JRSSEM 2022, Vol. 01, No. 9, 1280 1292
E-ISSN: 2807 - 6311, P-ISSN: 2807 - 6494
DOI : 10.36418/jrssem.v1i9.118 https://jrssem.publikasiindonesia.id/index.php/jrssem/index
EFFECT OF RELAXATION THERAPY ON ANXIETY LEVEL
AND BREAST MILK PRODUCTION IN PREGNANT AND
POSTPARTUM MOTHERS: Systematic Literature
Review
Mutiara Ayu Muthiatulsalimah
1*
Rr Sri Endang Pujiastuti
2
Aris Santjaka
3
Runjati
4
1,2,3,4
Master of Applied Midwifery Health Polytechnic, Ministry of Health, Semarang
e-mail: mutiattul@gmail.com
1
2
, arissantjaka@gmail.com
3
,
runjati@yahoo.com
4
*Correspondence: mutiattul@gmail.com
Submitted: 28 March 2022, Revised: 04 April 2022, Accepted: 15 April 2022
Abstract. Anxiety in pregnant and postpartum women can affect the condition of the mother and
baby. Psychological stress can influence the hypothalamus and pituitary gland to secrete
Adrenocorticotropic Hormone to produce cortisol. The amount of cortisol is high, resulting in
inhibited milk production. Relaxation therapy is able to stimulate the milk ejection reflex more
efficiently than standard practice in health care facilities which only focus on optimizing body
functions, without involving the mind and soul. This review conducted a systematic review to
evaluate the effect of interventions using Relaxation Therapy in increasing breast milk production.
A literature search was conducted using the PRISMA guidelines including studies of relaxation
therapy interventions during the pregnancy and postpartum period. Using a literature keyword
search strategy, 718 studies related to relaxation therapy in pregnant and postpartum women were
found and 25 studies were eligible for inclusion in the analysis. A total of 10 studies on anxiety in
pregnant women, 5 studies on anxiety in postpartum mothers, 3 studies on cortisol hormone levels,
5 studies on breast milk production and 2 studies on prolactin hormone levels. These studies were
conducted in Malaysia, France, England, Greece, Korea, Turkey, America, Taiwan, Iran, Indonesia,
Spain, Denmark and India. The samples analyzed were 1,608 pregnant women and 1227
postpartum women. Based on the results of a review, Relaxation Therapy in the form of
Hypnobreastfeeding and Music Therapy is effective in stimulating the production of breast milk
and prolactin hormones in postpartum mothers. Hypnosis, Music Therapy and Benson's relaxation
technique were associated with a significant reduction in anxiety levels as indicated by an increase
in PSS scores and a decrease in salivary cortisol.
Keywords: anxiety; cortisol hormone; milk production; prolactin hormone; relaxation therapy.
Mutiara Ayu Muthiatulsalimah, Rr Sri Endang Pujiastuti, Aris Santjaka, Runjati
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DOI : 10.36418/jrssem.v1i9.118 https://jrssem.publikasiindonesia.id/index.php/jrssem/index
INTRODUCTION
Pregnancy is the most important period
in the human life cycle. During pregnancy,
there is often a decrease in well-being, an
increase in anxiety and stress. During
pregnancy, mothers experience significant
changes in their physiological and
psychological functions. The process of
adjusting to this new situation then causes
anxiety. Anxiety in pregnancy is an
emotional reaction that occurs in pregnant
women related to the mother's concern for
the welfare of herself and her fetus (Li,
Newell-Price, Jones, Ledger, & Li, 2012);
(Kestler-Peleg, Shamir-Dardikman,
Hermoni, & Ginzburg, 2015); (Duijts,
Jaddoe, Hofman, & Moll, 2010).
Research on factors related to anxiety
levels before delivery, from 64 respondents
obtained 10.9% experienced mild anxiety,
70.3% moderate anxiety, and 18.8% severe
anxiety. This is caused by hormonal
changes that also cause the mother's
emotions to become unstable (LetiniĿ et al.,
2016); (Loke & Chan, 2013). Excessive
anxiety causes levels of stress hormones to
increase (beta-endorphin,
Adrenocorticotropic Hormone, cortisol and
epinephrine) (Cai, Wardlaw, & Brown,
2012); (General, 2017). When the amount of
stress hormone increases, the blood vessels
in the body will constrict. This reduces
blood flow and oxygen supply to the fetus
and disrupts its growth and development
(Ho, 2013). Pregnant women with high
levels of anxiety are strong predictors of
postpartum depression, these conditions
affect the breastfeeding process so that it
can affect milk production (Ali et al., 2020).
Research in the city of Palembang
showed that 32% of mothers stopped
breastfeeding because they complained of
insufficient milk (Lazard, Scheinfeld,
Bernhardt, Wilcox, & Suran, 2015). Another
study in Australia showed that 556 mothers
gave birth, 29% stopped breastfeeding
their babies in the second week on the
grounds that their breast milk was
insufficient (Fotiou, Siahanidou,
Vlastarakos, Tavoulari, & Chrousos, 2018).
The rate of desire to breastfeed in various
countries is now far higher than the rate of
starting breastfeeding. Reports in Canada
stated that during pregnancy about 80% of
mothers who intend to breastfeed there are
only 30% who breastfeed for at least 6
months. Feeling tired after giving birth
causes mothers to be lazy to breastfeed
their babies, besides that milk production is
not smooth causing mothers not to give
breast milk to their babies, this is what is
called lactation failure (Meedya, Fahy, &
Kable, 2010); (Legrand et al., 2017).
The psychological condition of the
mother affects the success of lactation.
Mothers who have symptoms of
depression tend to have low self-
confidence in breastfeeding and have
difficulty regarding the position of the baby
while breastfeeding (Tragea, Chrousos,
Alexopoulos, & Darviri, 2014); (Downe et al.,
2015). Some studies have reported that
emotional stress on the mother inhibits the
let-down reflex which causes disruption of
milk flow which results in a decrease in milk
volume so that it affect the duration of
breastfeeding. Psychological, social and
spiritual stress can affect the hypothalamus
and pituitary gland to excrete
Adrenocorticotropic Hormone (AC-TH).
This can affect the hormone adrenaline (a
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and Postpartum Mothers: Systematic Literature Review
hormone that affects stress) and produce
cortisol. When the amount of cortisol is
high, then milk production will be inhibited.
Therefore, a relaxation therapy is needed as
an effort to reduce the hormone cortisol
and reflect let-down in the mother (Shin &
Kim, 2011); (Bauer, Victorson, Rosenbloom,
Barocas, & Silver, 2010); (Newby, Lang,
Werner-Seidler, Holmes, & Moulds, 2014).
The intervention that has been
developed by many researchers to reduce
anxiety and increase milk production is by
using relaxation therapy. Relaxation
techniques are natural healing techniques
and are part of a holistic self-care strategy
to deal with complaints such as fatigue,
pain, sleep disturbances, stress and anxiety.
Physiologically, relaxation will stimulate the
parasympathetic nervous system so as to
increase the production of endorphins,
reduce heart rate, increase lung expansion
so that it can develop optimally and
muscles become relaxed. Relaxation
therapy is able to stimulate the milk
ejection reflex which is more efficient than
standard practice in health care facilities
such as breastcare which only focuses on
optimizing body functions, without
involving the mind and soul which also
affects milk production and breastfeeding
success. The application of holistic health
sciences must pay attention to the
psychoneuro-endocrino-immuno (PNE-I)
aspect because the imbalance between the
mind and the soul causes disturbances in
the balance between the nervous,
hormonal and immune systems. Therefore,
the application of relaxation therapy that
involves the soul and mind to increase milk
production and breastfeeding success is
very much needed.
The results showed that relaxation
exercises were effective in reducing the
anxiety of primigravida pregnant women
undergoing IVF. The results of other studies
also showed that relaxation during
breastfeeding affects the mother's
psychological condition and increases milk
production. The results of a systematic
review of 5 studies that examined
relaxation therapy on breast milk
production it was found that Relaxation
therapy has been shown to increase milk
production in mothers with babies
premature.
Based on the description above, a
review will be conducted on the effect of
Relaxation Therapy on anxiety levels and
milk production in pregnant and
postpartum women.
METHODS
The research design used the
Systematic Literature Review method by
collecting and analyzing 25 journals from
various database sources such as; PubMed,
Science Direct, and Google Scholar. This
literature search was determined within the
last ten years, from 2010 to 2020.
RESULTS AND DISCUSSION
A. Study Quality and Risk of Bias
Based on the overall study that is
summarized, it shows the results of data
analysis and significant testing
regarding the given intervention. A
total of 7 studies were rated as low risk
of bias, the studies applied the same
eligibility criteria to select all study
subjects, all potential subjects
Mutiara Ayu Muthiatulsalimah, Rr Sri Endang Pujiastuti, Aris Santjaka, Runjati
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underwent the same diagnostic
procedures and had the same chance of
detecting and reporting cases,
exposure history, including the time
and reason for the change in exposure
status diagnosed. without the influence
of knowledge of exposure status
(blind).
Assessment of study bias set out in
a systematic review is at risk of selection
bias because most of the determinants
of the large sample are non-probability
techniques, so there is a lack of random
selection procedures on research
samples. Studies using a pre-
experimental design are also at risk for
bias, because the study was conducted
in only one group and the results were
observed before and after the
intervention. The high risk of bias can
also be caused by several other factors
that contribute to the psychology of
each individual that triggers anxiety
that causes milk production to be not
smooth.
B. Analysis of Relaxation Therapy
Results on Anxiety Levels for
Pregnant Women
The results of the analysis of the
level of anxiety in pregnant women are
presented based on parameters,
namely seen through the State-Trait
Anxiety Inventory (STAI) score,
Depression Anxiety and Stress Scale
(DASS),Pregnancy Stress Rating Scale
(PSRS), Spielberger's Anxiety Scale,
Wijma Delivery Expectancy / Experience
Questionnaire B (W-DEQ).
Six studies used STAI to measure
anxiety levels in pregnant women. All
studies show a significant reduction in
anxiety levels. Studies that provide
hypnosis interventions show a decrease
in Anxiety to its minimum value of 20
(mild anxiety), right in the middle of a
hypnotic cycle. With p value = 0.05.
Studies that provide Relaxation
Breathing and Progressive Muscle
Relaxation interventions show the
results of the A-state median value of
the Intervention group 38.0 (mild
anxiety), the control group 40.0
(moderate anxiety), the median A-trait
value of the intervention group 37.0
(mild anxiety) control group 36.0 (mild
anxiety). Studies that provided self-
hypnosis showed results. The
intervention group's level of fear and
anxiety was lower than the control
group P = 0.001. The mean value of the
intervention group was 10.1 (normal),
the control group was 10, 5 (normal).
Two studies that provided Music
Therapy intervention showed results.
The intervention group showed a
significant reduction in anxiety
compared to the control group. The
pretest score of the intervention group
was 43.72 (moderate anxiety), posttest
42.79 (moderate anxiety), pretest
control group 43.23 (moderate anxiety),
posttest 43.87 (moderate anxiety).The
anxiety score of the music therapy
group, decreased by 5 points from 39.6
(moderate anxiety) to 34.1 (mild
anxiety) p = 0.01. And the recreational
therapy group score also decreased 5
points from 36.5 (mild anxiety) to 31.4
(mild anxiety) p = 0.04 The control
group decreased by 2 points from 35.6
(mild anxiety) to 33.2 (mild anxiety),
statistically (p > 0.05). The study that
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and Postpartum Mothers: Systematic Literature Review
provided Benson's relaxation technique
showed that the intervention group's
State Anxiety Score was 21,9 (mild
anxiety), control group 25 (mild
anxiety), Trait score 19.5 (normal),
control group 25.9 (mild anxiety).
Relaxation training is effective in
reducing anxiety in pregnant women
P=0.001.
One study using Depression Anxiety
and Stress Scale (DASS) to measure
anxiety levels. Studies that administered
hypnosis showed that the mean scores
of stress and anxiety were found to
remain within normal parameters
during the hypnosis session. Before the
intervention the average score of
anxiety was 2 (normal), the first
intervention average score remained 2
(normal), the second and third
interventions the average score
increased to 8 (normal). Although the
patients' stress scores improved slightly
during the second and third hypnosis
sessions they remained within normal
parameters.
Two studies used the Wijma
Delivery Expectancy/Experience
Questionnaire A (W-DEQ) to measure
levels of fear. The study that provided
the intervention in the form of
hypnobirthing showed the
experimental group's mean score of
16.47 (normal) was significantly lower
than the control group's 95.47 (severe
fear). Hypnobirthing was able to reduce
the fear of pregnant women during
delivery P = 0.000. Studies that
provided intervention in the form of EFT
In the EFT group the Wijma Delivery
Expectancy / Experience Questionnaire
score (version B) had a significant
difference from the control group (p <
0.001). EFT has the effect of reducing
maternal fear before delivery.
22
One study using Pregnancy Stress
Rating Scale (PSRS) to measure the level
of anxiety. Studies that provide music
therapy have a difference between pre-
test and post-test PSRS scores,
respectively, for the experimental group
Pre=53.7 (mild anxiety) Post=54.02
(mild anxiety) and the control group
Pre=49, 92 (mild anxiety) Post=54.94
(mild anxiety), p = 0.02.
C. Analysis of Relaxation Therapy
Results on Anxiety Levels in
Postpartum Mothers
The results of the analysis of the
level of anxiety in postpartum mothers
are presented based on parameters,
namely the State-Trait Anxiety
Inventory (STAI) score, Depression
Anxiety and Stress Scale (DASS),
Hamilton Rating Scale for Anxiety (HRS-
A), cortisol hormone levels.
Anxiety scores measured using STAI
showed that the study that provided
the hypnobreastfeeding intervention
had a significant and significant
difference in anxiety between the group
that was given the intervention and the
group that was not given the
intervention P=0.002. The mean score
of the intervention group was 27.9 (mild
anxiety), the control group was 34.07
(mild anxiety).
Three studies used the DASS to
measure anxiety levels in pregnant
women. All studies show a significant
reduction in anxiety levels. The study
that gave the hypnobreastfeeding
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intervention showed that the
respondents' anxiety before the
intervention of the experimental group
was 14.22 (moderate anxiety),
decreased to 7.67 (normal) after the
intervention. The control group, the
anxiety score was 13.83 (moderate
anxiety), decreased to 9.39 (mild
anxiety). P value 0.001. Study on
hypnosis intervention showed results
The intervention group had lower
postpartum anxiety than the control
group (postpartum care), the
intervention group score = 2.88
(normal), control = 38.36 (very severe),
p = 023. Studies that provided the
intervention Mindfulness Based Stress
(MBSR), Mindfulness-Based Cognitive
Therapy (MBCT), Mindful Self-
compassion (MSC) showed results The
intervention group showed a greater
reduction in anxiety than the control
group. Intervention group score
Pretest=7.08 (mild anxiety), Posttest
2.46 (normal), Control group score
Pretest=7.5 (mild anxiety), posttest 7.25
(mild anxiety) P=0.012.
Anxiety scores were measured using
HRS-A showing the results that there
was a significant difference between the
results of the pretest posttest. Pretest
the average intervention group was
20.63 (mild anxiety) and the posttest
score was 10.50 (normal), with
significance level value= 0.001
Three studies used cortisol levels to
measure anxiety levels in pregnant
women. All studies showed a significant
reduction in anxiety levels with a
decrease in cortisol levels as a
determining parameter. Studies that
provide an intervention in the form of
listening to audiorecording containing
relaxation show the results In the
intervention group the average cortisol
hormone level in the 2nd week before
the intervention was 0.048, after 0.039,
the control group was 0.041, the 6th
week before the intervention was 0.044,
after 0.036, the control group was
0.044. Studies that giving hypnosis
showed the results that Cortisol levels
(hypnosis and relaxation p = 0.02 and
0.03, hypnosis and usual care p = 0.08
and 0.05). group cortisol levels 30
minutes after delivery (hypnosis versus
relaxation p = 0.08, hypnosis versus
usual care 0, 10) and 6 weeks
postpartum (hypnosis versus relaxation:
p = 0.85, 0.51, and 0.68, hypnosis versus
usual care: p = 0.85, 0.93, and 0.96).
One
study displays the results of measuring
6th month salivary cortisol levels of 0.36
mg / dl at 8 am and an increase of 0.41
mg / dl at 8:30 in women who are
mostly breastfeeding, and 0.27-0.30 mg
/ dl in women who are mostly bottle-
feeding. Women who mostly breastfed
their babies had higher salivary cortisol
levels at 8 a.m. (p = 0.05) and 8:30 a.m.
(p = 0.02) than those who were bottle-
fed for 6 months. This effect remained
significant after controlling for feeding
differences (p = 0.01, p = 0.015,
respectively).
D. Analysis of Relaxation Therapy
Results on Milk Production in
Postpartum Mothers
The results of the analysis of breast
milk production in postpartum mothers
are presented based on parameters,
namely seen through measuring cups
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and Postpartum Mothers: Systematic Literature Review
and prolactin hormone levels.
Five articles used measuring cups
and breast pumps to measure milk
production in postpartum mothers. All
studies showed an increase in breast
milk production after the intervention.
Studies that provide
hypnobreadtfeeding show that there is
an effect of hypnobreastfeeding on
productionbreast milk in nursing
mothers who work, the average value
of production breast milk before
treatment 210 ml/day and after
treatment 255 ml/day. The study that
gave hypnobreastfeeding combined
with oxytocin massage showed that
the amount of milk production
between the intervention group
(median = 10.00; SD = 10.36) and the
control group (median = 4.50; SD =
4.21) was statistically significant ( p <
0.001). Studies that also provided
hypnobreasfeeding combined with
oxytocin massage in the
hypnobreastfeedin group and
massage oxytocin productionbreast
milk 79.10 ml/2 pumps/day, the
hypnobreastfeeding group only (60.51
ml/2 pumps/day), oxytocin massage
only (53.32 ml/2 pumps/day), and the
control breast care group 41, 18 ml/2
pumps/day. Studies providing music
therapy The volume of breast milk in
the music therapy group increased
significantly during the four days of the
intervention. Day 1 with MT was 7.04
ml (SD ± 1.49) and NMT was 6.56ml
(SD ± 1.49) v/s day 4 with MT 7.86 ml
(SD ± 1.32) and NMT was 7.34 ml (SD
± 1.31) & statistically significant (p-
value: 0.024). The study that gave
music therapy to the experimental
group produced significantly more
breast milk (P < 0.0012). The mothers
in this group also produced milk with a
significantly higher fat content during
the first 6 days of the study.
Two articles used prolactin hormone
levels to measure milk production in
postpartum mothers. Values (p < 0.05)
for both treatment groups. The
intervention group produced 200
grams of breast milk and the hormone
prolactin 250 ng/ml, in the acupressure
group the production of breast milk
was 90 grams and the hormone
prolactin was 100 ng/ml. In another
study, the intervention group had
higher prolactin levels (273.53 ng/ml)
than the control group (209.37 ng/ml).
In another study, prolactin levels were
found to be higher in postpartum
mothers with normal glucose levels
than in postpartum mothers with
prediabetes/diabetes (mean 98.2 vs
80.2 ng/mL, P = 0.0003).
DISCUSSION
E. Effect of Relaxation Therapy on the
anxiety of pregnant women
Anxiety and worry in pregnant
women if not handled seriously will
have an impact and influence on the
physical and psychological well-being
of the mother and the fetus. Anxiety in
pregnant women will increase when the
delivery schedule is getting closer,
namely entering the third trimester, the
mother begins to think about the birth
process and the condition of the baby
to be born. Mothers who suffer from
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stress and anxiety during the third
trimester of pregnancy will experience
an increase in the release of stress
hormones, causing disruption of blood
flow in the uterus and resulting in weak
uterine muscle contractions. This
incident causes the length of the labor
process (long parturition), the risk of
sectio caesaria, and delivery with tools.
The risk for the baby can cause
congenital abnormalities in the form of
failure to close the cleft palate,
premature birth, giving birth to babies
with low birth weight (LBW), emergency
(fetal distress) and in the long term
related to behavioral and emotional
disorders in children. Hypnosis has
been used for a long time in clinical
practice to treat health problems
including stress and anxiety
experienced by pregnant women.
Based on the results of the review, 2
studies that provided music therapy
showed a decrease in anxiety scores
after the intervention. Both studies took
the same research sample for anxiety
scores, namely pregnant women who
experienced moderate anxiety, but
differences appeared in anxiety scores
after the intervention. One study
decreased the score from 43.72 to
42.79, but the score category was still
classified as moderate anxiety.
Meanwhile, anxiety scores in other
studies decreased from 39.6 (moderate
anxiety) to 34.1 (mild anxiety).
The difference in anxiety categories
in the two studies was due to
differences in the duration of the
intervention. There are many factors
outside of pregnancy that cause
maternal anxiety levels to increase, this
is why giving an intervention for 14
days does not have a significant effect
in reducing anxiety scores compared to
studies that provide intervention at 48-
72 hours postpartum. Statistically, both
studies showed a p value <0.005,
meaning that the provision of
relaxation therapy intervention in the
form of music therapy had an effect in
reducing anxiety levels in pregnant
women.
Another study that shows the
results of a significant reduction in
anxiety levels is the provision of an
intervention in the form of
hypnobirthing. Studies that provided an
intervention in the form of
hypnobirthing showed the
experimental group's mean score of
16.47 (normal) was significantly lower
than the control group's 95.47 (severe
fear). Past meta-analysis results provide
evidence that relaxation therapy
reduces symptoms anxiety, depression,
phobia or worry in anxiety disorder
patients. The results of this review
support that relaxation technique
training is a non-pharmacological
intervention that can improve well-
being during pregnancy.
F. Effect of Relaxation Therapy on
postpartum maternal anxiety
Postpartum mothers will experience
physiological, psychological and social
adaptations. However, not all
postpartum mothers can pass the
postpartum adaptation smoothly.
Postpartum mothers may experience
psychological disorders during the
postpartum period, one of which is
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and Postpartum Mothers: Systematic Literature Review
anxiety. Sudden changes in postpartum
mothers are the main causes of
emotional disappointment, pain in the
early puerperium, fatigue due to lack of
sleep during labor and anxiety about
her ability to care for her baby, fear of
not being attractive to her husband,
especially emotions during the first
week of being unstable and changes
His mood in the first 3-4 days, this
period is very varied and influenced by
so many factors, the main emphasis is
on the nursing approach by providing
help, sympathy and encouragement.
The results of the previous review
presented the results that hypnosis was
able to reduce postpartum anxiety.
Based on the results of the review, 2
studies that gave hypnosis showed a
decrease in anxiety scores after the
intervention. Both studies showed a
decrease in anxiety with the normal
category. Studies that provide hypnosis
in the form of hypnobreastfeeding
combined with giving acupressure have
shown that anxiety decreases from
moderate anxiety (score 14.22) to
normal (score 7.67). Another study did
not present an anxiety score before the
intervention, the measurement of
anxiety scores was carried out 4 times
at 16, 20, 28 gestational ages and at 36
weeks of gestation, there was a
comparison of scores between the
intervention group (normal score 2.88)
and the control group (score 38.36
severe anxiety).
According to a study that examined
the effects of hypnobreastfeeding on
anxiety, the results showed that
hypnobreastfeeding was able to
function as an effective non-
pharmacological therapy to reduce
anxiety and pain without any adverse
side effects. Another study presented
data that from 60 postpartum mothers
there were significant differences. and
significant effect on anxiety between
the groups given the
hypnobreastfeeding intervention and
those who were not given the
hypnobreastfeeding intervention.
43
Hypnobreastfeeding relaxation can be
done since the third trimester during
pregnancy. It can be used as a means to
communicate with the baby and
prepare for labor and can reduce pain
during labor. Mothers who have relaxed
since pregnancy can go through the
labor process in a relaxed, comfortable
manner and are more prepared to
become mothers when the baby is
born. In addition, it can reduce the risk
of postpartum depression.
Another study presents data that
hypnosis is able to reduce cortiol
hormone levels in third trimester
pregnant women, if carried out
continuously during breastfeeding it
can reduce cortisol levels so as to create
a sense of comfort during
breastfeeding and increase milk
production.
One of the factors that have
the potential to contribute to increased
cortisol levels in postpartum mother is
the effect of the mother's sleep hours.
Fatigue and sleep disturbances from
breastfeeding at night or early in the
morning can be stressors and alter the
stress response. In addition, women
who breastfeed their babies directly
may wake up more than once during
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the night to nurse their babies. And
after waking up in the morning the
mother immediately started daily
activities, so the rhythm of cortisol
secretion began to increase at that
time, and resulted in higher cortisol
levels.
G. Effect of Relaxation Therapy on
postpartum mother's milk
production
Breast milk is the main choice of
food for infants, because at birth the
baby produces only a small amount of
salivary or pancreatic amylase, thus the
baby is not ready to digest complex
carbohydrates obtained from solid
foods. In addition, breastfeeding
provides many benefits, including the
fulfillment of nutritional,
immunological and psychological
needs. Meanwhile, the benefit for the
mother is that the reproductive organs
of the mother will return to their pre-
pregnancy state more quickly and will
increase closer contact between
mother and baby. As a method that is
able to create persuasive situations in
one's subconscious,
hypnobreastfeeding is able to increase
the motivation and confidence of
mothers to produce and give breast
milk to babies, create a sense of
comfort, reduce anxiety experienced by
mothers during breastfeeding.
The
results of a previous review showed that
relaxation therapy has been shown to
increase milk production in mothers of
premature babies. Body and mind
stress-releasing techniques have a
positive effect on breastfeeding
duration.
Based on the results of the review, 2
studies that provided
hypnobreastfeeding showed an
increase in breast milk volume after the
intervention. The duration of the
intervention was 7 and 4 days,
respectively. In studies that provide
intervention for 7 days have more
breast milk volume. Average
volumebreast milkbefore treatment
210 ml/2 pumps/day and after
treatment 255 ml/2 pumps/day on day
7 after the intervention. Another study
in the hypnobreastfeeding group, the
volume of breast milk was 60.51 ml/2
pumps/day on day 4 after the
intervention.Differences in volume are
affected by the end point of data
collection. According to theoryon the
days the first time the baby is born, if
the baby is breastfeeding well, the
breasts will empty quickly and produce
more milk, the milk production will
gradually be produced 10-100 ml / day
on days 1-9 after giving birth, and will
be optimally 700-800 ml at 10-14 days.
The results show that hypnotherapy
is more effective in triggering the
hormone prolactin which then triggers
an increase in breast milk production,
because hypnobreastfeeding can affect
the mother's belief, even though it is
temporary, in the form of focus of
attention.
CONCLUSIONS
Based on the previous discussion, the
authors conclude that Relaxation Therapy is
in the form of:
1. Hypnosis, Music Therapy, and Benson's
1290 | Effect of Relaxation Therapy on Anxiety Level and Breast Milk Production in Pregnant
and Postpartum Mothers: Systematic Literature Review
relaxation technique are able to
overcome anxiety in postpartum
mothers, and a decrease in cortisol
hormone levels which is one of the
parameters for assessing anxiety levels
in postpartum mothers.
2. Hypnobreastfeeding and Music
Therapy is able to overcome the
problem of insufficient milk production
in postpartum mothers and increase
the hormone prolactin which is the
hormone that determines breast milk
production.
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