Determinant of Early Breasting Initation Practice in New Born Baby

in the Working Area of Gunung Tua

Meyana Marbun

, Albiner Siagian

, Elmina Tampubolon

Public Health Department, DELI HUSADA Health Institute

Public Health Department, Sumatera Utara University

Keyword: Practice IMD, Newborn, Husband support

Abstract : The initiation for early lactch on the principle, that is not a mother which is suckled her baby, but the baby

should have actived to reach the niple of the mother, and do a contact for the mother’s skin to the baby’s

skin as soon as posible after the baby birth at least one hour (1 hour). A midwife which is help a child-birth,

must assist. The purpose of this research is for know a determinant of implementation on early suckle initiation

practice on thenew baby born at the area of the local government clinic Gunung Tua, Panyabungan Regency

on Februari 2018. The research design is use a quantitative cross sectional approach, respondent sample in

this study is 97 people . The data collecting is use the questionaire by interview, and use a test of chi-square

and double logistic regression.The result of this research is show that the mother which is implementation

IMD are 65 persons (67,0%). And which is not implementation IMD are 32 persons (33%) The result test of

chi-square variable which is relating to the IMD practice are the age, the kind of child birth, the official

support. The result of logistic regression test is the most dominant variable which is relating to the IMD

implementation practice is knowledge weight with the point OR = 18,426. The proposition to the official,

especially to the midwife is implementation the IMD on each aids of the normal child-birth acording to the

standard of up bringing normal child-birth.

1 INTRODUCTION

Child survival is an ongoing public health priority in

the South Asia region, which includes eight countries

Afghanistan, Bangladesh, Bhutan, India, Maldives,

Nepal, Pakistan and Sri-Lanka (UNICEF, 2014).

Infant Mortality Rate (IMR) is one of the important

indicators in determining the level of public health. In

developing countries, the time of delivery and the first

week after delivery is a critical period for mother and

baby. About two-thirds of deaths occur during the

neonatal period, two-thirds of these neonatal deaths

occur on the first week and two-thirds of the infant

deaths on the first week occur on the first day.

Whereas in Indonesia, IMR reached 32 per 1000 live

births in 2012 (Aprillia, 2009).

Early or timely initiation of breastfeeding is

crucial in preventing newborn deaths and influences

childhood nutrition however remains low in South

Asia and the factors and barriers warrant greater

consideration for improved action (Sharma and

Byrne, 2016). Early or timely initiation of

breastfeeding, specifically within 1 h of birth, refers

to the best practice recommendation by the World

Health Organization (WHO, 2012).

Many measures are relatively inexpensive and are

easily implemented to improve the health and

survival of newborns. One of them is breastfeeding

immediately after birth or commonly called early

breastfeeding initiation and exclusive breastfeeding.

This is supported by the statement of the United

Nations Childrens Fund (UNICEF), that as many as

30,000 infant deaths in Indonesia and 10 million

deaths of children under five in the world each year,

can be prevented through exclusive breastfeeding for

six months from the date of birth, without having to

provide food and additional drinks to babies (Aprillia,

2009). A recent systematic review and meta-analysis

revealed that breastfeeding initiation after the first

hour of birth doubles the risk of neonatal mortality

(Khan et al, 2015). In specific countries, initiating

within 1 h reduced deaths by 19 % in Nepal (Mullany

et al, 2008) and 22 % in Ghana (Tawiah et al, 2008).

The evidence, drawn from meta-analysis and over 63

developing countries, shows that early initiation of

breastfeeding prevents newborn infections, averts

418

Marbun, M., Siagian, A. and Tampubolon, E.

Determinant of Early Breasting Initation Practice in New Born Baby in the Working Area of Gunung Tua.

DOI: 10.5220/0009516304180427

In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 418-427

ISBN: 978-989-758-460-2

newborn death due to sepsis, pneumonia, diarrhoea

and hypothermia, and facilitates sustained

breastfeeding (Oddy, 2013).

Breastfeeding research predominantly focuses on

exclusive breastfeeding to the age of 6 months and

other infant and young child feeding (IYCF)

indicators (Lawn et al, 2010). Existing systematic

literature reviews on early initiation primarily draw

on evidence from developed countries and on the

effect of skin-to-skin contact on breastfeeding rates

(Dennis, 2002; Carfoot et al, 2003).

Based on Law No. 33 of 2012 article 9 health

workers and providers of health care facilities are

required to initiate early breastfeeding (IMD) of

newborns to their mothers for a minimum of 1 hour.

Early breastfeeding (IMD) initiation as referred to in

paragraph 1 is done by placing the baby on his

stomach on the mother's chest or on the mother's

stomach so that the baby's skin is attached to the

mother's skin

The MCH Program Data for the Mandailing Natal

District Health Office in 2009-2013, showed that the

infant mortality rate in Mandailing Natal District was

32/1000 live births. The highest number of infant

deaths in early neonatal (0-6 days) is 90 cases. The

cause of death of infants aged 0-6 days in Mandailing

Natal Regency is low birth weight (LBW) of 43 cases,

Asphyxia 20 cases, 27 cases due to other factors.

LBW is one of the causes of hypothermia. Because

the fat tissue in the subcutaneous is lacking and the

immature thermoregulation system. One of the

handling of heat loss (hypothermia) one of them by

doing IMD and based on the results of interviews with

20 mothers, there are only 3 mothers who do IMD in

infants (15%).

From the background description of the problem,

the problem in this study is the unknown determinants

of the practice of early breastfeeding in newborns in

the working area of Gunung Tua Health Center,

Panyabungan Subdistrict, Mandailing Natal District

in 2018. Purposes of this research to determine the

determinants of the practice of early breastfeeding in

newborns in the area of the Gunung Tua Public

Health Center, Panyabungan District, Mandailing

Natal District in 2018.

2 METHODS

2.1 Types of Research

The research design used was descriptive analytic

survey type with Cross Sectional design.

2.2 Research Location and Time

This research was conducted in the working area of

Gunung Tua Health Center, Panyabungan District,

Mandailing Natal District. This research was

conducted in January to February 2018.

2.3 Population and Sample

The population in this study were all mothers who

gave birth in 2018 with a total of 288 people (KIA

Data of Gunung Tua Health Center, 2018) The

sample in this study was 97 people. Sampling was

done by systematic random sampling.

2.4 Inclusion Criteria

The characteristics that must be fulfilled to be a

sample in this study are:

a) The baby's body weight is born> 2000 grams

and has no complications such as no asphyxia

(minimum apgar value of 7), no cyanotic skin

color, healthy babies and mothers.

b) Gestational age (> 37 weeks).

2.5 Method of Collecting Data

The data in this study include two types, namely

primary data and secondary data.

2.6 Validity and Reliability Test

The research data was taken using a questionnaire

that was filled in by the respondents themselves.

Previously conducted trials at the Panyabungan Jae

Health Center. The purpose of this trial is to

determine the validity and reliability of the

instrument's contents.

2.7 Data Processing Techniques

Data processing is performed using a statistical

analysis program. The data collected is processed

through several stages (Hastono, 2007) including:

editing data (Data Editing), encoding data (Data

Coding), enter data (Entry Data), data processing

(Processing), data cleansing.

2.8 Data Analysis Method

After processing the data, the next step is to analyze

the data using a statistical analysis tool application.

The analysis conducted in this study was divided into

Determinant of Early Breasting Initation Practice in New Born Baby in the Working Area of Gunung Tua

419

3 analyzes, namely univariate, bivariate, and

multivariate analyzes.

3 RESULT

3.1 Puskesmas Overview

This general description concerns the description of

the study site and various information related to the

research, derived from the Profile of the Mandaling

Natal District Health Office and documents available

at Gunung Tua Health Center, Panyabungan District,

Mandailing Natal District.

3.2 Demographics

The working area of the Gunung Tua Health Center

in the Panyabungan Subdistrict of Mandailing Natal

District is located in the southern part of North

Sumatra Province. Administratively, the working

area of the Gunung Tua Health Center consists of 1

sub-district, 13 villages, which has an area of

15,116.14 hectares or 9.93%.

3.3 Economy and Livelihoods

The main livelihoods of the community are farming,

private employees / civil servants / TNI / POLRI,

traders and breeders.

3.4 Health Facilities and Infrastructure

Consists of 1 unit of Puskesmas, 1 unit of auxiliary

puskesmas, 13 units of posyandu, and 3 units of

Private Medical Centers.

3.5 Characteristics of Respondents

It is known that the age of most respondents in the age

group ≥ 30 years is 53 people (54.6%) and a small

portion in the age group <30 years is 44 people

(45.4%). The majority of respondents in the

mandailing tribe were 82 people (84.5%) and a small

portion of the Malay tribe were 3 people (3.1%). Most

of the respondents' religion is Islam, 95 people

(96.5%) and a small proportion of Christians, 2

people (3.5%). Most respondents' education is Higher

Education ≥ SMP is 72 people (74.2%) and a small

portion is in low education <SMP is 25 people

(25.8%).

3.6 Univariate Analysis

Univariate data analysis aims to provide an overview

of the object of research based on data and variables

obtained from the group of subjects studied.

The independent variables in this study consisted

of parity, knowledge, birth weight, type of labor, staff

support and husband support. The majority of

mothers with a large parity (pultipara-

grandemultipara) have 66%, while those with a small

parity (primipara-scundipara) have 34%.

3.7 Knowledge Distribution of

Respondents in the Working Area

of Gunung Tua Health Center in

Panyabungan District, Mandailing

Natal District in 2018

That the majority of mothers with high knowledge are

67.0%, while mothers with low knowledge have

33.0%.

3.8 Baby Weight Distribution of

Respondents in the Working Area

of Gunung Tua Health Center in

Panyabungan District, Mandailing

Natal District in 2018

That the majority of mothers gave birth to babies

weighing 2500-2000 grams, namely there were

56.7%, while <2500 grams there were 43.3%.

3.9 Distribution of Respondents'

Delivery in the Gunung Tua

Community Health Center,

Panyabungan District, Mandailing

Natal District in 2018

That the majority of mothers gave birth with a

cesarean section were 54.6% while mothers who gave

birth were normal namely 45.4%.

3.10 Distribution of Support of

Respondents in the Working Area

of Gunung Tua Public Health

Center, Panyabungan District,

Mandailing Natal District in 2018

That the majority of mothers received support from

officers there were 60.8%, while 39.2% did not get

support from officers.

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3.11 Distribution of Respondents'

Husband Support in the Working

Area of Gunung Tua Public Health

Center, Panyabungan District,

Mandailing Natal District in 2018

The majority of mothers did not get husband support,

there were 54.6%, while those who received husband

support were 45.4%.

3.12 Distribution of IMD

Implementation Practices in the

Gunung Tua Community Health

Center in Panyabungan District,

Mandailing Natal District in 2018

The majority of IMD practices have 70.1%, while not

implementing IMD there are 29.9%.

3.13 Bivariate Analysis

Bivariate analysis was carried out to see the

relationship between the independent variables

namely age, education, parity, knowledge, birth

weight, type of labor, staff support, and husband

support with the dependent variable namely IMD

practice.

3.14 Relationship between Mother's Age

and IMD Practice

Based on the results of research on the relationship of

age with the practice of early breastfeeding in the

working area of Gunung Tua Health Center,

Panyabungan District, Mandailing Natal District, the

results of the analysis can be seen in the Table 1.

The results of the study based on Table 1 the

relationship of age with the practice of IMD obtained

results that mothers aged ≥30 years there were 32

(60.4%) who carried out IMD, while mothers aged

<30 years there were 36 (81.8%), and the value of =

0.022 it means that there is a significant relationship

between maternal age and the practice of

implementing IMD. Obtained OR value = 0.339,

means that mothers aged ≥ 30 years have the

opportunity 0.339 times to carry out IMD compared

to the number of mothers aged <30 years.

Table 1: Age Relationship with IMD Practices in the Gunung Tua Health Center Work Area, Panyabungan District,

Mandailing Natal District in 2018

Mother’s

Age

Practice IMD

Total p value OR (95%CI)

IMD Not IMD

N % N % N %

≥ 30 years 21 39,6 53 54,6

0,022

0,339

(1,132 – 0,870)

< 30 years 36 81,8 8 18,2 44 45,4

Total 68 70,1 29 29,9 97 100,0

Sumber : Data of Gunung Tua Puskesmas in 2018

3.15 Relationship of Mother's Education

with IMD Practice

The relationship of education with the practice of

IMD obtained results that are mothers with high

education ≥ SMP there are 63 (87.5%) to implement

IMD, while mothers with low education <SMP have

6 (29.2%), and the value of p = 0,000 it means that

there is a significant relationship between education

and the practice of IMD. A value of OR = 28,000

means that mothers with high education have 28

times the opportunity to carry out IMD practices

compared to women with low education.

3.16 The Relationship between Mother

Parity and IMD Practice

Based on the results of research on the relationship

between maternal parity with the practice of early

breastfeeding in the working area of the Gunung Tua

Health Center, Panyabungan District, Mandailing

Natal District, the results of the analysis can be seen

in the following Table 2.

The results of the study based on Table 2 parity

relationship with the practice of IMD obtained the

results that there are 46 (71.9%) mothers with

primipara-parity parity who carry out IMD, while

with multipara-grandemultipara parity there are 22

(66.7%), and the value of p = 0.767 means there is no

significant relationship between parity and IMD

practice.

Determinant of Early Breasting Initation Practice in New Born Baby in the Working Area of Gunung Tua

421

Table 2: Relationship of Parity with IMD Practices in the Work Areas of Gunung Tua Health Center in Panyabungan District

Mandailing Natal District in 2018

Maternal Parity

IMD practice

Total

p value

OR (95%CI)

IMD Not IMD

N % N % N %

Primipara-

Scundipara

46 71,9 18 28,1 64 66,0

0,767

1,278

(0,516 – 3,162)

Multipara-

Grandemultipara

22 66,7 11 33,3 33 34,0

Total 68 70,1 29 29,9 97 100,0

Source: Data of Gunung Tua Puskesmas in 2018

3.17 Relationship of Mother's

Knowledge with IMD Practice

Based on the results of research on the relationship of

knowledge with the practice of IMD obtained results

that there are 57 knowledgeable mothers (87.7%) to

carry out IMD, while those with low knowledge there

are 11 (34.4%), and the value of p = 0,000 means

there is a relationship significant between knowledge

and IMD practice. Obtained an OR = 13,602,

meaning that mothers with high knowledge have 13

times the opportunity to carry out IMD practices

compared to women with low knowledge.

3.18 Relationship between Birth Weight

of Babies and the Practice of IMD

Based on the results of research on the relationship

of birth weight with the practice of IMD obtained the

results that babies who weigh ≥ 2500-4000 grams

there are 45 (81.8%) to carry out IMD, while babies

weighing <2500 grams there are 23 (54.8% ), and p =

0.008 means that there is a significant relationship

between birth weight of babies with IMD practice.

With OR = 3,717, it means that mothers who give

birth to babies weighing berat 2500-4000 grams have

3.7 times the practice of IMD compared to mothers

who give birth to babies <2500 grams.

3.19 The Relationship between Type of

Labor and IMD Practices

Based on the results of research on the relationship

between types of labor with the practice of IMD

obtained results, namely mothers with spontaneous

labor there were 36 (81.8%) who carried out IMD,

while with cesarean sectio delivery there were 32

(60.4%), and the value of p = 0.038 means there is a

significant relationship between the types of labor and

IMD practices. Obtained an OR = 2.953 means that

women who have spontaneous labor have 2.9 times

the opportunity to carry out IMD practices compared

to respondents who have cesarean sectio deliveries.

3.20 Relationship of Support Officers

with IMD Practices

Based on the results of research on the relationship

between the support of officers and the practice of

IMD, the results show that there are 37 (62.7%)

supporting officers implementing IMD, while there

are 31 (81.6%), and p = 0.079 means that there is no

Significant relationship between staff support and

IMD practice.

3.21 Relationship between Husband's

Support and IMD Practice

The relationship of husband support with the practice

of IMD obtained results that there are 33 unsupported

husbands (75.0%) who carry out IMD, while

husbands who do not support 33 (66.0%), and the

value of p = 0.461 means there was no significant

relationship between husband's support and IMD

practice.

3.22 Multivariate Analysis

Based on the results of multivariate analysis the most

dominant variable related to the implementation of

IMD practices is knowledge. With OR = 18.426, it

means that mothers with high knowledge have 18

times the opportunity to practice IMD compared to

mothers with low knowledge after being controlled

with the support of officers about IMD.

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4 DISCUSSION

4.1 Relationship between Age and

Implementation of IMD Practices

The results showed a significant relationship between

age and IMD practice p = 0.022. OR = 0.339 which

means that respondents aged ≥ 30 years have the

opportunity 0.339 times to carry out IMD practices.

These findings are in line with Haryati (2005), which

states that elderly mothers have a significant

relationship with the implementation of IMD

practices with a value of p = 0.023 with an OR value

of 7.577 which means that older respondents have 7.5

times the opportunity to carry out practice early

breastfeeding initiation (IMD).

This is in line with research Rusnita, A. (2010)

that the possibility at the age of <30 years has no

experience compared to the age group tahun30 years

so that the first breastfeeding in the group ≥ 30 years

is faster. Whereas in accordance with the theory> 35

years will be at high risk for pregnancy so there may

be difficulties during childbirth that cause mothers

not to carry out IMD practices. According to Robbins

(2004), employees with older age are generally more

responsible and more conscientious compared to

young people. This is possible because a younger age

does not have much experience. This is in line with

the statement of Huclok (1998) in the research of

Faujiah (2009) that the more age, the maturity level

and strength of a person will be more mature in

thinking and working in terms of community trust.

Someone who is more mature will be more trusted

than someone who is not yet high enough maturity.

This is as a result of the experience and maturity of

his soul.

There is a significant relationship between

maternal age and the implementation of IMD in

newborns in this study, according to the researchers'

assumptions because actually every mother is able to

carry out IMD practices. This is very much influenced

by the support of the surrounding environment.

4.2 Relationship between Education

and the Implementation of IMD

Practices

The results showed a significant relationship between

education and the practice of IMD p value = 0,000.

OR = 28,000 which means that respondents with high

education have a 28 times probability compared to

respondents with low education. These findings are in

line with the research of Hariati, Y (2005) mothers

with higher education are associated with the practice

of early breastfeeding initiation (IMD) with a p value

of 0.011 with an OR value of 6.453, which means

mothers with higher education have a 6.4 times

chance to implementing IMD practices compared to

mothers with low knowledge.

Faujiah's research (2009) said that there was a

significant relationship between mother's education

and the implementation of early breastfeeding

initiation (IMD) with a p value of 0.031. This is in

line with research conducted by Ratri (2000) that

there is a statistically significant difference between

the average of IMD and education. Breastfeeding for

the first time on average is fastest in the group of

mothers with higher education (more than junior

high). This happens because mothers in the higher

education group have higher knowledge including in

terms of breast milk so that mothers will try to

breastfeed their babies soon after the baby is born.

Whereas in Afilianti's research (2002), it was

found that not giving breastfeeding for the first time

in newborns 68.6% of mothers with high education

and 57.9% of mothers with low education. The results

showed that an insignificant relationship could occur

possibly because the mother's education about health,

especially about lack of lactation that should be

known and understood by mothers from the start of

pregnancy.

Husna's research results (2018) obtained the

results of the chi square p value <0.05 means that

there is a significant relationship between education

and the implementation of IMD. According to

Notoatmodjo (2003), there are several factors that

influence one's knowledge, one of them is education.

Knowledge is closely related to education where it is

expected that there is someone with higher education,

so that person will also broad knowledge. Education

in general is any planned effort to influence others,

whether individuals, groups or communities, so that

they do what is expected by education practitioners.

According to researchers, the implementation of

IMD carried out by postpartum mothers is actually

not entirely influenced by maternal education.

Because it is likely influenced by other variables, or

the mother also often hears IMD so that the mother

knows what the purpose and benefits of IMD are for

the mother and her baby

4.3 Relationship between Parity and

the Implementation of IMD

Practices

The results showed there was no significant

relationship between parity and IMD practice with p

Determinant of Early Breasting Initation Practice in New Born Baby in the Working Area of Gunung Tua

423

= 0.767. OR = 1,278 which means that respondents

with parity ≥ 2 people have 1.227 times the

opportunity to carry out IMD practices. This is in line

with research Faujiah (2009) there is no significant

relationship between each parity with the

implementation of IMD in newborns with p = 0.460.

In this study also in line with Nelvi (2000) the

proportion of multipara respondents 34.2% did an

IMD higher than that of primipara which is 29.5%.

The analysis showed that there was no significant

relationship between parity and IMD implementation.

This result is not in line with the opinion of

Ebrahim (2000) on a mother who experiences a

second lactation and so tends to have more experience

in carrying out early breastfeeding initiation (IMD).

Similarly, in the third lactation and so on. Whereas in

the first lactation the mother did not have experience

in breastfeeding so the mother did not know how to

carry out early breastfeeding initiation (IMD). These

findings are also not in line with Aflianti (2002)

mothers whose parity ≥ 2 children have a significant

relationship with the implementation of IMD with =

0.010 with an OR value = 9.171 which means mothers

who have children ≥2 children will have a 9.7 times

chance performing IMD compared to mothers whose

parity <2 children.

According to researchers, the implementation of

IMD by mothers is actually not entirely affected by

parity, because mothers with low parity will be more

careful in maintaining the health of their babies

because they are still their first or second child. But

according to the results I got, parity mothers ≥ 2

children had more experience than the first or the next

child, and knew more about the purpose and benefits

of IMD for the health of the mother and her baby.

4.4 Relationship between Knowledge

and Implementation of IMD

Practices

The results showed a significant relationship between

knowledge with the practice of IMD with a value of

p = 0,000. OR = 13.602 which means that

knowledgeable respondents have the opportunity

13.602 times to implement IMD practices. These

findings are in line with research Aflianti (2002)

mothers of high knowledge have a significant

relationship between knowledge and implementation

of IMD, that is, p = 0.029 with an OR value of 14.814,

which means mothers with high knowledge will have

14.8 times the opportunity to carry out IMD practices

compared to low knowledge mother. Knowledge is

one of the factors that is suspected to influence a

person's behavior in acting or doing something.

According to Notoatmodjo (2008), knowledge is the

result of sensing a certain object. Most of human

knowledge is obtained through the eyes and ears. Like

education, knowledge also has a level, namely know,

understand, application, analysis, synthesis, and

evaluation, knowledge is a very important domain for

the formation of one's actions.

The implementation of IMD is very important. If

individuals, families, health workers and the

community, especially postpartum mothers, have

understood the understanding, benefits, and goals and

benefits of IMD, then IMD can be implemented well

so that it can be expected to increase the coverage of

exclusive breastfeeding, especially in the working

area of Gunung Tua Puskesmas in Panyabungan

District in this case. to increase public awareness in

implementing IMD is not just knowing and

understanding but it needs awareness and

understanding to inform mothers and the community

about the importance and benefits of implementing

IMD in the form of counseling and counseling.

4.5 Relationship between BBs and

Birth Babies with the

Implementation of IMD Practices

The results showed a significant relationship between

BB babies born with IMD practice  = 0.008. OR =

3,717 which means that respondents whose birth

weight is 3,717 times have an IMD practice.

Furthermore, this study is in line with research

Faujiah (2009) which says there is a significant

relationship between birth weight of babies with the

implementation of early breastfeeding initiation

(IMD).

According to this study Harianti, Y. (2005) that

babies with low birth weight (premature), should be

given ASI from their own mothers, if there are no

complications such as breathing difficulties, sepsis,

and malformations. So most premature babies are

usually able to breastfeed immediately.

Based on the statement of Greece Greece (2009)

states that babies with birth weight <2500 grams can

breastfeed properly. This success is due to various

factors such as the mother's very high motivation to

make early contact with her baby at any time and get

help and attention from nurses who understand about

IMD.

BB of a baby born ≥ 2500 gram is one of the

variables that greatly influences the implementation

of IMD, because babies whose weight < 2500 grams

are difficult to respond to the mother's chest because

the baby's weight is still low.

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4.6 Relationship between Type of

Labor and Implementation of IMD

Practices

The results showed a significant relationship between

the types of childbirth with IMD practice p = 0.038.

OR = 2.953 which means that respondents who have

spontaneous labor have 2.953 times the opportunity

to carry out IMD practices. These findings are in line

with Aflianti (2002) research that mothers who have

spontaneous labor have a significant relationship with

the practice of IMD with  = 0.024 with an OR value

of 1.923, which means mothers who have

spontaneous labor have 1.9 times the opportunity to

initiate practice early breastfeeding compared to other

types of cesarean delivery.

This is because this research, the caesarean

method still exists using general anesthesia. In

addition, the use of more analgesia in cesarean section

rather than spontaneous also reduces the possibility of

implementing IMD.

Faujiah's research (2009) says that mothers who

have IMD are mostly done with spontaneous labor.

The results of the bivariate analysis said that there

was a significant relationship between the types of

spontaneous labor and the implementation of IMD

with  = 0.026.

According to Roesli (2012) in cesarean delivery if

spinal or epidural anesthesia is given and the mother

is conscious so that it can be immediately positioned

for skin contact with the skin of the mother and her

baby. Try the first suckling in the operating room. If

the state of the mother and baby is not yet possible,

the baby is given to the mother at the fastest

opportunity. If general anesthesia is done, contact can

occur in the recovery room when the mother is able

to respond even though she is still sleepy or under the

influence of anesthesia.

4.7 Relationship between Officer

Support and Implementation of

IMD Practices

The results showed no significant relationship

between staff support with IMD practice  = 0.079

and OR = 0.380.

This is in line with Afilianti's (2002) research that

there is no meaningful relationship between staff

support and the implementation of IMD, this is due to

the lack of supervision from superiors so that the

implementation of IMD by health workers is not done

well.

These findings are different from the study of

Nuryanti (2011) mothers who received support from

staff had a significant relationship with the

implementation of IMD with  = 0.035 with an OR

value = 1.867 meaning that mothers who received

support from officers had a 1.8 times chance of

carrying out IMD practices.

These findings are also different. According to

research Faujiah (2009) said that there is a significant

relationship between the support of officers with the

implementation of IMD with  = 0.05.

According to researchers, mothers who received

support from staff were actually very influential on

the implementation of IMD) because without the

support of health workers or midwives. Postpartum

mothers will not practice early breastfeeding if they

are not supported by health workers, because health

workers encourage and motivate mothers to do IMD.

To realize the implementation of IMD can not be

separated from the level of knowledge of health

workers to inform mothers and the community about

the importance of the benefits of implementing IMD

from counseling and counseling.

4.8 Relationship between Husband's

Support and the Implementation of

IMD Practices

The results showed no significant relationship

between husband's support and IMD practice  =

0.461. OR = 1,543 which means that respondents who

received husband's support had an opportunity of

1,543 times to carry out IMD practices compared to

husbands who did not support the implementation of

IMD. This is different from Aflianti's research (2002)

which says that there is a significant relationship

between husband's support and the implementation of

early breastfeeding initiation (IMD) with p = 0.002.

According to researchers, the support of the

husband is also very influential in the practice of early

breastfeeding initiation, because according to

Indonesian culture, people say that they must have

permission from their husbands. But now mothers

must actually heed it because it is in the interest of the

mother and child. Because the benefits of IMD are not

for the husband but for the mother and baby

themselves.

4.9 Dominant Factors Regarding

Postpartum Mothers in Early

Breastfeeding Practices

The last modeling results show that the most

dominant variable is the knowledge variable with OR

= 18.426. This means that knowledgeable mothers

have 18.426 times the opportunity to carry out IMD.

Determinant of Early Breasting Initation Practice in New Born Baby in the Working Area of Gunung Tua

425

Knowledge is one of the factors that is suspected to

influence a person's behavior in acting or doing

something. According to Notoatmodjo (2007),

knowledge is the result of sensing a certain object.

Most of human knowledge is obtained through the

eyes and ears. Like education, knowledge also has a

level, namely know, understand, application,

analysis, synthesis, and evaluation, knowledge is a

very important domain for the formation of one's

actions.

IMD is a very important thing. If individuals,

families, health workers and the community

especially postpartum mothers have understood the

understanding, benefits, and goals and benefits of

IMD, then IMD can be implemented well so that it

can be expected to increase the coverage of exclusive

breastfeeding especially in the working area of the old

mountain health center in Panyabungan sub-district,

in terms of This is to increase public awareness in the

implementation of IMD, not just knowing and

understanding, but it needs awareness and

understanding to inform mothers and the community

about the importance and benefits of implementing

IMD in the form of counseling and counseling.

5 CONCLUSION

The conclusions that can be drawn from this study are

there is an influence between age, knowledge,

education, type of birth and birth weight of babies on

the practice of early breastfeeding in newborns where

the  value <0.05. The most dominant factor affecting

IMD is knowledge with an odds ratio (OR) = 18.426

meaning that mothers who have high knowledge

about IMD will carry out IMD as much as 18.426

times than mothers who have low knowledge.

6 SUGGESTIONS

It is expected that the special health workers at the

midwife to carry out IMD at every normal delivery

assistance in accordance with the standards of Normal

Childbirth Care and to socialize IMD to pregnant

women, namely about IMD and the benefits of doing

IMD for mothers and their babies so that during

delivery the mother does not refuse if health workers

will conduct an IMD, and to superiors to supervise

directly to mothers who give birth whether midwives

do IMD on newborns.

It is recommended to mothers to be able to

increase knowledge about the initiation of early

breastfeeding by attending the posyandu every

month, and to be able to work closely with the cadres

and closest health workers.

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