RELATIONSHIP OF EXCLUSIVE BREASTFEEDING WITH UTERINE INVOLUTION

Introduction: Process Breastfeeding affects the decrease in fundal height. that mother having impaired lactation will hinder the process of uterine involution which will result in bleeding. one way to prevent bleeding during puerperium is to give ASI as early as possible maybe the baby. Methods: This study uses an analytical method with a cross sectional approach. The sampling technique was non probability with accidental sampling method, where the researcher collected samples until fulfilled at PMB Nisbahningsih Gresik as many as 21 postpartum mothers. Results: The test results as many as 21 post partum mothers with statistical analysis used contingency coefficient test showed a p = 0.005 < α = 0.05, there was a significant the relationship of exclusive breastfeeding with uterine involution process in postpartum mothers at PMB Nisbahningsih gresik. Conclusions: The results of this study it can be concluded thah that there is a relationship between exclusive breastfeeding on uterine involution. Therefore it is expected that post partum mothers give exclusive breastfeeding to their babies so that the process of runs normally.


INTRODUCTION
Uterine involution is a change which is the process of returning the uterus and the birth canal after the baby born until it reaches a prepregnancy state.These changes occur in the uterus, that is the muscles of the uterus and decidua.Exclusive breastfeeding will stimulate an increase in uterine contractions, thus facilitating lochia discharge and marked by a decrease in the height of the uterine fundus (Prawirohardjo, 2019) (sARWONO,2019).Currently there are still many postpartum mothers who do not give exclusive breastfeeding.(Agustia et al., 2019) (Agustia et al., 2019) The Ministry of Health noted that in Indonesia, as many as 66% of babies receive exclusive breastfeeding (INDONESIA, 2021) (Ministry of Health 2021).Budiharja, Director General of Nutrition and Maternal and Child Health (KIA) at the Ministry of Health, said that the main problem with low breastfeeding in Indonesia is socio-cultural factors and a lack of knowledge about pregnant women, families and society.
Meanwhile, based on the preliminary study of researchers conducted on May 5, 2022, 25 people who gave birth, 16 (64% of people) gave exclusive breastfeeding, and 9 (36% of people) did not give exclusive breastfeeding.Of the 9 people who experienced hemorrhage, 3 (33.33% of people) and 6 (66.67% of people) did not experience hemorrhage.
Infants who do not receive breast milk only drink formula milk very often suffer from malnutrition.Whereas in the mother it will cause involution to slow down and hemorrhage may occur (Padlilah, R., Ariyanti, R., 2019) (Padlilah R, 2019).Based on the background above, the researcher is interested in conducting research with the title "The Relationship Of Exclusive Breastfeeding With Uterine Involution Process In Postpartum Mothers At PMB Nisbahningsih Gresik".

MATERIALS AND METHODS
This research was analytical with a cross-sectional approach.In this study was used a non-probability sampling technique with an accidental sampling technique.Samples were 21 respondent postpartum mothers.All samples postpartum mother who came to visit 1 week after birth at PMB Nisbahningsih Gresik.Data collection technique used a observation sheet and questionnaire.Analysis of data were done using the Chi Square Test.Based on table 5.5 at getting data 21 post partum mothers, given exclusive breastfeeding 14 post partum mothers (67 %) and not exclusive breastfeeding 7 post partum mothers (33 %).Based on table 5.5 at getting data 21 post partum mothers, most of the uterine involution were appropriate 12 post partum mothers (57%) and almost half of the uterine involution were not appropriate 9 postpartum mothers (43%).

The relationship of exclusive breastfeeding with uterine involution process in postpartum mothers
Table 3. Cross Tabulation of the relationship of exclusive breastfeeding with uterine involution process in postpartum mothers at PMB Nisbaningsih Gresik, Juli 2022.The results show the relationship of exclusive breastfeeding with uterine involution process in postpartum mothers at PMB Nisbaningsih Gresik analyzed with contingency coefficient test X2 count = 7.87 > X2 table = 3.84 with a significant level of p = 0.005 < α = 0.05, so it can be concluded that there is a relationship between exclusive breastfeeding and the process of uterine involution in postpartum mothers at PMB Nisbaningsih Gresik

Exclusive breastfeeding for postpartum mothers at PMB Nisbaningsih Gresik
Based on the results of the study, it was shown that most of them gave exclusive breastfeeding, 14 postpartum mothers (67%), and almost half of the mothers who did not provide exclusive breastfeeding 7 postpartum mothers (33%).
There are still many mothers who do not give exclusive breastfeeding to their babies.This is because there is encouragement from the family if the baby is only given breast milk the baby will not be full.Even though exclusive breastfeeding has benefits for the baby and for the mother.Benefits for babies include calories from breast milk to meet the needs of babies until the age of six months, breast milk contains protective substances, strengthens the bond between mother and child.The benefits for the mother are preventing postpartum hemorrhage and accelerating the return of the uterus to its original shape, accelerating the mother's return to her pre-pregnancy weight, delaying fertility.

Uterine involution in postpartum at PMB Nisbaningsih Gresik
Based on the results of the study, it was found that out of 21 postpartum mothers, the majority of uterine involutions were appropriate 12 postpartum mothers (57%), while 9 (43%) of postpartum mothers had inappropriate uterine involutions.
Appropriate uterine involution can be due to exclusive breastfeeding, but not only exclusive breastfeeding can cause the uterine involution process to go well.There are other factors, namely early mobilization affecting uterine involution because if the mother does not mobilize early the involution process will run slowly.Parity affects uterine involution because women who are pregnant or give birth too often, their elasticity will decrease because they are stretched too often.And women who are old can also affect uterine involution because they experience a decrease in muscle elasticity and a decrease in muscle tension so that it is difficult for the uterus to return to its original state.

Relationship Of Exclusive Breastfeeding With Uterine Involution Process In Postpartum Mothers at PMB Nisbaningsih Gresik
The statistic test using the contingency coefficient test formula using the SPSS computer, the contingency coefficient test obtained a value X2 7.87 < X2 3.84 with a significance level of p = 0.005 < α = 0.05, so it can be concluded that Ho is rejected, which means there is a relationship of exclusive breastfeeding with uterine involution in postpartum women at PMB Nisbaningsih Gresik.
Exclusive breastfeeding will stimulate an increase in uterine contractions, thus facilitating lochia discharge and is characterized by a decrease in the height of the uterine fundus (Manuaba, 2017) (Manuaba, 2017).In accordance with the theory (Rosad, 2015) Suparyanto ( 2015), in the breastfeeding process there is a let down reflex from the baby's sucking which stimulates the posterior pituitary to secrete the hormone oxytocin which is carried by the blood towards the uterus and helps the uterus to contract so that the process of uterine involution occurs.Exclusive breastfeeding can affect uterine involution.Exclusive breastfeeding it will stimulate an increase in uterine contractions, thus facilitating lochia discharge and is characterized by a decrease in uterine fundal height (Manuaba, 2017) (Manuaba, 2017).In accordance with the theory (Rosad, 2015) Suparyanto ( 2015), in the breastfeeding process there is a let down reflex from the baby's sucking which stimulates the posterior pituitary to secrete the hormone oxytocin which is lifted by the blood towards the uterus and helps the uterus to contract so that the process of uterine involution occurs.Therefore exclusive breastfeeding can affect uterine involution.

CONCLUSIONS
The conclusion studies are most postpartum mothers at PMB Nisbahningsih Gresik give exclusive breastfeeding, most postpartum mothers at PMB Nisbahningsih Gresik uterine involution runs normally and significant the relationship of exclusive breastfeeding with uterine involution process in postpartum mothers at PMB Nisbahningsih gresik

Table 1 .
Breastfeeding Distribution Characteristics of respondents based exclusive breastfeeding at PMB Nisbaningsih Gresik, Juli 2022.