JRSSEM 2022, Vol. 01, No. 9, 1302 – 1315
E-ISSN: 2807 - 6311, P-ISSN: 2807 - 6494
DOI : 10.36418/jrssem.v1i9.144 https://jrssem.publikasiindonesia.id/index.php/jrssem/index
THE EFFECTIVENESS OF SOY BEAN, OXCYTOCIN
MASSAGE AND BACK MASSAGE ON BREAST MILK
PRODUCTION OF POSTPARTUM MOTHERS SYSTEMATIC
LITERATURE REVIEW
Handayani
1*
Masrifan Djamil
2
Sri Wahyuni
3
Shandy Wigya M
4
1,2,4
Poltekkes Kemenkes Semarang,
3
Poltekkes Kemenkes Surakarta, Indonesia
e-mail: handayaniketut123@gmail.com
1
, rifan.mmd@gmail.com
2
, yuni_punung@yahoo.com
3
,
shandywigyam@gmail.com
4
*Correspondence: handayaniketut123@gmail.com
Submitted: 23 March 2022, Revised: 04 April 2022, Accepted: 16 April 2022
Abstract. Breast milk production that is less or not smooth is a problem that is often experienced
by postpartum mothers. That is due to lack of nutritional intake and lack of therapy to facilitate
milk production. Giving soybeans, oxytocin massage and back massage are ways to increase breast
milk production. The search for articles in this systematic literature review uses 6 databases with a
time start from 2015-2020. The articles using Indonesian and English. The inclusion criteria were
postpartum mothers, the interventions given were using soybean, oxytocin massage, and back
massage. The measurement results are in the form of breast milk production. The designs used in
the article search are True Experiment and Quasy Experiment. The preparation of this systematic
literature review uses the PRISMA guideline. Analysis of data from a systematic literature review,
17 studies were eligible for identification, 6 studies were true experiments and 11 studies were
quasy experiments. The intervention soybean containing isoflavone showed statistically significant
results on breastmilk production with p value < 0.05. The intervention oxytocin massage showed
significant results on breastmilk production with p value <0.05. Intervention back massage showed
significant results on breastmilk production with p value <0.05. intervention OKPU massage
showed significant results on breastmilk production with p value <0.05. Interventions with soy,
oxytocin massage, back massage and OKPU massage have a positive effect on breastmilk
production. Oxytocin massage and OKPU massage proved more effective based on significance
value and effect size.
Keywords: soybean; oxytocin massage; back massage; breastmilk production.
Handayani, Masrifan Djamil, Sri Wahyuni, Shandy Wigya M
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DOI : 10.36418/jrssem.v1i9.144 https://jrssem.publikasiindonesia.id/index.php/jrssem/index
INTRODUCTION
The postpartum period requires
adaptation that involves the family to
achieve quality health (Jordan, Farley, &
Grace, 2018). During the postpartum
period, one of the important roles of a
mother is breastfeeding. Breastfeeding is
the ideal method of good breastfeeding for
newborns. Expanded support and effort
can affect the success of
breastfeeding (Lawrence & Lawrence,
2015).
Exclusive breastfeeding in Indonesia is
still a problem that needs attention. The
impact if the baby is not given breast milk
can affect the growth process including
emotional development as well (Fikawati &
Syafiq, 2010). Exclusive breastfeeding has
many advantages and benefits for both the
baby and the mother. One of the benefits
for babies is that breast milk is easily
digested so that the baby's digestion will
remain healthy. Meanwhile, one of the
benefits for mothers is to accelerate post-
natal health recovery or postpartum
recovery (Fredregill & Fredregill, 2010);
(Mufdlilah, Subijanto, Sutisna, & Akhyar,
2017).
Many factors can affect the success of
exclusive breastfeeding, one of which is the
smooth production of breast milk. The
problem that is often experienced by
postpartum mothers is that breast milk
production is less or not yet smooth due to
poor nutritional intake and there is still a
lack of therapy to facilitate breast milk
production (Imasrani, Utami, & Susmini,
2016). The efforts that have been made to
deal with the problem of breast milk
production are breast care which has
become the standard of care in
breastfeeding mothers. postpartum
mothers and recommendations for
consuming katuk leaves, but based on the
results of RISKESDAS (Basic Health
Research) in 2018, the coverage rate for
exclusive breastfeeding in Indonesia was
37.3% (Badan Penelitian dan
Pengembangan Kementrian Kesehatan RI,
2018) while in Central Java Province in 2019
it was 66% (Dinas kesehatan Provinsi Jawa
Tengah, 2020), where this figure is still far
from the national target the coverage of
exclusive breastfeeding is 80%
(Kementerian Perencanaan Pembangunan
Nasional RI, 2012).
Consuming katuk leaves is good for
postpartum mothers, but sometimes
mothers still don't know how to process
them. Breast care or what is often called
breast care is a treatment that has
advantages, namely maintaining breast
hygiene, stimulating the breast glands and
preventing blockage of the milk production
ducts. The drawback is that it only focuses
on the breast, there is no emphasis on
certain points that can stimulate milk
production and without involving
affirmations which also affects the success
of breastfeeding (Sari & Khotimah, 2018).
Other efforts that can be done include
consuming soy juice drinks and
complementary therapies which are also
called holistic therapies such as OKPU
massage (Oxytocin and Back) where
complementary therapy is a trend in several
countries (Widyatuti, 2008). Massage is also
a therapy developed in midwifery.
Soybean can be an option, is a
functional food ingredient that has many
benefits (Aida Krisnawati, 2016). Soybeans
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Production of Postpartum Mothers Systematic Literature Review
contain isoflavones which are included in
the flavonoid group. The isoflavone
content in soybeans varies, but the
dominant ones are genistein and daidzein
(Baber, 2013); (K.P Ko, 2014). In addition, is
oflavone compounds also have antioxidant
activity which is beneficial for the health of
the body, including postpartum mothers
(Istiani, Handajani, & Artini Pangastuti,
2015).
OKPU massage is an abbreviation of
oxytocin and back, this massage uses the
basis of oxytocin massage combined with
one of the techniques of back massage,
namely the efflurage movement. Oxytocin
massage is a massage performed along
both sides of the spine starting from the
cervical spine (cervical vertebrae) to the
twelfth thoracic spine. This oxytocin
massage is able to stimulate the oxytocin
hormone needed for the lactation process,
so that postpartum mothers can be helped
for the problem of smooth breastfeeding
(NF Wulandari, 2020)
;
(Latifah, Wahid, &
Agianto, 2015).
Back massage is a massage movement
that consists of several techniques
including effleurage, friction, tapotage,
counter pressure massage, petrissage
massage and slow stroke back massage. In
OKPU massage, only the effleurage
technique will be combined, where the
movement is lightly rubbing using the palm
of the hand. These movements can provide
a calming or relaxing effect (Jahdi,
Mehrabadi, Mortazavi, & Hamid Haghani,
2016).
Based on the description above,
researchers are interested in conducting
research with the title "Effectiveness of
Soybean Juice Drink and OKPU Massage
(Oxytocin and Back) on Breast Milk
Production in Postpartum Mothers" with a
Systematic Literature Review (SLR)
approach.
METHODS
The search for articles in this systematic
literature review uses 6 databases with a
time start from 2015-2020. The articles
using Indonesian and English. The inclusion
criteria were postpartum mothers, the
interventions given were using soybean,
oxytocin massage, and back massage. The
measurement results are in the form of
breast milk production. The designs used in
the article search are True Experiment and
Quasy Experiment. The preparation of this
systematic literature review uses the
PRISMA guideline.
RESULTS AND DISCUSSION
The Effectiveness of Soy bean on Breast
Milk Production in Postpartum Mothers
Table 1. Soy bean on breast milk production
No
Author's,
Country,
Year
Research
Design
Sample
Intervention
Result
1.
Adriana
Moura
Vieira et al,
True
experiment
18 wistar
rats
Soy diet
There were results after
the 50th day of the
study period, namely
Handayani, Masrifan Djamil, Sri Wahyuni, Shandy Wigya M
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Brazil,
2018
19
the fat content of
breast milk and
isoflavones increased.
2.
Zhi Huang,
China,
2020
20
True
experiment
220
breastfeedin
g women
Dietary pattern
of breastfeeding
women with
macronutrient
composition of
breast milk
Shows that there is a
relationship between
the diet of
breastfeeding women
and the macronutrient
composition of breast
milk. One of the
foodstuffs that can be
consumed is soy milk, p
= 0.04.
3.
Yusaku
Tsugami,
Japan,
2017
21
True
experiment
female rats
Isoflavone
treatment
Promotive
group: p-
ethylphenol,
daidzein and
equol. Inhibitory
groups:
coumestrol,
biocanin,
genistein and
formonetin
Isoflavones and their
metabolism can affect
milk production ability
through different
interactions with
prolactin signaling.
4.
Elika
Puspita,
Indonesia,
2018
22
Quasi
Experiment
Postpartum
mothers 4-
10 days
postpartum
Consumption of
soy milk
After the intervention,
there were changes in
35 of them with very
smooth milk
production and 5
people with smooth
milk production.
p value = 0.000 (p <
0.05). It shows that
giving soy milk has an
effect on increasing
breast milk production.
5.
Lina Wang,
China,
2019
23
Quasy
experiment
of 75
mothers
with term
pregnancies
Stages of
lactation with
intake of
soybean oil and
PUFA content in breast
milk was positively
correlated with intake
of soybean oil (p=0.00)
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Production of Postpartum Mothers Systematic Literature Review
.
food containing
ALA
and ALA intake
(p=0.003) , levels of
ALA in colostrum and
mature breast milk
positively correlated
with intake of soybean
oil ( p = 0.02) and LA (P
= 0.03)
6.
Weie
Zhou,
China,
2020
24
Quasy
experiment
Breastfeedin
g mother
Dried soybeans
are ground into
powder and then
mixed with
water, the result
that will be given
to the mother is
soy milk
Results obtained show
a high correlation.
Urine, saliva samples
and mother's milk
samples showed
exposure to the
isoflavones daidzein
and genistein.
Correlation coefficient
0.998.
Table 2. Effect Size of soybeans on breast milk production
No
Author
Results of Measurement of
Breast Milk Production
Effect Size
Experiment
Control
1.
Adriana
46.02 ± 34.21
N= 6
78.88 ± 38.26
N= 6
0.90
2.
Zhi Huang
1.37 ± 0.73
N=220
0.8 ± 0.1
N= 90
1.09
3.
Yusaku
NR
NR
4.
Elika
NR
NR
5.
Lina Wang
NR
NR
6.
Weie Zhou
110.94 ± 7.23
91.22 ± 2.96
N=6
106.52 ± 6.45
89.36 ± 4.38
N=6
0.49
Note : mean ± SD, ES : effect size , NR : Non Reported, N : number of samples
The Effectiveness of Oxytocin Massage on Breast Milk Production
Handayani, Masrifan Djamil, Sri Wahyuni, Shandy Wigya M
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Table 3. Oxytocin Massage on Breast Milk Production
No
Author
Name,
Country,
Year
Research
Design
Sample
Intervention
Results
1.
Kadek Yuli
Hesti,
Indonesia,
2017
25
Quasi
experiment
44
postpartum
mothers
The experimental
group was given
oxytocin
massage and
breast care. The
control group
was given breast
care counseling.
The difference in the
mean of milk secretion
between the pretest
posttest of the
experimental group and
the control group with a
p value of 0.000.
Thus, the combination
intervention of oxytocin
massage and breast
care can increase milk
secretion in postpartum
mothers.
2.
Nurdiana,
Indonesia,
2016
26
Quasi
experiment
20
postpartum
mothers
Oxytocin
massage for
approximately 10
minutes. It is
given twice in the
morning and
evening, after 24
hours after birth
for up to 3 days.
There is a significant
difference in prolactin
hormone levels before
and after oxytocin
massage. P value <
0.05.
3.
Tabita
Mariana
Doko,
Indonesia,
2019
27
Quasi
experiment
40
primiparous
postpartum
mothers
The intervention
group was given
oxytocin
massage and
breast care.
The control
group was given
breast care.
increased milk
production with baby
weight p 0.003
(p<0.05), breastfeeding
frequency p 0.000
(p<0.05), baby's sleep
duration p 0.000
(p<0.05, bowel
frequency p 0.000
(p<0.05), urinary
frequency p 0.000
(p<0.05), and maternal
rest p 0.000 (p<0.05)
1308 | The Effectiveness of Soy Bean, Oxcytocin Massage and Back Massage on Breast Milk
Production of Postpartum Mothers Systematic Literature Review
4.
Merah
Delima,
Indonesia,
2016
28
Quasi
experiment
21
breastfeedi
ng mothers
Oxytocin
massage for 3
days
Statistical test p value
0.000. So this study
shows that oxytocin
massage has an
effectPanglukies
5.
Ratna,
Indonesia,
2017
29
Quasi
experiment
32
postpartum
mothers
Intervention
group: oxytocin
massage using
lavender
essential oil and
a mixture of
sunflower seeds
Control group:
breast care
P value of prolactin
levels (p= 0.00 ) volume
of breast milk (p= 0.00)
baby weight (p= 0.00)
frequency of urination
(p= 0.017) frequency of
defecation (p= 0.002) It
can be concluded that
there is an effect of
oxytocin massage using
lavender essential oil on
the increase in the
hormone prolactin and
milk production
Table 4. Effect Size Massage Oks cytosine on breast milk production
N
o
Author
Measurement Results of Breast
Milk Production
Effect Size
Experiment
Control
1.
Kadek Yuli
17.09 ±
5.032 220.91 ±
54,328
N= 22
17.09 ±
5.032 72.00 ±
28.947
N=22
3.42
2.
Nurdiana
76.547 ± 69.362
N=20
NR
3.
Tabita MD
2696.5 ± 201.8
3048.2 ± 205.7
7.25 ± 0.444
11.45 ± 0.604
N=20
2678.2 ± 217.19
2910.5 ± 218.33
7.50 ±
10.50 ± 0.513
N=20
0.64
1.69
4.
Mera
Pomegranat
e
7.05 ± 0.740
±
N=21
Panglukies
Handayani, Masrifan Djamil, Sri Wahyuni, Shandy Wigya M
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5.
NR1.183
199.41 ± 58.036
331.54 ± 84.603
N=16
171.50 ± 60.94
189.33 ± 57.151
N=16
1.96
Note : mean ± SD, ES : effect size, NR : Non Reported, N : number of samples
Table 5 . Back massage on breast milk production
No
Author
Name,
Country,
year
Research
Design
Sample
Intervention
Results
1.
Anita
Asrani,
India,
2018
30
Quasi
experiment
60 postnatal
mothers
Back massage
It was found that there
was a significant change
in the back massage
intervention in
postnatal mothers with
values on day 2 and 3
being very significant (p
< 0.001). The mean total
post-test score was
statistically significant
on day 3 (p < 0.05).
2.
Ni Made
Rai
Widiastuti,
Indonesia,
2020
31
Quasi
Experiment
15
postpartum
mothers
Back massage
p value p value = 0.0001
which means that there
is an effect of back
massage on postpartum
mother's milk
production.
3.
Fajar dhini
yahya,
Indonesia,
2019
32
Quasi
Experiment
45
primiparous
postpartum
mothers
There are three
groups: the
back massage
group, the
acupressure
group and the
combination
back massage
and
acupressure
group, the
highest increase in the
intervention
combination back
massage and
acupressure P value p
value = 0, 00. The
conclusion is that back
massage and
acupressure can be
used as complementary
therapy for primiparous
postpartum mothers as
an effort to increase
1310 | The Effectiveness of Soy Bean, Oxcytocin Massage and Back Massage on Breast Milk
Production of Postpartum Mothers Systematic Literature Review
milk production.
Table 6. Effect Size of back massage on breast milk production
No
Author
Results of Measurement of
Breast Milk Production
Effect Size
Experiment
Control
1.
Anita Asrani
8.66 ± 3.46
14.60 ± 5.33
N=30
8.42 ± 1.31
12.90 ± 1.21
N=30
0.43
2.
Ni Made
7.87 ± 1
N =15
9.73 ± 1.4
N=15
1.52
3.
Fajar Dhini
16,733 ± 6.37
N= 15
14,733 ± 4.39
N=15
0.36
Table 7. OKPU Massage on Breast Milk Production
No.
Author
Name,
Country,
Year
Research
Design
Sample
Intervention
Results
1.
Titik
Setyawan,
Indonesia,
2020
33
Quasy
Experiment
34
postpartu
m mothers
from the
first day to
the fourth
day
. Intervention
group: SPEOS
(Stimulation of
Endorphin
Oxytocin
Suggestive
Massage) and
classical music.
Control group:
standard of
postpartum care
The results obtained in
the intervention group
breast milk production
increased from 4.35 ml
to 46.66 ml with a p
value of 0.0001.
control group from
5.48 ml to 19.07 ml p =
0.0001. There is an
effect of SPEOS and
classical music on
breast milk
production.
2.
Melyana
Nurul
Widyawati,
Indonesia,
2016
34
True
experiment
52
primiparo
us
postpartu
m mothers
There are 4
groups: loving
massage group,
aromatherapy
group, group
loving massage
combination
aromatherapy
The p value for stress
level intervention
loving massage p =
0.001. aromatherapy
intervention p= 0.01.
the loving massage
and aromatherapy
intervention p= 0.001
Handayani, Masrifan Djamil, Sri Wahyuni, Shandy Wigya M
| 1311
and the last group
is the control
group.
while the control
group p= 0.343.
3.
Diah Eka
Nugraheni,
Indonesia,
2017
35
Quasi-
experimenta
l
30
postpartu
m mothers
Giving a
combination of
endorphin,
oxytocin and
suggestive
massage
stimulation every
day from day 1
postpartum to 4
weeks.
The SPEOS method
intervention had an
effect on breast milk
production in
postpartum mothers
with an average
increase in breast milk
of 135.17 ml, p value =
0.00, then for an
increase in infant body
weight with an
average of 483.30
grams, p value = 0.00.
Table 8. Effect Size of OKPU Massage on Breast Milk Production
N
o
Author
Results of Measurement of
Breast Milk Production
Effect Size
of Experiment
Control
1.
Point
Setyawan
46.66 ± 10.02
N=17
19.07 ± 7.93
N=17
3.05
2.
Melyana
19.38 ± 6.26
19.31 ± 8.521
16.92 ± 6.764
N
= 13
27.85 ± 2.025
27.85 ± 2.025
27.85 ± 2.025
N= 13
1.82
1.37
2.18
3.
Diah Eka
117.83 ± 13.81
135.17 ± 10.54
N=30
NR
A. The Effectiveness of Soy Juice on
Breast Milk Production
Studies on soybeans or isoflavones
on breast milk production that has
been analyzed amounted to 6 articles. 4
articles with soy intervention, 1 article
with isoflavone treatment intervention
and 1 more article with breastfeeding
mother's diet intervention, one of which
is soy milk. Studies on soybeans on
breast milk production have been
1312 | The Effectiveness of Soy Bean, Oxcytocin Massage and Back Massage on Breast Milk
Production of Postpartum Mothers Systematic Literature Review
analyzed as many as 3 studies with a
true experimental design and 3 studies
with a quasi experimental design. The
results of research studies mostly state
that soybeans and their isoflavone
content have a positive effect on breast
milk production.
In accordance with the theory to
maintain the supply of breast milk, one
of the efforts that can be done is the
fulfillment of nutrients. Nutrients in
breastfeeding mothers have an
influence on the process of breast milk
production and also the recovery
process after childbirth.
36
Breastfeeding
mothers are advised to consume foods
that have sufficient nutritional value
such as vegetables, fruit, nuts and eggs.
Research with dietary intervention
on breast milk production based on the
significance and value of effect size
shows that the study conducted by Zhi
Huang in China is effective with p value
= 0.04 and effect size 1.09, but in this
study the intervention does not focus
on soybeans but the diet of
breastfeeding mothers, one of which is
there's soy milk. Based on the focus of
the intervention using soy milk, namely
a study conducted by Elika in Indonesia
with p value = 0.000, the effect size
value cannot be calculated because the
mean and standard deviation are not
shown. The next study with soy milk
intervention was the Weie Zhou study
in China, but the Weie Zhou study did
not show ap value but only a
correlation coefficient of 0.998 and a
weak effect size category of 0.49. Based
on the use of samples of breastfeeding
mothers, there are 4 studies, namely the
study conducted by Zhi Huang, Elika,
Lina Wang and Weie Zhou. There are 2
studies using rat samples, namely those
conducted by Adrina and Yusaku.
Based on the quality of the study, there
was 1 study in the poor category, 4
studies in the sufficient category and 1
in the good category, namely the study
conducted by Lina Wang.
B. The Effectiveness of Oxytocin
Massage on Breast Milk Production
Oxytocin massage is included in
complementary obstetric therapy.
When oxytocin massage is performed,
the hypothalamus will produce the
hormone oxytocin which is then
channeled to the posterior pituitary, the
hormone oxytocin goes to the
myoepithelial cells where it will secrete
breast milk. The anterior pituitary will
secrete the hormone prolactin where
the hormone prolactin is responsible
for producing breast milk.
Research with an intervention on
oxytocin massage on breast milk
production found results based on the
significance and value of effect size,
showing that the study conducted by
Kadek Yuli in Indonesia was effective
with ap value = 0.000 and an effect size
of 3.42, but in this study the
intervention not only focused on
oxytocin massage but also no breast
care intervention. Based on the focus of
the intervention using only oxytocin
massage, namely a study conducted by
Nurdiana in Indonesia with ap value of
< 0.05, the effect size value cannot be
calculated because the type of research
is one group so the mean and standard
deviation that appears is only the
Handayani, Masrifan Djamil, Sri Wahyuni, Shandy Wigya M
| 1313
intervention group.
C. Tapotage
Counter pressure, petrissage and
slow stroke back massage. Back
massage can provide a calming or
relaxing effect, making postpartum
mothers feel comfortable which can
then help the secretion of the hormone
oxytocin for breastfeeding.
18
Research with intervention on back
massage on breast milk production
based on the significance and value of
effect size shows that the study
conducted by Ni Made in Indonesia was
effective with p value = 0.001 and the
effect size category was strong, namely
1.52, but in this study the sample was
only 15 postpartum mothers. Based on
the focus of the intervention using only
back massage, namely a study
conducted by Ni Made and Anita in
Indonesia. Anita's study with an
average post-test score on the 3rd day
had a significant p value < 0.05, but the
weak effect size was 0.43. Subsequent
studies conducted by Fajar stated that
the combination of back massage with
acupressure increased milk production
p = 0.00. The back massage
intervention group itself also
experienced an increase in breast milk
production but the increase was most
in the combination group. Based on the
quality of the studies, the three studies
were categorized as good.
D. The Effectiveness of OKPU (Oxytocin
and Back)
Massage on Breast Milk Production
OKPU (Oxytocin and Back) massage is a
massage that uses oxytocin massage as
a basis and is combined with one of the
techniques of back massage. The
hormones that will be produced from
this oxytocin and back massage are the
hormones prolactin and oxytocin. The
hormone prolactin plays a role in the
production of breast milk and the
hormone oxytocin plays a role in the
process of milk secretion.
There are still few journal articles
discussing two interventions of
oxytocin massage and back massage,
therefore, as an illustration, researchers
analyzed the SPEOS intervention where
the intervention included oxytocin
massage and endorphin massage.
Endorphin massage is almost like a
back massage.
Research with OKPU massage
intervention (Oxytocin and Back) on
breast milk production based on the
significance and value of effect size
shows that the study conducted by Titik
in Indonesia is effective with p value =
0.001 and effect size category is strong,
namely 3.05. Actually in this study the
control group also experienced an
increase in the average milk production
but the increase was smaller than the
intervention group. The effect size in the
study conducted by Melyana also
shows a strong category, namely 1.82
for the loving massage group and 2.18
for the combination loving massage
and aromatherapy group. The study
conducted by Diah could not calculate
the effect size because it is one group.
Based on the focus of the intervention,
2 studies used the SPEOS intervention
and 1 study used the loving massage.
However, based on the quality of the
study, 1 study in the good category was
1314 | The Effectiveness of Soy Bean, Oxcytocin Massage and Back Massage on Breast Milk
Production of Postpartum Mothers Systematic Literature Review
conducted by Melyana in Indonesia and
2 studies in the sufficient category,
namely those conducted by Titik and
Diah Eka.
CONCLUSIONS
Interventions with soy, oxytocin
massage, back massage and OKPU
massage have a positive effect on
breastmilk production. Oxytocin massage
and OKPU massage proved more effective
based on significance value and effect size
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Commons Attribution (CC BY SA) license
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