THE IMPACT OF HANDS ON PUMPING ON THE LEVEL OF BREAST MILK PRODUCTION ON POST PARTUM MOTHERS

The exclusive breastfeeding in Indonesia has not yet reached the national level target. Data from Private Hospital in West Jakarta found that there were only 60% of mothers who gave exclusive breast feeding in 2016, 38% of whom said they were unsuccessful due to low breast milk. The method that can be used to increase milk production is Hands on Pumping (HOP) technique, HOP is a technique of flushing the breast milk by relying on the strength of our thumb and index finger. To observe the effect of HOP on breast milk production in post partum mothers. We employed a quasi experimental design with pre and post test design, with the control group. The sample size was 68 mothers post multiparous partum with criteria 34 as the HOP experimental group and 34 post partum mothers as the control group (without HOP). On the third day of the intervention group there was a significant increase in breast milk production from the first day. The experimental group received HOP intervention (34 mothers) with a rise of 121.08 ml. This means that there is a difference in milk production before and after treatment. On the third day, the results of the p value are 0,000, with p value <0.05, which brought to the conclusion that there was an influence of HOP on breast milk production. HOP can significantly increase milk production. Next researcher is recommended to conduct similar research by paying attention to other factors that also affect breast milk production, such as psychological, nutrition, maternal breast conditions, and hormones.


INTRODUCTION
Breast milk is the best food for babies created by God because its content is rich in nutrients, vitamins, minerals, antibodies that are suitable for the baby's needs (Roesli, 2009) (Amarille, 2016). Another factor that inhibits exclusive breastfeeding because 25% of patients complain of pain while breastfeeding, 20% of patients complain of anxiety and fear of lack of milk production, and 12% of patients said they did not know or did not understand how to put their baby in the right position and attachment while breastfeeding.
Factors that can inhibit the failure of exclusive breastfeeding in infants are often due to lack of milk production flowing smoothly and rapidly (Perinasia, 2012).
One technique for increasing breast milk production is Hands On Pumping (HOP), which is one of the nursing interventions in health services. HOP technique is the technique of flushing the breast milk using hands by relying on the strength of our thumb and index finger (Perinasia, 2012).

METHODS
This study is a quasi-experimental research design using pre-post test design with control group that takes measurements at the beginning and at the end of the study (Notoatmodjo, 2010  The table above shows a significant increase in milk production from the first day of the intervention group receiving HOP intervention with an increase of 121.08 ml. This means that there is a difference in milk production between before and after treatment. On the third day of P value 0,000, p value <0,05 concluded that the influence of HOP on milk production. The stimulation that results from the muscles of the breasts generated by HOP techniques stimulates smooth muscle contraction, and the stimulation is useful to activate and increase the production of breast milk (Perinasia, 2012, Roesli, 2010.  The table above illustrates that there is a similar increase in breast milk production in the mothers of the intervention group and control group, it can be seen from the increase in breast milk production on the first day of the two groups until the third day. The intervention group had an increase in breast milk production at 122.76 ml, which is far more than the control group.

RESULTS AND DISCUSSION
The third day is a period of lactoginesis II where the breast that has been stimulated from the baby's mouth during breastfeeding can increase milk production more than that in the mothers who do not breastfeed their babies (Biancuzo, 2003;Evariny, 2008 (Bahiyatum, 2008;Perinasia, 2012;Dahl, 2015).
The similarity of the increase in breast milk production on the third day of the two respondents based on the results of the study can be seen from the fact that the two groups did the same thing to breastfeed their babies as early and as activelyas possible. In the beginning of the study, researchers began the Early Breastfeeding Initiation known as IMD. Baby's skin contact with mother's skin stimulates the production of oxytocin and prolactin in mothers to increase milk production (Roesli, 2008).
The increase of breast milk production on the third day was an average of 11.52 ml.
Both respondents have a difference in the amount of breast milk production produced by 111.24 ml. This research is in line with the theory of breastmilk formation in lactogenesis II that on the third day after birth the breasts will experience fullness of breast. The volume of breast milk will increase because of the stimulation caused when the mother is breastfeeding and when the mother is doing HOP which is one way to increase breast milk production (Susanto, 2009). The