POSTPARTUM 'S KNOWLEDGE ABOUT BREAST CARE AS EXCLUSIVE EFFORTS AT RS ST ELISABETH, BATAM CITY

Background : The puerperium is a recovery period after the birth process begins at the birth of the placenta, and ends when the reproductive organs return to normal, such as in a woman who is not pregnant. An effort is needed to increase milk production during the puerperium, one of which is breast care so that the rights of babies to get breast milk from their mothers are fulfilled. The purpose of this study was to determine the knowledge of postpartum mothers about breast care. Method : The research method used is descriptive, conducted at the hospital. ST Elisabeth Batam City, the research was conducted for 6 months, the population in this study were all postpartum mothers who were in the postpartum room of Elisabeth Hospital Batam City when the research took place, namely as many as 33 people, the sampling technique was carried out by using total sampling technique with research instruments using a questionnaire. Result : The results showed that the majority of good knowledge as many as 24 people (72.7%) and less knowledgeable as many as 9 people (27.3%). conclusion : The conclusion of this study most of the knowledge of postpartum mothers about breast care is Good. Suggestions for respondents to apply breast care properly in order to be able to provide breastfeeding exclusively


PRELIMINARY
The puerperium is a recovery period after the birth process begins at the birth of the placenta, and ends when the reproductive organs return to normal, such as in a woman who is not pregnant. Parents, especially mothers, need to have knowledge and readiness to conceive, give birth and breastfeed their children. Breast care is one of the important parts that must be considered in preparation for later breastfeeding, this is because the breast is an essential organ for producing breast milk, which is the staple food for newborns, so its care must be carried out as early as possible. In increasing breastfeeding for babies, the main problem and principle is that mothers need help and information and support to care for the breasts while breastfeeding their babies. During childbirth, it increases the confidence that they can breastfeed their babies properly and know the function and benefits of breast care during breastfeeding (Anwar, 2005in Nur, 2012 During the postpartum period, many problems will arise, one of which is the non-smooth release of breast milk. One way to deal with this problem is the implementation of breast care as a prevention against problems in breastfeeding during the puerperium and breastfeeding and postpartum mothers need proper breast care so that the mother's breasts remain healthy and their health status improves. Breast care during the puerperium is a treatment that is carried out to prepare the breasts to be in good condition while breastfeeding their babies, including breast hygiene care both before and after breastfeeding (5). dry. Caring for the breasts both during pregnancy and after childbirth, in addition to maintaining the shape of the breasts, it will also facilitate the release of breast milk Breast care during the puerperium is a treatment that is carried out to prepare the breasts to be in good condition when breastfeeding their babies, including breast hygiene care both before and after breastfeeding, nipple care and care for the nipples to keep them limp, not hard and not dry. Caring for the breasts both during pregnancy and after childbirth, in addition to maintaining the shape of the breasts, it will also facilitate the release of breast milk The non-smooth delivery of breastmilk can affect the mother not being able to provide exclusive breastfeeding to her baby. According to data obtained from breastfeeding infodatin in 2014, the percentage of babies who are exclusively breastfed in Indonesia is 54.3%. From this figure, North Sumatra Province ranks 4th in the coverage of babies who receive the lowest exclusive breastfeeding, namely 28,459 (41.3%), Maluku 3,332 (25.2%), North Sulawesi 6453 (34.7%) and West Java 195,323 (33.7%) Based on reports from the Indonesian Demographic and Health Survey (IDHS, 2007) over 25 years of age, one third of women in the world (38%) are found not to breastfeed their babies due to breast engorgement, and in Indonesia the coverage rate for exclusive breastfeeding reaches 32.3%.
Referring to the strategic plan target in 2015 in Indonesia of 39%, nationally, the coverage of exclusive breastfeeding for infants less than 6 months is 55.7% has reached the target. The coverage of breastfeeding in West Kalimantan itself has reached 68.4%, which means that it has reached the desired target (Indonesia Health Profile, 2015). With regard to breastfeeding, midwives have main tasks such as empowering breast care and overcoming lactation problems and monitoring the condition of the mother and babies (Rukiyah, 2008).
One of the problems with lactation that often occurs in postpartum mothers is swollen breasts. Swollen breasts usually occur in the first days of the baby's birth, this can occur due to late breastfeeding, less frequent expressing of milk and the limitation of time to breastfeed. In addition, the use of a tight bra and the condition of the nipples that are not clean can cause blockages in the ducts (Roische and Saryono, 2009).
In 2010 in Indonesia, the incidence of mastitis and subsequent nipple abrasions in breastfeeding was 55% due to improper breast care and 46% in Indonesia the incidence of breast milk dam was due to inadequate breast care. It is estimated that the number of mothers who experience problems with breast hygiene in Indonesia is estimated at 876,665 people and in North Sumatra it is around 40-60% Seeing how important the breast is as a producer of breast milk, the mother must also know the right breast care so that the baby can breastfeed immediately and get enough milk from the mother. Basically, breast care is not only done before childbirth but can also be done after giving birth (Sujiyanti et al, 2010). Breast care itself has the meaning of being an action taken to treat breasts, especially during the postpartum period to facilitate breastfeeding (Taufan Nugroho, 2014).
Postpartum breast care is a continuation of breast care during pregnancy (Sujiyanti et al, 2010). Breast care for nursing mothers is very important because one of its benefits is to accelerate the production of breast milk, which is the staple food for babies. Implementation of postpartum breast care starts as early as possible, namely 1-2 days after the baby is born, this is done 2 times a day (Sujiyanti et al, 2010).
Breast care is closely related to the knowledge of postpartum mothers, because with the support of good knowledge it will affect the attitude of the mother to carry out breast care properly, correctly and regularly so that the baby's rights to obtain breast milk will be fulfilled.
Research conducted by Aghnia Kamila conducted in 2014 with the title "The Relationship of Knowledge and Attitudes with Breast Care at the Banda Aceh Mother and Child Hospital" obtained a p-value of 0.001 0.005 so that the hypothesis Ha is accepted and Ho is rejected, this means that there is a relationship between the knowledge and attitudes of postpartum mothers with breast care.
A similar research was also conducted by Indah Nugharani in 2015 with the title "Postpartum Mother Knowledge Level about Breast Care at BPM Mulia Petirsari Pracimantoro Wonogiri". The results obtained from the research of 31 respondents, 4 people with good knowledge of post-partum mothers (12.9%), 20 people (64.5%) with sufficient knowledge and 7 people (22.6%) who had less knowledge about post-partum mothers. This study concluded that the level of knowledge of postpartum mothers about breast care at BPM Mulian Pertisari Pracimantoro Wonogiri mostly with sufficient knowledge level is as many as 20 respondents (64.5%) Lactation (breastfeeding) is the whole process of breastfeeding, starting from the production of breast milk to the process of the baby sucking and swallowing breast milk (Kristiyanasari, 2011). Exclusive breastfeeding is breastfeeding only for babies until the age of 6 months without additional fluids or other foods. Breast milk can be given until the baby is 2 years old (Rini & Kumala 2016). According to research, children who are not breastfed have an IQ (intellectual quotient) 7-8 points lower than children who are exclusively breastfed.
Factors that affect the smooth production of breast milk include breast care. Breast care is an activity that is carried out consciously and regularly to maintain breast health. Breast care is very important for mothers because it is a treatment procedure performed by patients or assisted by other people, usually starting from the first or second day after giving birth (Rosanah, 2015). The goal of breast care is to improve blood circulation and prevent blockage of the milk ducts, so that milk is excreted smoothly. Breast milk production and breastfeeding are influenced by two hormones, namely prolactin and oxytocin. Prolactin affects the amount of breast milk production, while oxytocin affects the process of expressing breast milk (Maritalia, 2012).
Based on the background, the authors are interested in conducting research and take the title Knowledge of Postpartum Mother about Breast care as an effort to provide exclusive breastfeeding

RESEARCH PURPOSES
This study aims to determine the knowledge of postpartum mothers about breast care as an effort to provide exclusive breastfeeding

RESEARCH METHODOLOGY
The research method used is descriptive, conducted at the hospital. ST Elisabeth Batam City, the research was conducted for 6 months, the population in this study were all postpartum mothers who were in the postpartum room of Elisabeth Hospital Batam City when the research was taking place, namely as many as 33 people, the sampling technique was carried out by using total sampling technique with research instruments using a questionnaire

DISCUSSION
Based on the research that has been done, from 33 respondents, it was found that 24 (72.7%) postpartum mothers had good knowledge.
Breast care during the puerperium is an act of caring for the breasts performed either by the patient or with the help of other people, which is carried out from the first or second day after delivery with the aim of facilitating breastfeeding, avoiding swelling and difficulty breastfeeding. The results of research conducted by Aghnia Kamila conducted in 2014 with the title "The Relationship of Knowledge and Attitudes with Breast Care at the Maternal and Child Hospital Banda Aceh" with the results showed that some respondents had good knowledge, namely 49 (57.0%) meanwhile some of the respondents had less knowledge, namely 37 (43.0%) From the research results, it was found that the majority of respondents fell into the category of the 20-30 year age group, while the least was the age group <20 years. According to Maritalia (2012), age will affect the ability and self-readiness of the mother to go through childbirth and breastfeeding This is in line with the research conducted by Safitri (2016) entitled factors affecting the smooth production of breast milk in breastfeeding mothers in Bendan Village, Banyudono District, Boyolali Regency, showing that most respondents are 21-35 years old while the least ones are <20 years old. In this study the researchers assumed that the age group of 20-30 years was included in the age group who had physical and emotional maturity. So that at this age it is easier to receive and digest the information obtained or given Breast care will be successful if the mother has knowledge of the benefits of breast care in increasing milk production (Atmawati, 2010). Nainggolan (2009) said that the success of a mother in giving exclusive breastfeeding cannot be separated from the factors that affect the quality and quantity of breast milk because with good knowledge, one's behavior can be directed towards better things.
According to Notoatmodjo 2003 Dalam Dina 2015 explains that education is any effort that is planned to influence other people, be it individuals, groups, or communities so that they do what is expected by education actors. Education is an important factor to make someone gain knowledge and become qualified, but we do not also forget that knowledge can also be obtained through a number of facts and experiences obtained, both personal experience and the experience of others. A good mother's knowledge can be influenced by several factors, one of which is education and information sources (Elvie Yanti, 2014) This research is in line with research conducted by Atmawati (2010) entitled the relationship between the level of knowledge of mothers about breastfeeding and post partum breast care behavior at the An Nissa Maternity Hospital in Surakarta, showing that most of the respondents are knowledgeable about breastfeeding and behave well towards breast care. 50%. In this study the researchers assumed that post partum mothers who often watched television, listened to the radio and received health education during the postpartum period to breastfeeding tended to understand more about breast care.
The results of the study also showed that the majority of respondents had high school education, while the least respondents were elementary school. According to Radharisnawati (2016), the higher the level of knowledge of breastfeeding mothers, the higher the knowledge and awareness of breastfeeding mothers to improve and regulate diet during breastfeeding so that it will affect the smooth production of breast milk. This is in line with the research conducted by Nugrahani (2015) entitled the level of knowledge of postpartum mothers about breast care at BPM Mulia Petirsari Pracimantoro Wonogiri, showing that most of the education is high school and the least is elementary school.
In this study, the researchers assumed that the higher a person's education, the more experience and information he would get, so that the more knowledge one would have.Respondents who are well informed this is due to their higher education level and postpartum mothers get information about breast care and have an interest in finding out about the importance of breast care, postpartum mothers are also able to find out, apply, analyze, synthesize and evaluate the importance of doing care breasts during the puerperium CONCLUSION From the research conducted, it can be concluded that the majority of good knowledge are 24 people (72.7%) and 9 people have less knowledge (27.3%).

For further researchers
It is hoped that further researchers can further develop their research, for example using more samples in order to obtain maximum results on the knowledge of postpartum mothers.

For Health Workers
In order to always improve education to post-partum mothers about breast care, the results of exclusive breastfeeding have increased both at the health center, posyandu or other health service places 3. For Respondents It is hoped that respondents will be more active in seeking information about mother and baby care, so that it can be applied in daily life