The Practical Experience of Early Initiation of Breastfeeding among Primiparous Mother: A Scoping Review

Background: Primiparous mother has an essential role in reducing mortality and pain in newborns. One of the efforts to increase the success of Breastfeeding (ASI) is by practicing Early Initiation of Breastfeeding (IMD) by newborns to their mothers. The practice of IMD will greatly assist in the continuity of exclusive breastfeeding, so that the baby will be fulfilled up to the age of 2 years, and prevent malnourished children.
Aim: To review the evidence regarding to the practical experience of Early Initiation of Breastfeeding (IMD) in primiparous mother.
Method: This scoping review method used the Arksey & O'Malley framework which consisted of 5 stages, namely identifying scoping review questions with the PICO framework; identifying relevant articles by determining inclusion and exclusion criteria; searching for articles through relevant databases, namely Pubmed, Science Direct and Wiley, search for Gray Literature through the Search Engine, namely Google Scholar; Selection of articles with Prism Flow Chart which is used to describe the flow of search for articles, conduct Critical Appraisal to assess the quality of articles; undertake the charting data; compile, summarize and report results
Results: Dealing with the 4 articles obtained, there were 3 articles with grade A from the RCT method, quantitative non-randomized, and qualitative. 1 grade B article with non-randomized quantitative method. Furthermore, 4 themes were obtained, namely social support, childbirth factors, the needs of primiparous mothers, and psychological factors.
Conclusion: It indicated that there was a gap between the results of review articles in developed and developing countries, namely that primiparous mother in developing countries, the primiparaous mother tended to focus on the issue of support from health workers. Meanwhile the results of research in developed countries, primiparous mother focused on psychological problems.


BACKGROUND
In accordance with the World Health Organization (WHO), the mortality rate of infant is mostly related to nutritional factors by 53% (WHO, 2018). Breastfeeding is one of the most effective ways to ensure the health and survival of children. The life of child is approximately 820,000 that will be saved each year, if breastfeeding reaches the Universal level. Globally, it is merely 40% of babies under 6 months of age are exclusively breastfed (WHO, 2018).
WHO and UNICEF recommend that children start breastfeeding within the first hour after birth and are exclusively breastfed for the first 6 months of life, it implies that there is no other food or fluids that given, including water (WHO, 2018). Besides, WHO also provides training courses for health workers to provide skilled support to breastfeeding mothers, to assist them to overcome problems, and monitor children"s growth (WHO, 2018).
One of the efforts to increase the success of Breastfeeding (ASI) is by practicing Early Initiation of Breastfeeding (IMD) by newborns to their mothers. Early Initiation of Breastfeeding (IMD) is a process by which a baby can breastfeed immediately after birth within the first hour after birth. The way of babies to do initiate early breastfeeding is called as The Breast Crawl or crawling looking for nipples (Olina, 2017).
Breastfeeding has been indicated to produce many physical and psychological benefits for both the mother and the newborn. However, the rate and duration of exclusive breastfeeding remains low in the worldwide. Making contact with mother and baby immediately after birth has shown favorable results for continued breastfeeding (Vila-Candel et al., 2018).
Early Initiation of Breastfeeding (IMD) will greatly assist in the continuity of providing exclusive breast milk (ASI), so that the need of the babies will be fulfilled to the age of 2 years, and prevent malnourished children. WHO is actively promoting breast milk as the best source of nutrition for infants and young children, due to it has been proved to reduce infant morbidity and mortality (WHO, 2018).
Breastfeeding from an early age has a positive impact on both the baby and the mother. For babies, breastfeeding plays an important role in supporting the growth, health and survival of the baby due to the breast milk is rich in nutrients and antibodies. Whereas for mothers, breastfeeding can reduce morbidity and mortality because the breastfeeding process will stimulate uterine contractions, thereby reducing the incidence of postpartum bleeding (Ministry of Health, 2014).
Although early breastfeeding has proven to reduce the risk of death for newborns, its implementation has not been optimal. Factors that influence the lack of success in Early Initiation of Breastfeeding (IMD) are the lack of knowledge of mothers about the importance of implementing Early Initiation of Breastfeeding (IMD), particularly primiparous mother.
Breastfeeding is a new responsibility for primiparous mother after giving birth. However, this new task often led to a psychological impact on primiparous mother due to a lack of knowledge and experience about breastfeeding. Therefore, the important role of health workers in preparing primiparous mother during their pregnancy, especially in terms of knowledge about breastfeeding (Rahmayanti et al., 2018).
Primiparous mother who lacks of the knowledge and experience, the person will undergo anxiety very easily, as a result of its anxiety, it can affect Early Initiation of Breastfeeding because anxiety can affect breast milk production, besides that the factors of support from husbands, family and health workers are also very important in the success of the practice of Early Initiation of Breastfeeding (IMD) (Achadyah, 2017).
Even though, Early Initiation of Breastfeeding (IMD) is the initial process for babies to breastfeed immediately after birth, this is a very important process to do because early initiation of breastfeeding can make exclusive breastfeeding to be successful, however its implementation is still very rarely implemented (Nova S, 2019).

OBJECTIVE
The aim of this scoping review was to review the evidence regarding the practical experience of Early Initiation of Breastfeeding (IMD) in primiparous mother.

METHODS
Scoping review was a method used in this study. Scoping reviews aim to answer questions from predetermined research topics using various sources of similar research articles and then it is classified and given conclusions (Widiasih et al., 2020).
In compiling a scoping review, there are several steps that researcher must do, according to (Arksey & O"Malley, 2005) in (Levac et al, 2012), there are four purposes for conducting a scoping review, namely (1) to examine the extent and nature of the activity. research, (2) to determine the value in conducting a full systematic review, (3) to summarize and disseminate the findings and (4) to identify research gaps in the existing literature (Levac et al, 2012). The problem in this study was that the researcher wanted to identify the results of previous studies regarding "the practice of Early Initiation of Breastfeeding (IMD) towards primiparous mothers".
Based on the phenomena that will be studied, the PICO framework is used to determine the scoping review questions and to assist literature searches. The steps taken were by using the PICO framework (Population, Intervention, Comparison, Outcome); Based on the framework above, the scoping review question chosen was: "How is the experience of early initiation of breastfeeding (IMD) towards primiparous mothers?" After determining the scoping review questions, then determining inclusion and exclusion criteria. The inclusion criteria were as follows; articles published between 2015-2020, articles published in English or Indonesian, documents / reports / draft policies / WHO sites / certain formal organizations, articles discussing the practice of Early Initiation of Breastfeeding (IMD) towards the primiparous mother. Exclusion Criteria; opinion articles, comments, review articles, reports, and book reviews.
The database used in searching for relevant evidence was using the PubMed, Science Direct, and Wiley databases, besides, the gray literature (google scholar / WHO). Search using the PubMed database accessed via Google, Science Direct using access from PNRI, the Wiley Online Library accessed through the Unisa Library. The search strategy and specific keywords used in the search process using truncation and boolean strategies will also be used in literature searches.
The next step was selecting articles by entering keywords that match the theme (((((((((((Primiparou *) OR (first mom *)) OR (first mother *)) OR (new mom * )) OR (new mother *)) OR (new parent *)) AND (Early Initiation of Breastfeeding)) OR (Initiation Breastfeeding)) AND (Practice *)) OR (Implementation *)) OR (Application *)) AND ( Experience *)) OR (Perspective *)) OR (View *). To specify literature searches, then determined the literature search period which in this study was limited to articles published in the last 5 years from 2015-2020 and the selected articles were free full text or open access.
In an article search of all accessed databases, it identified an initial 85 articles relevant to the scoping review question. In the process of selecting this article, the researcher used a prism flow chart to transparently describe the process that had been undertaken. A prism flow chart is a minimum set of evidence-based items for reporting in systematic reviews and meta-analyzes. Prism flow charts are considered as appropriate thing because its use can improve quality.

Figure 1. Prisma Flow Chart
Based on the final results of the screening of the prism flow chart, 4 articles were selected and it is in accordance with the good quality, then entered into the data charting table (table 2.Data Charting), then data extraction was carried out to classify several points or parts of the article such as research objectives, research design, number of samples, and the results of the study.
Furthermore, to find out the quality of the articles that have been selected, a critical appraisal was undertaken. Critical Appraisal in this Scoping review used the Mixed Method Appraisal Tool (MMAT). MMAT was designed to assess the methodological quality of a study from five research categories, namely, qualitative  (Hong et al., 2018).
Dealing with the 4 articles, the critical appraisal process has been undertaken, it was found that all articles that were assessed were included in grade A for the Randomize Control Trial design, grade A and B for the quantitative non-randomized design, and grade A for the Qualitative design.

RESULTS
Based on the critical appraisal results from the 4 articles that have been selected, 1 article used the Randomized Control Trial (A1), 2 non-randomized quantitative studies (A2, and A3), and 1 article used a qualitative study (A4).

Figure 2. Study Design
Based on the total articles obtained grade A (Good) as many as 3 articles, grade B (Good Enough) as many as 1 article, and there were no articles that have grade C, all articles published in 2015-2020.  The results of the articles obtained from developing countries were 1 article covering Indonesia (1), and 3 articles from developed countries including Singapore (1), Spain (1), and Canada (1).

DISCUSSION
Based on the scoping results of 4 articles the researcher found several themes, namely; social support, factors of childbirth, needs, and psychological factors of primiparous mother.

Social Support
Primiparous mothers or new mothers really need support, including support from peers, health workers, and support from workplaces for working mothers. a. The Support from Peers Peer support is very important for primiparous or new mothers because of their lack of knowledge and experience, mothers really need as much information as possible both from the media and from their peers who may already have more experience in breastfeeding.
Peers can be found when a mother is attending a class for pregnant women, and at that time new mothers can exchange ideas or perhaps share about what they experienced or felt at that time. It is hoped that sharing from primiparous mothers can get positive motivation and information and that will increase the confidence of primiparous mothers, with the hope that new mothers can succeed in the practice of Early Initiation of Breastfeeding (IMD). Involving in KIH should be able to increase mother's knowledge in implementing IMD (Wijayanti, 2013). The support from friend can affect directly on a person's intention to behave. This is due to peer support can lead to individual confidence in the opinions of others who are considered important, in this case friends and motivation, the role of fellow breastfeeding groups or breastfeeding groups is expected to strengthen mothers and provide breast milk to their babies. (Emma et al., 2016). b. The Support of Health Workers The support from health workers can play an important role in supporting a mother's success in nursing her baby by building self-confidence and providing support to the mother. Mothers who have sufficient information about the practice of breastfeeding are 6 times more likely to give breast milk to their babies than mothers who do not have information (Lenja et al., 2016).
It is in line with the research result of Wijayanti (2013) which asserts that health worker support is one of the reinforcing factors for changes in the behavior of a person or group of people that allows reward for steady and recurring behavior changes, the behavior of mothers who are willing to breastfeed their babies is influenced by perceptions of information that received from health workers (Wijayanti, 2013).

The Factor of Childbirth
Prologed childbirth is a stressful process for both mother and baby that can trigger the secretion of the hormone cortisol, a significant association between childbirth, stress hormones and lactation output. Pregnant women who experienced prolonged childbirth experienced an increase in stress hormones in the blood sample examined and the frequency of breastfeeding was less on the first day after delivery, in the first 5 days of primiparous who underwent prolonged childbirth and the frequency of breastfeeding was less. In fact, it also provided a lower volume of breast milk output (Irawan S et al., 2017).
According to a review article by Sharma and Byrne (2016), one of the factors that has been shown to influence the implementation of IMD is the type of delivery, this is then related to the health and physiological conditions of the mother after childbirth. During childbirth, the mother undergoes through several phases and one of the phases that is passed is the taking in phase, where the mother is still focused on her own condition to undergo the recovery process. (Juwita, 2017).

The Need of Mother a. Information
The factor of information factor is also very esential for primiparous mother, it is due to the lack of knowledge and experience. According to Notoatmodjo (2010), a person's education level will also affect their knowledge, and behavior is formed because of the knowledge that is aimed at the learning process. (Juwita, 2017).
Besides, the failure in the practice of IMD is also a factor of failure in exclusive breastfeeding due to the lack of knowledge of mothers about the information provided by health workers regarding the benefits of breastfeeding for babies and mothers (Purnamasari & Mufdlilah, 2018). Some health workers provide information on how to breastfeed properly, hpwever not all health workers provide the same information and ultimately confuse the mother with the information obtained (Andini et al., 2019).
According to the assumption of researcher that change is caused by health education so that it can affect and increase the knowledge of person. Education can be obtained through counseling so that the society can more easily access knowledge about IMD. Through counseling, we can directly evaluate the level of society response through questions and answers so that feedback can be found. In addition, the role of health workers is very important in conveying new information so that primiparous mother does not miss the information. (Subekti, 2019). b. Support Most primiparous mothers in the postpartum period will really need other people, husband, families, and / or professionals, to anticipate their needs and questions. In addition, they tend to listen to anything that is told about how to be the best mother (Subekti, 2019). Support can be the form of informational support where the husband provides advice and information to primiparous mother, the husband argues directly to ask the mother to breastfeed immediately, the husband's emotional and instrumental support is also carried out by helping to carry babies, providing nutritious food for mothers to increase breast milk production (Rahmayanti et al., 2018).

Psychology
Anxiety is closely related to psychology; anxiety is also largely dependent on a person"s life experiences. Special events or situations can accelerate the emergence of anxiety attacks, the primiparous mothers who often experience anxiety due to a lack of knowledge and experience about breastfeeding practices. (Irawan S et al., 2017).

CONCLUSION
Primiparous mother has an important role to reduce the mortality of infant, one of the ways is by carrying out the practice of Early Initiation of Breastfeeding (IMD), so that infants will be fulfilled their needs, and prevent malnourished children. There was a gap between the results of review articles in developed and developing countries, it indicated that primiparous mother in developing countries tended to focus on issues of support from health workers. Whereas, the results of research in developed countries, primiparous mother focused on psychological problems.
Regarding to the 4 articles, not one article was found that discussed male participants, all were primiparous mothers. Future studies need to involve male participants or husband of primiparous mothers. Besides, there are no studies that discuss family support. Hence, it is necessary to conduct the research related to family support. Further, this research focused on developed countries, so that the following research needs to examine developing countries.