Management of Expressed Breast Milk as a Strategy to Optimize of Exclusive Breastfeeding

Exclusive breastfeeding had many benefits for mothers and babies. Maternal employment was one of the factors that was closely related to the decline in exclusive breastfeeding coverage. Therefore, there was a need for education for mothers of toddlers to continue providing breast milk even though they were working. This community service program aimed to provide education to mothers of toddlers on how to manage expressed breast milk so that even though the mother was working, her child still received breast milk. The method used was to provide health education about the importance of exclusive breastfeeding and procedures for managing expressed breast milk. The number of Posyandu Balita participants was 123 toddlers and their mothers


INTRODUCTION
Breastfeeding is a common method of providing breast milk as a food supply for infants and young children.It is the cheapest and simplest method to meet the baby's nutritional needs.Breast milk will improve sensory and cognitive abilities and protect children from infectious and chronic diseases.Poor infant feeding practices may impact on children's growth and development (Pareek, 2019).Exclusive breastfeeding (EBF) is a method of giving breast milk merely for infants to provide complete nutrition in the first 6 months of life (Charlick et al., 2019).Exclusive breastfeeding has many benefits for mothers and babies.For babies, EBF can reduce infant mortality due to common infectious diseases, help recovery, and increase children's immunity.Regarding its benefits for mothers, EBF is a safe feeding method that can protect mothers from the risk of ovarian and breast cancer and reduce obesity (Charlick et al., 2019).
Although EBF has been proven to have a positive effect, the coverage of EBF is still very low.Globally, the coverage of EBF was 30-50% (Laksono et al., 2021), but was around 35,7% in Indonesia (Laksono et al., 2021), 67% in East Java (Profil Kesehatan Provinsi Jawa Timur, 2023), and 59,3% in Kediri District (Profil Kesehatan Kabupaten Kediri Tahun 2022, 2022).Maternal employment is one of the factors that is closely related to the decline in exclusive breastfeeding coverage.Mothers working on a work-from-office (WFO) basis give breast milk to their babies before they are 6 months old as a substitute for breast milk and as a complement to breast milk.WFO working mothers provide breast milk substitutes at the age of 3-4 months because maternity leave has ended.In contrast, WFO working mothers who provide breast milk along with breast milk feel that the breast milk they receive is not enough for the baby's needs.In line with research by Mustika (2017), which concluded that maternal employment factors have a significant impact on exclusive breastfeeding.Working from the office (WFO) is a challenge for breastfeeding mothers because they have to schedule time to express breast milk between working hours.Based on the background above, it is necessary to design counseling/socialization about increasing knowledge and the manner to give EBF.

METHOD
The community service program was carried out at the Posyandu Balita in Pelem Village, Bendo Community Health Center on Saturday, January, 20th 2024.The number of Posyandu Balita participants was 123 toddlers and their mothers, but around 61 toddlers and their mothers actively participated in Posyandu.The demographic target for this community service activity was mothers of toddlers who were registered at Posyandu and were willing to take part in educational activities until completion, they were 30 mothers of toddler.The methods that were given in the community service program were health education, monitoring and evaluation regarding exclusive breastfeeding, management of expressed breast milk, and procedures of the correct breastfeeding positions.Education was carried out 2 x 50 minutes.Education was carried out in two stages, the first stage was by providing material about the importance of exclusive breastfeeding and the next stage was practicing sessions on correct breastfeeding positions, management of expressed breast milk, and discussion with participants.After being given education about the importance of exclusive breastfeeding and the next stage was practicing sessions for correct breastfeeding positions, management of expressed breast milk, and evaluation by giving questions to participants.Increased knowledge was known when participants could answer questions after conducting outreach activities.They could explain about tehe importance of exclusive breastfeeding, correct breastfeeding positions, and proper management of expressed breast milk.

RESULT
Community service activities regarding education on the importance of exclusive breastfeeding, correct breastfeeding positions, and management of expressed breast milk went well and smoothly.The activities were carried out interactively and the socialization participants were also very enthusiastic to be involved in discussions and question-andanswer sessions.This was proven by the many questions from several participants as well as the participant's participation in responding to the presenter's answers and questions from other participants.The activeness of the presenters in asking questions to participants regarding the extent to which they know and understand the importance of exclusive breastfeeding, breastfeeding in the correct position, and breast milk management through a pre-test given to participants via a pre-socialization questionnaire showed that 85% said they did not understand.Meanwhile, another 15% said they already understood.The outcome of the activity based on the post-test results showed that 100% of mothers understood well the importance of exclusive breastfeeding, correct breastfeeding positions, and management of expressed breast milk and 0% said they did not understand exclusive breastfeeding, correct breastfeeding positions, and management of expressed breast milk.so that the increase in understanding of mothers of toddlers is 85%.

DISCUSSION
Expressed breast milk management is a procedure for managing breast milk that is obtained by pumping either by hand, manual pump, or electric pump.This is done as a strategy to support the sustainability of the exclusive breastfeeding program.Mothers who know about good management of expressed breast milk will not be confused when imagining a situation where they cannot breastfeed or the baby cannot breastfeed, while breast milk production is still good.Management of expressed breast milk allows mothers to be able to store their breast milk as a breastfeeding reserve for their babies even when faced with conditions that make it impossible.After maternity leave, giving breast milk to the babies to be continued.Expressed breast milk can be given gradually.Expressed breast milk is obtained by expressing/squeezing breast milk from the breast and then placing it in a glass bottle or other place to be given to the baby.Expressed breast milk is generally given when the mothers are away from the babies for a long time, for example when the mothers go to work.Breast milk can be expressed when the breasts feel full.To make the exclusive breastfeeding program successful for working mothers, adequate conditions are needed in the workplace so that mothers can express breast milk to provide supplies for the baby when they leave work the next day.Even though mothers don't need a large place, mothers need a closed room with a lockable door to express breast milk.Family support also significantly influences exclusive breastfeeding (Kristina et al., 2019).Parental/family support is the external factor that has the greatest influence on exclusive breastfeeding because family support has a huge influence on the mother's self-confidence.A strong sense of self-confidence and belief in the adequacy of breast milk can provide a positive attitude in providing exclusive breastfeeding (Astuti, 2013).On the other hand, mothers who lack self-confidence tend to have difficulty facing challenges and difficulties in breastfeeding their babies (Fahriani et al., 2016).Improper breast milk expression procedures will have consequences for the mother and baby, including breast milk not being able to express optimally, milk production decreasing, and swollen breasts.Many mothers do not express themselves properly due to limited rest hours and many special rooms for expressing breast milk are not provided by the company.

CONCLUSION
Providing education on expressed breast milk management to mothers of toddlers can increase knowledge and skills in breast milk management.Pre-socialization questionnaire showed that 85% said they did not understand.Meanwhile, another 15% said they already understood.The outcome of the activity based on the post-test results showed that 100% of mothers understood well the importance of exclusive breastfeeding, correct breastfeeding positions, and management of expressed breast milk and 0% said they did not understand exclusive breastfeeding, correct breastfeeding positions, and management of expressed breast milk.so that the increase in understanding of mothers of toddlers is 85%.Program it is hoped that this education will receive support from various parties, especially from families, health workers, and agencies where mothers of toddlers work so they can improve success in providing exclusive breastfeeding.