The Impact Of Endorphin Massage On The Efficient Production Of Postpartum Breast Milk In TPMB Sulastri,

. Initiating breastfeeding within the first day of delivery has been shown to decrease the likelihood of newborn mortality. It is specifically demonstrated to provide exclusive protection against diarrhea, respiratory infections, and pneumonia ASI. The project seeks to investigate endorphin massage's impact on smoothness development in postpartum women at TPMB Sulastri, S.ST., M.Kes in 2024.ASI stands for Automatic Speech Recognition. This research employs a quasi-experiment design utilizing a pretest-posttest control group strategy. The sample included of 14 participants in the intervention group and 14 participants in the control group. Purposive sampling techniques were employed. The instrument utilizes Standard Operating Procedures (SOP) and checklist sheets. A three-day Endorphin massage treatment was administered and assessed using the Mann-Whitney test. The study found that 50% of individuals had a moderate frequency of meal intake. The utilization rate of non-hormonal contraceptives was 71.4%. The weight of newborns does not exceed 100% of the BBLR. The gestational age at the time of labor is 100% accurate. The mean milk output of the intervention group was 2.6 before and 7.5 after. The mean of the control group was 2.5 before and 5.2 after. The endorphin massage significantly impacted the efficient production of breast milk in postpartum moms. This was evidenced by a p-value of 0.000 (< 0.05) and a positive Correlation Coefficient value of 0.88, indicating a highly robust association between the two variables. Ultimately, endorphin massage has a significant impact on facilitating the efficient production of breast milk in mothers throughout the postpartum period. It is desirable for lactating postpartum women to regularly engage in endorphin massage to ensure the continuous and unobstructed flow of breast milk during the entire two-year duration of breastfeeding.


INTRODUCTION
The well-being of mothers and young children is a key measure of a country's overall health, as seen by the elevated rates of Maternal Mortality (AKI) and Infant Mortality (AKB).Indonesia possesses the most elevated infant mortality rate among Southeast Asian countries.The primary factors contributing to infant mortality include diarrhea, malnutrition, and infections.Exclusive breastfeeding is a natural process that can effectively prevent and reduce infant morbidity and mortality.It has a positive impact on Kartini DOI 10.62885/medisci.v2i1.439| 67 pneumonia.Exclusive breastfeeding is a highly beneficial strategy for preventing complications related to BBLR, reducing stunting, and lowering the risk of obesity or chronic diseases (Mawaddah, 2022).
The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) advocate for the practice of nursing infants within the first hour after delivery, known as early breastfeeding initiation (EBI).During the Immediate Mother and Newborn Contact (IMD) process, the mother and baby will have direct skin-to-skin contact.This contact serves to enhance the mother's confidence and promote the successful practice of Exclusive Breastfeeding for a duration of 6 months, with the possibility of continuing for The process of lactation relies on the chemicals prolactin and oxytocin, which are secreted by the neurohypophysis.Prolactin is involved in the formation of breast milk, while oxytocin is involved in milk production.Both physical and psychological changes influence the lactation process.The functioning of the hormone oxytocin is modulated by psychological factors, stress, excessive anxiety, and discontentment (Arsi et al., 2021).
There are two main techniques to boost breast milk production: pharmacological procedures, which involve the use of drugs, and non-pharmacological methods, which do not involve the use of drugs.Pharmacological approaches are typically costly and have more pronounced adverse effects compared to non-pharmacological or complementary methods for enhancing breast milk production.These alternative methods, as stated in the Indonesian Minister of Health Regulation Number 6 of 2016, involve the use of plantbased substances or herbs such as papaya leaves, moringa leaves, mulberry leaves, green beans, lampes, anise, spinach, Bidara Upas, Blustru, Chicken Datap, Bitter Black Cumin, Jackfruit, Patikan Kebo, Pulai, Temulawak, and Turi.Additionally, relatively simple techniques like acupressure, acupuncture, aromatherapy, and massage can be employed (Yuliani et al., 2021).Massage therapy is a non-pharmacological remedy that is simple and secure to do in postpartum mothers.The patient's husband or family can also perform this intervention after receiving training from a midwife or health provider-therapeutic Kartini DOI 10.62885/medisci.v2i1.439| 68 manipulation of the body's soft tissues to improve physical and mental well-being.The postpartum period encompasses several relaxation methods that enable women to safely and gently care for their kids without experiencing excessive fatigue (Retnosari et al., 2022).
A nonpharmacological approach to enhance breast milk production is using endorphin massage, as Arsi et al. (2021) suggested.The endorphin massage technique is an alternate strategy to alleviate postpartum discomfort and promote relaxation.Endorphins are recognized as compounds that offer numerous advantages.Endorphin massage can enhance the synthesis of endorphin hormones and promote the activation of prolactin and oxytocin reflexes, resulting in an augmentation of breast milk volume and production (Umami et al., 2023).When this massage is administered to postpartum mothers, it can provide a feeling of tranquility and relaxation.This, in turn, enhances the reaction of the posterior pituitary gland during lactation, leading to an increased production of the hormone oxytocin.Consequently, the letdown reflex is heightened.According to a study conducted by Hidayati and Hanifah (2019), the utilization of endorphin and oxytocin massage techniques has been found to enhance breast milk production.This leads to a faster release of breast milk than no massage treatment.
According to the pre-survey data conducted by TPMB Sulastri Pagelaran, the report indicates that the researcher interviewed three postpartum mothers out of 15 individuals surveyed in a month.Among these mothers, two reported that their breast milk had not yet been produced, while one reported that although it had been produced, it was not flowing smoothly.The mother reported that when attempting to breastfeed, the infant continuously cried due to frustration over the lack of breast milk.The mother herself experienced anxiety over the same issue.Consequently, the family recommended resorting to formula milk.According to the interview findings, some mothers who regularly consume vegetables and fruits still experience difficulties in producing breast milk.One mother even tried using breast milk boosters, but the results were still unsatisfactory.As a result, formula milk was given to ensure the baby could sleep well.According to the midwife's account, among others, she stated that postpartum mothers cannot produce breast milk on the first day due to the inefficient release of breast milk, resulting in low milk production.
The duration of 0-3 days is necessary because, during this period, the mother undergoes preparations for the subsequent 3-8 days.This stage involves the transition from colostrum to breast milk.From the ninth day after giving birth until the commencement of the involution stage, breast milk production will be controlled (PMB Sulastri, 2024).
During gestation, the fetus develops using the mother's blood supply.After birth, this blood transforms milk, which serves as the optimal primary source of nutrition for the newborn.Breast milk is highly appropriate and optimal for a kid's growth, as it provides a mother with the reassurance that her child will be protected from diseases.
Mothers should nurse their children for two complete years, specifically for those who desire to excel in breastfeeding.Additionally, the father's responsible for providing nourishment and assistance to the mother through acts of kindness and customary practices.An individual is not burdened but rather by their level of capability.Parents should not endure suffering for their children; it is the responsibility of the successors to do so.If both individuals mutually agree and decide to stop breastfeeding (before the age of two) of their own free will and after discussion, they commit no wrongdoing or offense.Additional research by Pratimi et al. (2020) found that the average breast milk production before Endorphin Massage was 2.667 in the control group and 2.400 in the treatment group.After the massage, the control group showed an increase in breast milk production to 3.267 with a p-value of 0.259, while the treatment group had an average increase to 4.933 with a p-value of 0.001 (p < 0.05).The study concludes that Endorphin Massage substantially enhances breast milk production in moms after childbirth.Hidayati and Hanifah ( 2019) conducted identical research.The data analysis conducted using the Wilcoxon test yielded a p-value of 0.000.The study investigates the impact of the Massage Endorphins and Oxytocin method on breast milk production in breastfeeding mothers aged 0-6 months in Gading Village.
If the Qur'an mandates a task, it undoubtedly entails numerous advantages and benefits.Conversely, disregarding the command will result in flaws in human existence.
This paper aims to analyze the issues about breastfeeding mentioned in the Qur'an, specifically focusing on the interpretation of Surah Al-Baqarah verse 233.This verse, found in the order of the Qur'anic mushaf, states that mothers should breastfeed their children for two complete years for those who wish to fulfill the entire breastfeeding period.The father is responsible for providing sustenance and clothing for the mother through ma'ruf.An individual is not encumbered but rather by their level of capability.The researcher aims to investigate the impact of endorphin massage on the efficient production of breast milk in postpartum mothers at TPMB Sulastri, S.ST., M.Kes in 2024.

LITERATURE
Massage therapy is a non-pharmacological intervention that is easy and safe to do in postpartum mothers.The patient's husband or family can also carry out this intervention after being trained by a midwife/health worker.Postpartum massage is one of the relaxation methods; this method allows postpartum mothers to enjoy the process of releasing babies that are safe, gentle, and not quickly tired.Endorphin massage is a technique that provides a sense of calm and peace that can increase the release of endorphin hormones, hence the name Endorphin massage.This includes touch and light massage all over the body (Retnosari et al., 2022).
Massage endorphins are natural substances produced by the body and have many benefits.The most crucial benefit of endorphins is to inhibit the course of pain from the source of pain, namely the part of the body that has experienced trauma to the center or brain.If the release of endorphins in the body fails, pain will occur.The level of endorphins in each individual's body is different, so some people may feel more pain than others for the same type of pain.Endorphins are produced by the body itself and are known to be the body's best natural substance for pain relief.Endorphins can be triggered to be released through an endorphin massage.
According to Kuswandi, Endorphin massage is a light massage technique or gentle touch on pregnant women that triggers Endorphins released by the body so that pregnant women feel calm and comfortable.Endorphin massage is better done before the delivery process takes place.(Masning et al., 2017).

Purpose of Endorphine Massage
1. Normalizes heart rate and blood pressure 2. Improves relaxation 3. Releases endorphins 4. Inhibiting the transmission or sending of pain messages (Masning et al., 2017).

Benefits of Endorphine Massage
Endorphins are known as substances that have many benefits.Mongan thinks gentle massage can trigger substances, such as endorphins, to be removed.Endorphins It is known to release oxytocin, which is a hormone in the body that is needed during childbirth so that it can reduce pain.In addition to releasing substances, Endorphinsmassage Endorphins also has other benefits, namely controlling growth hormone and sex, controlling stress or frustration felt by the body, boosting the immune system, and reducing symptoms of eating disorders.In pregnant women, it is vital to do an endorphin massage.A gentle massage or delicate touch given to pregnant women both before and during childbirth can give the mother a calming and comfortable effect.This is because Endorphin massage can make the heart rate and blood pressure normal through the surface of the skin so that the mother feels relaxed (Masning et al., 2017).Endorphin massage can also reduce the severity of postpartum Blues in postpartum mothers (Retnosari et al., 2022).

Endorphine Massage Procedure
Endorphins are polypeptides produced by the body for pain relief.Endorphins can be triggered to be released by doing meditation activities, taking deep breaths, and eating spicy foods, or it can also be done by means of chiropractic therapy, acupuncture, and massage.How to do an Endorphin massage is: 1. Advise the mother to choose the most comfortable position possible.The position can be done by sitting or lying on its side to the left or right.Ask the husband to accompany his wife by sitting comfortably next to or behind her.
2. Ask the mother to take a deep breath with both eyes closed for a few moments to relax the mother.Pour lemongrass oil to make it easier to massage the palms.Then, gently stroke the outer surface of the mother's arm, starting from the upper arm to the forearm, using the fingertips.
3. After about 5 minutes, do the same on the other arm.
4. Similar actions can be performed on other parts of the body, such as the palms, neck, shoulders, and thighs because even if only a gentle touch is given, the mother can feel more relaxed and comfortable.
5.Then, perform actions on the mother's back.Advise mothers to choose a comfortable position, either sitting or lying on their sides.Next, gently massage the mother starting from the neck, forming an inverted V from the neck and moving towards the side of the ribs.
6.After that, the massages are done down the shoulders, back, buttocks, and tailbone grooves, encouraging the mother to relax.
7. When getting a massage, say words that can calm your feelings, like "relax and be happy."Husbands can also express words of love to their mothers when actions are carried out, such as "I am able to breastfeed comfortably." 8. After doing all the actions, ask the husband to hug the mother so that she feels more comfortable and create a calming and touching atmosphere (Masning et al., 2017).(Masning et al., 2017).

Indications and Contraindications of Endorphin Massage
The indications of this endorphin massage are people who are experiencing stress and pain, such as pregnant women who enter 36 weeks of pregnancy.At this age, the massage can stimulate the release of endorphins and oxytocin hormones, which can trigger contractions.
Contraindications of Endorphin massage are: 1. Presence of swelling or tumors 2. Presence of hematomas or bruises 3. Hot temperatures on the skin

Presence of skin diseases
In pregnancy: early pregnancy or not yet a term, amniotic fluid premature rupture, high-risk pregnancy, uterine contraction disorders (Masning et al., 2017).

Endorphin Massage Treatment
Based on research conducted by ( 2020 sampling, which is based on inclusion criteria, which are assessed based on six criteria, namely the frequency of baby bowel movements and bowel movements, the color of urine and feces, the length of sleep after breastfeeding, and the baby's weight loss is not > 10%.
Postpartum mothers on the third day who entered the inclusion criteria: 15 mothers in the treatment group were given Endorphin massage for three days from day 3 to day five postpartum while 15 mothers in the control group were not given Endorphin massage.
Another research conducted by Halimah Pawestri (2022) The method in this scientific paper uses a descriptive approach with a case study approach through nursing care.The inclusion criteria in this case study were: (1) Patients with compositional/nonanalytic consciousness; (2) Patients can be positioned at an angle; (3) Breasts are no problem.The patient was given endorphin massage and suggestion for 30 minutes every day and given three consecutive days, and breast milk was calculated cumulatively using a measuring cup every day.The massage is done twice a day, namely at 07.00 WIB and 08.00 WIB.Anxiety that arises in mothers is evaluated using the Hamilton Anxiety Rating Scale (HARS).

Use of Oil Massage
Massage oil usually uses essential oils that can be easily absorbed into the skin tissue and stimulate the sense of smell.The content of massage oil consists of essential oils whose properties and mixed properties can be combined according to their properties and purpose.If there is a wrong process when combining, it will cause the massage oil mixture to become less valuable and give an unwanted aroma.A good massage oil does not have an allergic effect on its use because it uses natural ingredients.Massage oil can be used as a means of massage.Massage oil can speed healing by applying and massaging it on the sore spot.This massage process will stimulate the process of launching blood flow and body fluids and help the body relax.Massage oil aromatherapy from the purification of citronella oil has a soft, smooth texture and does not have coarse grains (Tanjung & Pangaribuan, 2018).

METHOD
The types of research used in this study are quantitative, namely research that uses sampling techniques to obtain findings that can be expressed numerically and manipulated mathematically (Hardani et al., 2020).The design used in this study is a quasi-experiment with the following approach: In this study, the researcher used a design Pretest-Posttest Control Group Design, which is in line with the opinion (Sugiyono, 2019)  Using this design, the experimental and control groups have the same characteristics because they are randomly taken from a homogeneous population.In this design, both groups were first given a preliminary test (pretest) with the same test (Sugiyono, 2019).
The method is to apply a treatment condition to one experimental group and then compare the results with those of a control group not subject to treatment conditions.
Utilizing a checklist, this study administered a pre-test to assess breast milk production in postpartum moms (O1) and (O2) prior to therapy.The experimental group received a three-day treatment called Endorphin Massage (X), while the control group received breast care (O).After the treatment, both groups underwent a post-test to measure milk production in postpartum mothers.The intervention group (O3) and the control group (O4) were assessed on the third day using a checklist sheet.The endorphin massage is administered over a period of three days, with an indeterminate time occurring five times daily.Each massage lasts between 3 and 5 minutes, and there is a 30-minute break between each session.The structure of this research design is as follows: Inclusion criteria are the criteria or characteristics that need to be met by each member of the population that can be taken as a sample.Meanwhile, the exclusion criteria are the characteristics of population members that cannot be taken as a sample.(Notoatmodjo, 2018).
The inclusion criteria for this sample are: 1. Mothers who are willing to be research respondents

Mothers who do not consume cigarettes and alcohol
The Exclusion Criteria for this sample are: 1. Drink booster breast milk 2. Already familiar with formula milk 3.No IMD

Data Collection Tools and Methods
The data used in this study is primary data obtained directly from the results of observation and intervention in postpartum mothers on days 0-3 at PMB Sulastri, SST., M.Kes, Pagelaran District, Pringsewu Regency.

Research Tools/Instruments
Research instruments are tools that will be used to collect data.(Notoatmodjo, 2018).
The researcher used instruments such as observation sheets (Checklist) and SOP Endorphin Massage to measure instruments in this study.

Data Collection Methods
The data collection technique is a method or method used by the author to collect data, which the author will later use to obtain materials, information, and information related to the research.The data collection method in this study is primary data collected   According to Table 4, newborn newborns' weight frequency distribution data primarily came from babies born without BBLR.Specifically, 28 individuals (100%) at TPMB Sulastri, S.ST., M.Kes contributed to this data.According to gestational age frequency distribution data during childbirth in Table 5 was primarily collected by 28 individuals (100%) at TPMB Sulastri, S.ST., M.Kes.

Univariate Analysis Intervention
Kartini DOI 10.62885/medisci.v2i1.439| 79 Table 6 indicates that the consistent production of pre-test breast milk with endorphin massage treatment yielded an average value of 2.6, with a minimum value of 2 and a maximum value of 4. After the endorphin massage treatment, the post-test resulted in an average score of 7.5, with a minimum score of 7 and a maximum score of 8.This indicates an increase in the average production of smooth breast milk in postpartum mothers after receiving the endorphin massage treatment at TPMB Sulastri, S.ST., M.Kes in 2024.Table 7 reveals that the control group achieved an average value of 2.5, with a minimum value of 2 and a maximum value of 4, in the smooth production of pre-test breast milk (before).After the post-test, the control group's therapy yielded an average score of 5.2, with a minimum value of 4 and a maximum value of 7. Consequently, there was a rise in the mean value of the lactation output in the control group of postpartum moms at TPMB Sulastri, S.ST., M.Kes in 2024.The normality test findings are presented in Table 10, where the Shapiro-Wilk test was employed due to the sample size being less than 50 responders.The normality test findings indicate that the breast treatment after group had a normal distribution.However, the endorphin massage before and after group, as well as the control group of breast care before, showed non-normally distributed data values.Furthermore, the variables that impact food consumption and the utilization of contraceptives were shown to have nonnormal distribution both before and after the data collection.Testing for the variation in birth weight and gestational age before and after childbirth cannot be conducted due to the

Bivariate Analysis Disruptive Variables
Table 9 presents the statistical analysis results conducted using the Mann-Whitney test.Based on the disturbing variable, the test reveals a significant disparity in the average values between the two groups.Furthermore, no correlation is observed between food intake, contraceptive use, birth weight, and gestational age at childbirth, as indicated by a p-value greater than 0.05.The data presented in table 10 indicates that the Mann-Whitney test revealed a significant difference in mean values between the two groups.Specifically, the smooth breast milk production in the intervention group showed a mean value of 4.9 before and after the intervention, with a p-value of 0.000, which is less than the significance level of 0.05.This indicates that the hypothesis Ha is supported and the null hypothesis Ho is rejected.This implies that there is a significant effect of endorphin massage on the smooth production of breast milk in postpartum moms at TPMB Sulastri, S.ST., M.Kes in 2024.
The correlation coefficient value of 0.88 further confirms that the two variables have a strong association.

Distribution of Frequency of Feeding Intake, Use of Contraceptives, Weight of Newborn Babies, and Gestational Age During Childbirth
The food intake data of postpartum moms was mostly derived from a sample size of 14 individuals, constituting 50% of the total participants, as indicated by the distribution of feeding frequency data.The utilization of contraceptives mostly stemmed from the adoption of non-hormonal contraceptives by a total of 20 individuals, accounting for 71.4% of the sample population.The weight of newborns primarily determined the weight of newborns without Birth Before Last Menstrual Period (BBLR), comprising 28 individuals (100%).The gestational age at childbirth was primarily determined by 28 individuals (100%) at TPMB Sulastri, S.ST., M.Kes.
Various factors can influence the production of breast milk, including diet, mental well-being, contraceptive usage, breast hygiene, breast structure, physiological conditions, sleep patterns, frequency of breastfeeding, infant's suction strength, birth weight, nutrition during pregnancy and childbirth, and the consumption of cigarettes and alcohol.(Azizah and Rosyidah, 2019).
Prolactin is influenced by maternal nutrition, with higher levels of nutritional intake resulting in increased milk production.Nevertheless, the hormone oxytocin is essential for the production of breast milk, and the baby's sucking influences its function.Increased frequency of infant suckling stimulates greater production of breast milk.Oxytocin is commonly known as the hormone associated with affection.This is because the level is significantly impacted by factors such as mood, happiness, love, security, calmness, and comfort.(Azizah and Rosyidah, 2019).
Researchers hypothesize that dietary intake, contraceptive use, birth weight, and gestational age during childbirth significantly influence the breastfeeding process in the levels.According to Rosyidah (2019), it has been demonstrated that breastfeeding mothers who nurse between 8 to 12 times in a 24-hour period have an increase in prolactin levels, as well as an increase in serum prolactin levels.Oxytocin is a hormone that is involved in the production of breast milk.It stimulates the let-down reflex.The secretion of breast milk from the alveoli to the lactiferous duct is facilitated by the let-down reflex, also known as the Milk Ejection Reflex (MER).Due to the baby's suction stimulus, the hypothalamus will transmit a signal to the posterior pituitary gland, prompting the release of oxytocin.
Oxytocin activation induces contraction of the myoepithelial cells surrounding the alveoli within the mammary glands.Contraction of myoepithelial cells propels milk from the active duct into the active sinuses, making it ready for expulsion when the baby sucks on the nipple.Oxytocin release is affected by the baby's suction stimulation, leading to nipple erection that facilitates milk production by transporting it from the active sinuses to the nipple pores.Furthermore, oxytocin is a hormone that can induce uterine contractions both during labor and in the postpartum period.This can help prevent excessive bleeding after childbirth and speed up the process of the uterus returning to its normal size.The let-down reaction, also known as the Milk Ejection reaction (MER), can be enhanced by happy emotions, positive thoughts, a strong connection between the mother and the infant, as well as the baby's unique sounds and odors that the mother perceives.Postpartum women may experience a decrease in metabolic energy rate (MER) due to anxiety, stress, and discomfort.
Massage therapy is a non-pharmacological remedy that is simple and secure to do in postpartum mothers.After receiving training from a midwife or health worker, the patient's husband or family members can also do this intervention.Postpartum massage is a relaxation technique that enables moms after childbirth to experience a safe, gentle, and rejuvenating process of releasing tension and fatigue.Endorphin massage is a technique that promotes a feeling of tranquility and serenity, leading to an enhanced production of endorphin hormones.Hence, it is referred to as endorphin massage.This encompasses tactile and gentle manipulation applied to the entire body (Retnosari et al., 2022).
According to a study conducted by Pratimi et al. (2020) The study findings revealed that the average breast milk production prior to Endorphin massage in the treatment group was 2,400, whereas the average increase in breast milk production in the treatment group was 4,933.Additional research carried out by Magfirah (2021) The According to the assumption of the researcher, breastfeeding mothers are recommended to do endorphin massage on the first day to the third day so that the stage where there is a balance of milk production starting from the ninth day of the postpartum mother to the beginning of the involution stage runs smoothly, in the research conducted by the researcher it was found that there was an increase in postpartum maternal production for an average of 3 days after the massage was carried out.Postpartum mothers who have been given endorphin massage have been proven to increase the smoothness of breast milk production compared to those who are not given endorphin massage; this is because, during endorphin massage, mothers are also motivated to breastfeed their babies so that they feel more comfortable and feel more confident to breastfeed their babies so that they facilitate breast milk production in mothers.

Control
Table 9 reveals that the control group achieved an average value of 2.5, with a minimum of 2 and a maximum of 4, in the smooth production of pre-test breast milk (before).Following the post-test, the control group's therapy resulted in an average score of 5.2, with a minimum value of 4 and a maximum value of 7. Consequently, there was a rise in the mean smooth milk production among postpartum mothers in the control group at TPMB Sulastri, S.ST., M.Kes in 2024.
Lactation is the physiological process of synthesizing and secreting breast milk.This process occurs in the alveoli, which are small sacs located within the lobes of the breast.
The alveoli are surrounded by myoepithelial cells, which have the ability to stimulate the nerves in the myoepithelium.This stimulation leads to contractions that facilitate the movement of milk into the active ducts.Breast milk is retained in the lactiferous duct until it is triggered by stimulation.The Milk Ejection Reflex (MER) triggers the contraction of the myoepithelial cells surrounding the lactiferous duct, resulting in the secretion of milk through the nipple (Azizah & Rosyidah, 2019).
Multiple issues frequently arise throughout the process of breastfeeding.
Specifically, the mother may have symptoms such as stress, nipples that are flat or sunken, nipples that are blistering or painful, breasts that are swollen, milk ducts that are obstructed, or mastitis.The production of breast milk itself is the inhibiting element in breastfeeding.Inadequate lactation and sluggish milk ejection might result in insufficient up to 2 years (Ministry of Health of the Republic of Indonesia, 2021).The government should develop a Government Regulation on Exclusive Breastfeeding to comply with the provisions of Article 129 paragraph (2) of Law Number 36 of 2009 concerning Health.The Pagelaran Health Center has implemented initiatives to facilitate the optimal production of breast milk through the provision of health education and nutrition counseling (Pringsewu Health Office, 2022).
), The research sample was 30 postpartum mothers with inactive breast milk production, which was divided into two groups, namely 15 mothers in the group that was given treatment Endorphin Massage and 15 mothers in the control group.The Non-Probability Sampling determines the sample use accidental Kartini DOI 10.62885/medisci.v2i1.439| 74 mothers who immediately breastfeed their babies at birth (IMD) 4. Child suction factor or frequency of breastfeeding (Babies generally breastfeed 8-12 times within 24 hours.The length of breastfeeding varies and generally lasts between 20 to 30 minutes, with an estimated minimum of 15 minutes for one breast).5. Rest pattern (6-8 HOURS) 6. Mothers who do breast care 7. Mothers with normal breast anatomy 8. Mothers who have good family support/mothers do not have stress factors.
. Due to the absence of a normal distribution in the data, the study used a nonparametric bivariate correlation test called the Mann-Whitney test.
the T-test yielded an average value of 8.50 for the treatment group Endorphin Massage.
Endorphins Consisting of morphine, called morphine, belong to the opioid group, which occurs in suppresses the occurrence of pain.Endorphins are one of the compounds neuropeptides, endorphins.Endorphin massage is a residue of lipoprotein amino acids that bind to opiate receptors (opium) in various regions of the brain.The pituitary gland, situated beneath the brain, is responsible for the production of endorphins.Endorphins are a mixture of naturally occurring substances and morphine.Therefore, it can be inferred that the endorphin hormone acts as a morphine.Some individuals even claimed that his strength exceeded that of Morphine by a factor of 200.Our bodies naturally create endorphins.Endorphins can be excreted or created through several methods, such as relaxation techniques (deep breathing, laughter, smiling, hypnosis), exercise (which helps eliminate chemicals in the body), acupuncture treatments, meditation techniques focused on positive thinking, and massage.Endorphins bind to opiate receptors in our brains to alleviate pain.The release of endorphins helps to alleviate both tension and pain.Unlike opiate medicines such as morphine and codeine, endorphins are naturally created by our body and do not lead to addiction or dependence

Table 1 . Research Design
For the characteristics of the sample not to deviate from the population, before sampling is carried out, it is necessary to determine inclusion and exclusion criteria.Kartini DOI 10.62885/medisci.v2i1.439| 76

Table 8 .Results of Shapiro-Wilk Normality Test
A data normality test is performed before conducting the T-test to ascertain if the data follows a normal distribution.The Kolmogorov-Smirnov/Shapiro-Wilk normality test determines if the data is normally distributed.If the value of Sig. is greater than 0.05, it indicates that the data is typically distributed.If the significance value (Sig.) is less than 0.05, then the data is considered to be non-normally distributed.