak Diberi
Terapi Relaksasi Hypnobirthing.
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