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The Effect Of Domperidone Toward Breast Milk Production On Sectio Caesarea Mother

Mothers that give birth with section caesaria (SC) often experience difficulty to get a adequate breast milk production. Various kinds of effort have been conducted to overcome this problem, including pharmacological intervention. One of the medicines that could be possibly used is domperidon. Domperidon is an antagonist receptor of peripheral dopamine that works by choking inhibition effect of prolactin secretion facilitated by dopamine to improve breast milk production.The research aimed to unveil the effect of domperidon toward breast milk production on mother that give birth with SC in Indonesia. This is a quasi-experiment research with two groups post-test only design. The sample of this research 30 were post sectio caesarea patients consisting of 15 patients in intervention group and 15 patients in control group. Purposive sampling was used in the research to get the samples. The instrument used was observation sheets. Result analysis was conducted by calculating the frequency distribution and bivariate analysis with Mann Whitney test. The average score of breast milk production among post-SC mother in the intervention group was 22,60, while the average score of breast milk production among post-SC mother in control group was 15,47, Asymp. value Sig (2 tailed) 0,020 (0,020 < 0,05). Domperidone has been approved to have a significant effect to improve breast milk ISSN 2354-7642 (Print), ISSN 2503-1856 (Online) Jurnal Ners dan Kebidanan Indonesia Tersedia online pada: http://ejournal.almaata.ac.id/index.php/JNKI INDONESIAN JOURNAL OF NURSING AND MIDWIFERY


INTRODUCTION
Breast milk production is a process of releasing oxytocin hormone to floe breast milk Mothers with SC will experience anesthesia and postoperative pain so they are not free to breastfeed their babies intensely. Besides, after surgery mother must be moved to the Recovery Room. Although, currently, implementing early breastfeeding initiation (IMD) can also be done in the operating room, not all hospitals have the same policy. In addition, the feeling of the mother who is not sure that she can give breast milk to her baby because of the condition will cause a decrease in oxytocin so the milk cannot come out immediately after giving birth and finally the mother decides to give formula milk (5).
Domperidone is known to be used as a breast milk booster among nursing mothers. IDAI stated that domperidone used as a lactogogue (a substance that can be trusted to increase milk production) was first reported in 1983. This substance increases prolactin serum in lactating women. Side effects of domperidone are very rare, including dry mouth, headache (relieves with reduced dose) and stomach cramps. Longterm high-dose domperidone treatment in mice was associated with an increase in the number of breast tumors. This has never been reported in humans (6).
In Asia and Europe, domperidone has long been used as a prokinetics and antiemetic. The clinical use of domperidone is in the treatment of gastroesophageal reflux disease, diabetic gastroparesys, chronic dyspepsia, and is sometimes recommended to stimulate postpartum lactation. Domperidone is the most recommended medicine because it has been production on post-SC mothers. Improving breast milk production could be conducted non-pharmacologically, but pharmacological therapy could also be considered if the nonpharmacological therapy doesn't work well in improving breast milk production.  (4).286-291 proven effective, it has no side effects on the baby, and rare side effects in breastfeeding mothers. In addition, based on the literature, domperidone, as a galactogogue, has been widely used in various countries even though it is off label ", such as Australia, the Netherlands, Belgium, England, Ireland, Italy, Japan and Canada (7).
Domperidone is preferred over other drugs to increase milk production because it does not cross the blood brain barrier. Domperidone is a peripheral dopamine receptor antagonist, works by inhibiting the inhibitory effect of dopaminemediated prolactin secretion, so that milk production increases (8).
For mothers whose milk production decreases and does not respond to non-

RESULT AND DISCUSSION
Based on Table 1, it shows that from 15 respondents of post-SC mothers in the intervention group, the mean of breast milk production is 22,60 with deviation standard 6,905; the minimal amount is 7 mL and the maximal amount is 32 mL. From the interval estimation, it could be concluded that 95% is convinced that the breast milk production is between 18,78-26,42. While from 15 respondents of post-SC mothers on the control group, the mean of breast milk production is 15,47, with deviation standard 8,855; the minimal amount is 2 mL and the maximal amount is 30 mL. From the estimation of the interval, it could be concluded that 95% is convinced that the breast milk production is between 10,56 -20,37.
Based on Table 2, the result of Mann Whitney test shows that the rank of breast milk production average on the intervention group is 19,00 and on the control group is 12,00. There is difference of average rank between intervention and control group. The value of Asymp. Sig.
The score or the value of correlation coefficient is 0,422. This score is within the correlation strength score (0,40-0,599); it means that the level of correlation strength between domperidone variabke and breast milk variable is modest.  The research showed that there is a significant difference between a group of post-SC mother who consume domperidone and a group of post-SC mothers who do not cosume domperidone as can be seen in table 1. The pain after SC will choke breast milk production. Beside the infant will be sleepy and less responsive to breastfeed, especially on the mother who consume painkiller before SC (5).
Consuming domperidone is not only effective as prokinetic and antiemetic, but also beneficial to improve breast milk production among nursing mother. On the lactation process hipotalamus In accordance with research conducted previously that consuming Domperidone 60 mg/ day for 14 days improve the breast milk volume as 367% compared to 30 mg/day that only improves 215% (9).
There are some factors that cause the breast milk production decreases in the intervention group such as IMD, physical condition of mother/ infant, so room in and breast milk on demand could not be done. A number of researches have stated that Nullipara mother will result in higher prolactin serum compared to multipara in the same dosage of medicine. However, the volume of breast milk produced by multipara is still higher that nullipara (8). The limitation of the research is that the subject of the research is less in number and the researchers did not observe the prolactin serum in every sample being observed.

CONCLUSION AND RECOMENDATIONS
There is a significant correlation between domperidone variable and breast milk production with the correlation strength level between domperidone and breast milk production is medium. We have to support exclusive breastfeeding by giving motivation, health education, avoiding stress for nursing mother.
It is as a consideration to have collaboration to have pharmacological therapy (Domperidon) in order that mother could breastfeed her infant to improve psychological relationship and infant growth.