ENGLISH PAPER

“EXCLUSIVE BREASTFEEDING”

BY:

MADE WINDA KRISNAWATI ARISANDI

( P07124214 032 )

KEMENTERIAN KESEHATAN R.I.

POLITEKNIK KESEHATAN KEMENKES DENPASAR
JURUSAN KEBIDANAN PRODI DIV KEBIDANAN KLINIK
2017
 PREFACE

First of all, thanks to Ida Sang Hyang Widhi because of the help of Hyang
Widhi, writer finished writing the paper entitled “EXCLUSIVE
BREASTFEEDING” right in the calculated time.

The purpose in writing this paper is to fulfill the assignment that given by
Mrs. Ni Made Dwi Mahayati, SST., M.Keb as PJMK and lecturer in English in
Midwife Practice Course.

in arranging this paper, the writer trully get lots challenges and
obstructions but with help of many indiviuals, those obstructions could passed.
writer also realized there are still many mistakes in process of writing this paper.

because of that, the writer says thank you to all those who help in
writing this paper. hopefully god replies all helps and bless you all. the writer
realized this paper is still imperfect in arranging and the content. The author really
hopes for all parties to be able to provide criticism and suggestion. Finally,
hopefully this paper can provide benefits and learning materials to all of us

Denpasar, October 23th, 2018

Writer

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 TABLE OF CONTENTS
Page
TITLE PAGE ................................................................................................ i
PREFACE .................................................................................................. ii
TABLE OF CONTENTS .............................................................................. iii
CHAPTER I INTRODUCTION
A. Issue Background .................................................................................... 1
B. Problem Formulations ............................................................................. 2
C. Writing Purposes ..................................................................................... 2
D. Writing Benefits ...................................................................................... 2
CHAPTER II LITERATURE REVIEW
A. The Meaning of Exclusive Breastfeeding ............................................... 3
B. Benefits of Exclusive Breastfeeding ....................................................... 3
C. Compositions of ASI............................................................................... 5
D. ASI Production ........................................................................................ 6
E. Giving Exclusive Breastfeeding to Infants ............................................. 7
CHAPTER III CLOSING
A. Conclusion ............................................................................................. 10
B. Suggestions ............................................................................................ 10
REFERENCES

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 CHAPTER I
INTRODUCTION

A. Issue Background
Exclusive breastfeeding (EBF) has been defined by the WHO as the situation
where “the infant has received only breast milk from his/her mother or a wet
nurse, or expressed breast milk and no other liquids, or solids, with the exception
of drops or syrups consisting of vitamins, minerals, supplements, or medicines” .
Breastfeeding is a natural food that serves as a complete source of infant nutrition
for the first six months of life. It contains all the necessary nutrients provided in a
bioavailable and easily digestible form, protecting both mothers and children
against illnesses and diseases with immunological properties.
Breast milk contains essential fatty acids needed for the infant's growing
brain, eyes, and blood vessels and these are not available in other types of milk.
Breastfeeding on demand at day and night at least 8 times in 24 hours will provide
more milk as suckling stimulates milk production Infants that are exclusively
breastfed have a lower chance of becoming ill or dying from diarrhea and
infections and are less likely to acquire pneumonia, meningitis, and ear infections
than those that were not exclusively breastfed. this is protective against single and
recurrent incidences of otitis media in particular and the risk of hospitalization for
lower respiratory tract infections during the first year of life. In addition,
breastfeeding also benefits the society by reducing healthcare costs, parental
employee absenteeism, and the associated loss of family income. The Global
Strategy for Infant and Young Child Feeding describes the essential interventions
to promote, protect and support breastfeeding

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B. Problem Formulations
Based on the background that has been stated, the formulation of the problem in
this writing is:
1. what is exclusive breastfeeding,
2. what are the benefits of exclusive breastfeeding,
3. the composition of ASI
4. ASI Production
5. how to give exclusive breastfeeding to infants

F. Writing Purposes
The purpose of this paper is :
1. to find out the meaning of exclusive breastfeeding
2. benefits of exclusive breastfeeding
3. the composition of ASI
4. ASI Production
5. how to give exclusive breastfeeding to infants

G. Writing Benefits
With the writing of this paper, it is expected that readers, especially
prospective midwives, can know and apply about exclusive breastfeeding to
infants. and can add knowledge about exclusive breastfeeding

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 CHAPTER II
LITERATURE REVIEW

A. The Meaning of Exclusive Breastfeeding

Exclusive breastfeeding is breastfeeding for 6 months without the
addition of other fluids, such as formula milk, oranges, honey, tea water and
water, and without additions solid food, such as bananas, milk porridge, biscuits,
rice porridge, and team rice, except for vitamins and minerals and medicine
(Roesli, 2000). In addition, exclusive breastfeeding is also related to the act of
giving breast milk to infants up to 6 months of age without other food and drinks,
except medicinal syrup. After the baby's age is 6 months, then the baby starts to
be given complementary foods for breast milk, while breast milk can be given up
to 2 years or more (Prasetyono, 2005).
ASI is a type of food that fulfills all the elements of the baby's needs
both physically, psychologically, socially and spiritually. ASI contains nutrients,
hormones, elements of immune growth, anti-allergic, and anti-inflammatory.
Nutrients in ASI include almost 200 nutrients (Hubertin, 2004).
ASI is a God-made liquid that meets the nutritional needs of infants and
protects them against possible diseases. The balance of nutrients in breast milk is
at the best level and the milk has the best form for the body of a young baby. At
the same time ASI is also very rich in food extracts that accelerate the growth of
brain cells and the development of the nervous system (Yahya, 2007)

B. Benefits of Exclusive Breastfeeding

Breastfeeding is the best method of feeding babies, especially for babies
less than 6 months old, as well as beneficial for mothers. ASI contains all the
nutrients and fluids needed to fulfill all infant nutrition in the first 6 months of
life. At the age of 6 to 12 months, breast milk is still the main food for babies,
because it contains more than 60% of baby's needs. To meet all the needs of the
baby, it needs to be supplemented with complementary foods (MP-ASI). After the
age of 1 year, even though ASI can only fulfill 30% of the baby's needs,

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breastfeeding is still recommended because it still provides benefits. ASI is
uniquely adapted for human babies.
Unique and specific ASI composition cannot be balanced by formula
milk. Breastfeeding is not only beneficial for babies but also for mothers who are
breastfeeding. benefits of breastfeeding for babies include; ASI as nutrition, ASI
can increase the baby's immune system, develop intelligence, and can improve the
fabric of love (Roesli, 2000).
The benefits of ASI for babies are as nutrients. ASI is an ideal source of
nutrition with a balanced and adjusted composition baby growth. ASI is the most
perfect baby food, both quality and quantity. With proper breastfeeding
procedures, ASI is food Single will be enough to meet the growing needs of
normal babies up to the age of 6 months. After the age of 6 months, babies must
begin to be given solid food, but breast milk can be continued until the age of 2
years or more. Country many western countries do Special research to monitor the
growth of exclusive ASI recipient infants and proven that exclusive breastfeeding
infants can grow in accordance with the growth recommendations of WHO-
NCHS standards (Danuatmaja, 2003).
In addition, ASI can increase the baby's immune system. Given ASI
means the baby has got immunoglobulin (immune substance or body resistance)
from the mother through the placenta, but the levels of these substances will
quickly decrease immediately after birth. The body of the newborn will produce
its own immunoglobulin sufficiently when it reaches the age of about 4 months.
When the innate immunoglobulin level of the mother decreases which is formed
by the baby's body is not sufficient, there is a period of immunoglobulin gap in the
baby. In addition, breast milk stimulates the formation of baby antibodies faster.
So, ASI is not only passive immunization, but also active. A fact that mortality
(mortality) and mobility midwifery (number of illnesses) in exclusive
breastfeeding babies is much lower than babies who do not get breast milk
(Budiasih, 2008).
Then the last is ASI can establish affection. Babies who are often in the
arms of their mothers because of breastfeeding can feel mother's affection and get
a sense of security, peace, and protection. This feeling of being protected and

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cherished is the basis of the baby's emotional development, which then shapes the
child's personality to be good and confident.
For mothers, the benefits of breastfeeding can reduce bleeding after
childbirth. If the baby is breastfed immediately after birth, the possibility of
bleeding after delivery (post partum) will be reduced (Siswono,2001) Because
breastfeeding mothers have increased levels of oxytocin which is also useful for
constricting / closing blood vessels so that bleeding will be more stop fast. This
will reduce the maternal mortality rate. In addition, breastfeeding can also be
excluded pregnancy in the mother due to breastfeeding is a safe, inexpensive, and
quite successful method of contraception. As long as the mother gives exclusive
breastfeeding 98% will not become pregnant in the first 6 months after giving
birth and 96% will not get pregnant until the baby is 12 months old.

C. The Composition of ASI

ASI contains most of the water as much as 87.5%, therefore babies who
get enough breast milk do not need to get additional water even if they are in hot
temperatures. The viscosity of breast milk is in accordance with the baby's
gastrointestinal tract, while formula milk is thicker than ASI. This can cause
diarrhea in babies who get formula milk. The composition of ASI are:
carbohydrates, proteins, fats, minerals, vitamins.
In ASI there is lactose, lactose is the main carbohydrate in ASI which
functions as a source for the brain. Lactose levels found in breast milk are almost
twice that of lactose found in formula milk. Carbohydrate levels in colostrum are
not too high, but the amount increases especially lactose in transitional breast milk
(7-14 days after giving birth). After passing this period, the carbohydrate content
of ASI is relatively stable.
Besides carbohydrates, breast milk also contains protein. ASI protein
content is quite high and the composition is different from the protein contained in
milk formula. Protein in breast milk and formula milk consists of protein whey
and casein. Protein in breast milk consists more of whey protein and which is
more easily absorbed by baby's intestines, while formula milk contains more
protein casein which is harder to digest by the baby's intestines. The amount of

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casein found in ASI only 30%, compared to formula milk which contains high
amounts of protein (80%). Besides that, ASI has complete amino acids, taurine.
Taurine is thought to have a role in brain development because these amino acids
are found in quite high amounts in brain tissue which is developing.
ASI also contains fat, the fat content in breast milk is initially low and
then increases in number. Breast milk changes every time the baby sucks, which
happens automatically. In addition to the sufficient amount, the type of fat
contained in breast milk contains long chain fat which is the fat needs of brain
tissue cells and is very easy to digest and has a high enough amount. In the form
of Omega 3, Omega 6, DHA (Docoso Hexsaconic Acid) and Acachidonid acid are
important components for baby's elimination.
Besides carbohydrates, fats, proteins, ASI also contains minerals,
vitamin K, vitamin A, vitamin D, vitamin E, and vitamins that dissolve in water.
Almost all vitamins are water soluble, such as vitamin B, folic acid, vitamin C
found in ASI. Food consumed by the mother affects the levels of this vitamin in
ASI. Vitamin B1 and B2 levels are quite high in breast milk but levels of vitamin
B6, B12 and folic acid may be low in mothers with poor nutrition

D. ASI Production
The process of removing milk begins or is stimulated by the baby's
mouth suction on the mother's nipple. The movement stimulates the Pictuitary
Anterior gland to produce a number of prolactin, the main hormones that rely on
milk. The process of removing milk also depends on Let Down Reflex, where the
suction can stimulate the Pictuitary Posterior gland to produce the hormone
oxitolesin, which can stimulate fine fibers in the milk duct walls to allow milk to
flow smoothly.
Failure in physiological breast development to collect milk is very rare.
Physiologically, the breasts are active weaves that are arranged like trees growing
inside the nipple with branches that become twigs smaller. Milk is produced at the
end of the twig and flows into large branches to the channel into the nipple.
Visually the breast can be described as a sprig of grape, representing the secreting
gland where each cell is able to produce milk, if the Myoepithelial cells in the

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alveolar wall contract, the wine is squeezed and releases milk into the branch that
flows into more branches large, which slowly meets inside the aerola and forms a
lactiterous sinus. The center of the areda (a pigmented chart) is the nipple, which
is not rigidly located and easily sucked into the baby's mouth.

E. Giving Exclusive Breastfeeding to infant

The obligation that must be carried out by a mother is to give ASI
exclusively to her child. Whatever the reason, the mother is obliged to continue
breastfeeding her baby, except if indeed the mother has health problems in her
breasts that produce breast milk. A good way to breastfeed: enough with 10
minutes but still regular Most mothers often linger in breastfeeding babies, it aims
to make the baby full, and easily fall asleep. Now there is a term that says baby
led method, this method is breastfeeding the baby by following his wishes. Most
of these methods are carried out by young mothers. But this method is also not the
best for mothers and babies. But a study says that breastfeeding with a short time
but still regular is actually effective in adding weight to the baby.
The right way to breastfeed
The purpose of correct breastfeeding is to stimulate milk production to strengthen
the baby's sucking reflex :
1) position
a) Madona's position or holding: the baby lies facing the mother, the
baby's neck and upper back are placed on the lateral forearm of the
breast. Mother uses the other hand to hold the breast if needed
b) Football position or pinching: baby lying or back circular between
arm and side of mother's chest. The mother's forearms and hands
support the baby, and he uses his other hand to hold the breast if
needed
c) Lying on your side: mother and baby lie on their sides facing each
other. This position is the safest position for mothers who experience
healing from the process of childbirth surgically

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2) Management stage of breastfeeding
Position of the mother's body and baby's body
a) Mother must sit or lie down relaxed
b) Hold the baby on the back of his shoulder, not on the base of the head
c) Turn the whole body of the baby so that it faces the mother
d) Close the baby's chest with the mother's chest or the bottom of the
mother's breast
e) Attach the baby's chin to the mother's breast
f) With this position the baby's ears will be in one line with the baby's
neck and arms
g) Keep the baby's nose from the mother's breast by pressing the baby's
bottom with the inside of the mother's arm

Position of the baby's mouth and nipples

a) Remove the breast milk slightly apply to the nipples and areola
b) Hold the breast with a handle like the shape of the letter C, the breast
is held with the thumb on the top and the other finger supports under
or with a handle like a scissors (the nipple and areola are clasped by
the index finger and middle finger like scissors) behind the areola
c) Touch baby's cheeks / lips to stimulate reflex rooting (sucking reflex)
d) Wait until the baby's mouth is wide open, and the tongue sticks down
e) Quickly bring the baby to the mother's breast by pressing the shoulder
behind the baby instead of the back of the head
f) Position the nipple over the baby's upper lip and face to face with the
nose
g) Then point the nipple upward along the ceiling of the baby's mouth
h) Try most of the areola to enter the baby's mouth, so that the nipple is
between the meeting of the hard palate (hard palate) and soft palate
(palate).
i) The baby's tongue will press the lower wall of the breast with a
reddish movement so that ASI will come out

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 j) After the baby suckles or sucks the breast properly, the breast does not
need to be held or supported anymore
k) Some mothers often place their fingers on the breast with the baby's
nose in order to make it easier for the baby to breathe. This is not
necessary because the baby's nose has been kept away from the breast
by pressing the baby's buttocks with the mother's arm
l) The mother's hands are free to strok the baby

3) Signs of a baby's position to suckle properly

a) The front part of the baby's body is attached to the mother's body
b) The baby's chin is attached to the mother's breast
c) The baby's chest is attached to the mother's chest which is at the base
of the breast (lower breast)
d) The baby's ear is in one line with the baby's neck and arms
e) The baby's mouth is wide open with the lower lip open
f) The baby's nose is approaching sometimes touching the mother's
breast
g) The baby's mouth covers as many areola as possible (not just nipples),
so that most of the areola are not visible
h) The baby's tongue supports the lower nipples and areola
i) The baby's lower lip curves out
j) Babies suck strongly and deeply slowly and sometimes with a pause
k) Sometimes a baby's voice swallows
l) Babies are satisfied and calm at the end of suckling
m) The nipple doesn't hurt or blisters

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 CHAPTER III
CLOSING

A. Conclusion
Exclusive breastfeeding is breastfeeding for 6 months without the addition
of other fluids, such as formula milk, oranges, honey, tea water and water, and
without additions solid food, such as bananas, milk porridge, biscuits, rice
porridge, and team rice, except for vitamins and minerals and medicine.
Breastfeeding is the best method of feeding babies, especially for babies
less than 6 months old, as well as beneficial for mothers. ASI contains all the
nutrients and fluids needed to fulfill all infant nutrition in the first 6 months of
life.

B. Suggestions
1. It is necessary to increase general health counseling, especially regarding
breastfeeding and breastfeeding to the community, especially for pregnant
women about nutrition and breast care during pregnancy, so that breast
milk production is sufficient.
2. The role of health workers in hospitals, maternity clinics, Posyandu needs
to be improved in providing counseling or guidance to pregnant women,
new mothers and nursing mothers about breastfeeding and breastfeeding

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 REFERENCES

http://repository.usu.ac.id/bitstream/handle/123456789/26924/Chapter%20II.pdf?
sequence=4&isAllowed=y
diakses pada tanggal 21 oktober 2018 pukul 13.00 wita

https://superbidanhapsari.wordpress.com/2009/12/14/makalah-pemberian-asi-
eksklusif/
diakses pada tanggal 21 oktober 2018 pukul 12.15 wita

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