Benefits of Oketani Massage to Solve Breast Milk Problems: A Scoping Review

Many problems arose during the puerperium, including the production of little breast milk, milk that was not smooth


INTRODUCTION
According to the WHO, the percentage of mothers exclusively breastfeeding their babies is 25% in Central Africa, 32% in the Caribbean & Latin America, 30% in East Asia, 47% in South Asia, and 46% in emerging nations.40% of infants less than six months are breastfed exclusively (WHO, 2015).In 2021, 56.9% of all infants in Indonesia are exclusively breastfed nationally.This number is higher than the 40 percent program goal for 2021 (Kemenkes RI., 2021).Breastfeeding could save more than 820,000 children under 5 years old if all children aged 0-6 months were exclusively breastfed.Ineffective breastfeeding can cause various health problems, including malnutrition, infectious diseases, and developmental disorders in children and toddlers; breastfeeding can also reduce the health costs of children in the family (WHO, 2022).
Prolactin and oxytocin hormone release affect milk production.These two hormones are released in a way that is influenced by the mother's mental state.The working function of the hypothalamus decreases when a mother experiences psychological tension (stress), which inhibits the pituitary gland from secreting the hormones prolactin and oxytocin (Machmudah et al., 2018).Problems during the puerperium include little milk production, non-smooth milk expenditure, and breast milk dam.Milk that accumulates in the breasts, if not removed, causes the breasts to swell, the areolae to become more prominent, the nipples flatter, and it is difficult for the baby to suckle.The breast skin looks redder and shiny, the mother has a fever, and the breasts feel very painful (Rosita, 2017).
Breast care aims to increase blood flow and avoid milk duct blockage to enhance breast milk secretion.Lactation massage is a type of breast care that can be performed, namely Oketani massage, which was popularized in Japan by Sotomy Oketani and used in Korea, Japan, and Bangladesh.After giving birth, a mother's new responsibility is caring for her baby and taking care of other household tasks.Mothers will experience fatigue and increased anxiety so that milk production can be disrupted and even reduce the mother's intention to breastfeed her baby more often (Machmudah et al., 2018).Oketani massage is beneficial for boosting milk production and can give the mother a sense of ease and relaxation.Okiteni massage can make the areola and breast area smoother and more flexible, making the baby easier to suckle.Paya Alveoli will smooth the flow of milk (Nani Jahriani, 2019).Based on these problems, this study aimed to study scientific evidence about the benefits of Oketani massage.

METHOD
Scoping Review is a literature review that explores knowledge gaps, research goals, and implications for decision-making by mapping the concepts behind the research, sources of evidence, and categories of evidence available (Tricco, Lillie, Zarin, O'Brien, Colquhoun, Kastner, et al., 2018).The researcher chose Prisma-ScR as a source for the preliminary literature review because it includes a comprehensive and in-depth list of preparatory courses.Prisma-ScR has 22 assessment items, 20 important reporting items, and 2 optional items (Tricco, Lillie, Zarin, O'Brien, Colquhoun, Kastner, et al., 2018).The article inclusion criteria to be reviewed are articles related to the effectiveness of Oketani massage on breastfeeding problems, the timeframe for publishing articles 2017-2023, in English or Indonesian, original research, and open access.Exclusion criteria are thesis, thesis, and research report.The databases used are Science Direct, ResearchGate, and PubMed.These keywords were used for a literature search: "Breastfeeding Mothers OR Mothers who have problems breastfeeding OR Mothers with breast milk dam AND Oketani Massage OR Oketani MethodMendeley is a reference management program that researchers use to sort publications, such as checking for duplication, picking titles and abstracts, and reading the entire text.In the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Flowchart below, you can see how to find the number of articles and how to filter them.(Tricco et al. 2018):

ELISA
(Enzym-Linked Immunosorbent Assay) was used to evaluate prolactin levels.Each respondent had blood drawn three times: prior to the intervention, three days later, twelve hours after the cesarean section, and on the third day in the evening, just before the patient was scheduled to return.
After the treatment, there was a statistically significant difference (p=0.035;0.005) in prolactin levels between the study and control groups, and a p-value of 0.000 (<0.05)indicated a significant difference in milk production between the two groups at posttests 1 and 2.

Data Item
The researcher identified each article relevant to the review's topic.The breast massage approach known as Oketani massage concentrates on the mother's areola and nipples.Oketani Milk Expenditure Management is a way of massage brought up by a Japanese nun named Sotomi Oketani.Oketani massage was one of the earliest breast care procedures popularized in Japan by Sotomi Oketani.It has been used in Bangladesh, Korea, and Japan, among other places.Oketani Back Rub can help breastfeeding mothers overcome challenges during childbirth.Oketani massage can relieve pain after childbirth.After giving birth, The mother's body begins to relax.Unlike a standard breast massage, it's not the same thing.The areolas, nipples, and breasts will grow softer and more elastic due to Oketani massage, making the baby easier to suckle.Milk flows more evenly due to pressure on the alveoli.

Synthesis of Results
The three databases have 392 relevant articles with several scoping review questions based on article search results.There were 100 articles from research gate, 30 from Research Rabbit, 292 from Science Direct, and 9 from Pubmed.In addition, Mendeley Reference is used to import each article.A total of 109 articles were filtered based on the title and abstract of the article "Benefits of Oketani massage to overcome breastfeeding problems", and 30 duplicates were found.After getting 18 full-text articles and re-screening them according to the framework, several articles did not meet the inclusion criteria and study results.;only 11 articles were similar, and 91 were deemed irrelevant and excluded.The PRISMA flowchart can enhance publication reporting quality and be the foundation for other researchers to report systematic reviews (Tricco, Lillie, Zarin, O'Brien, Colquhoun, Levac, et al., 2018).

Selection Of Sources Of Evidence
based on search results for the PICO framework keywords from three databases.Mendeley is then used to perform the filtering procedure.The article screening stages are described using the Prisma Flowchart.

Characteristics of Evidence Sources
The 11 articles were chosen based on several factors, such as the nation's name and the characteristics of the study methodology.Characteristics of articles by country, namely Indonesia (82%), Bangladesh (9%), and Iran (9%).Characteristics of articles based on research design, namely Cross-Sectional (9%), Experimental Study (9%), Pre-experimental (9%), and Quasy Experimental (73%).
Critical Appraisal Within Sources of Evidence 11 articles within the scope of this review use quantitative studies.Articles 1 and 2 perfectly answer questions from the Joana Briggs Critical Appraisal Tools (JBI), which are used to evaluate each article critically.In addition, This article's instruments, data collection techniques, sampling techniques, and samples have all been validated to reduce error rates.Articles without comparison groups (3,4,5,6,7,8,9,10) give imperfect results.

Oketani Massage Oketani Massage Technique
On A7 explained the eight steps of Oketani massage.For 15 to 20 minutes, the one-minute Oketani massage stage is repeated.Some advantages that the mother will experience include less pain and discomfort, increased milk production, and increased elasticity in some areas of the breast, such as the areola, neck of the nipple, and the top of the nipple, improving the milk flow and milk production, protecting against and treating women who have flat or inverted nipples.Oketani massage will also give the respondent a general sensation of relief and comfort, enhance breast milk quality, avoid mastitis and swollen nipples, and help alleviate/reduce lactation issues (Romlah & Rahmi, 2019).
There are eight different manual techniques used in Oketani breast massage on A10.Steps 1 through 7 are called "grooming" and Step 8, "expressing or milking".An operation and expressions series takes one minute, then repeated every fifteen to twenty minutes.Pulling and pushing Steps 1-3 entail mild pressure to detach the hard component of the breast from the pectoralis major fascia without giving distress to the mother.In the fourth to the sixth step, both hands pull across the breast with two thumbs down and to either side.Step 4 involves pushing the entire breast toward the umbilicus.The fifth and sixth steps are techniques for isolating the breast's firm base.Also, Step 7 is a gentle clockwise rotation of the breast by extending the base.Step 8 involves expressing the right breast's outside, lower, and inner surfaces, as well as the inside of the upper rim, in four different directions, and the left breast's inner, lower, outer, and inner surfaces, as well as the inside of the upper rim.Manual procedures are performed rhythmically and delicately.Both the right and left breasts are massaged with Oketani.All mothers receive massage treatment after receiving the appropriate training and abilities under a complementary medicine practitioner's supervision (Mahdizadeh-Shahri et al., 2021).
In A11, it is explained that Oketani massage is applied to the area between the breast and the underlying chest muscle.Oketani breast massage is a manual breast care technique created by Sotomi Oketani to enhance breastfeeding, particularly in cases of low milk, uncomfortable nipples, or mastitis.It is a non-painful connective tissue massage that energizes the mother calms the tissue and encourages secretion to make it easier for the infant to suckle.Eight kinds of manual massage techniques on the breasts numbered 1, 2, 3, 4, 5, 6, 7, and 8. Massages 1 through 7 are a set or treatment, and each is different for each breast.The massages and expressions take one minute, then repeated every fifteen to twenty minutes (Tasnim et al., 2019).

Oketani Massage Combination
Patients undergoing national section for three days received 12 hours of intervention in group A1 every morning and evening.Each intervention lasted 45 minutes.Oketani massage is an alternative form of massage performed after rolling massage.For each intervention, the control group received 15 minutes of breast care every morning for three days.Certified and experienced researchers and enumerators delivered the interventions.The intervention is given to each patient in their own room.One of the obstacles researchers encountered when conducting interventions was fear of early mobilization; however, motivation and encouragement can help overcome these obstacles.The findings showed A p-value of 0.035 (0.005) indicates a statistically significant difference in prolactin levels between the experimental and control groups following the intervention, as well as a p-value of 0.000 (0, 05) indicates a significant difference between the two groups' milk production at posttests 1 and 2. The rolling and ocate rub mixture significantly increases prolactin levels and milk production (Yuliati et al., 2017).The intervention group received oxy massage or oxytocin injections for three consecutive days in group A2 to increase milk production.Oxytocin and Oketani massage instruction sheets were used.In this study, there was no control group.With a p-value of 0.0001 (0.05), the Wilcoxon test revealed a substantial increase in milk production in the Oketani massage group before and after the intervention.In the oxytocin massage group, the Wilcoxon test showed a difference between before and after the intervention with a p-value of 0.0001 (<0.05).Independent sample t-test revealed that the Oketani massage and oxytocin massage groups produced different volumes of breast milk before and after the intervention, with a P value of 0.046 (<0.05) (Anggraini et al., 2022).

Oketani benefits Breast Milk Production
The results of A1 showed a significant difference in milk production between the two groups in posttests 1 and 2 with a p-value of 0.000 (0,05) and a statistically significant difference in prolactin levels between the experimental and control groups after intervention with a p-value of 0.035 (0.005) (Nababan et al., 2020).In article A2, it was found that Oketani massage was more effective in increasing milk production in nursing mothers seen from the average value of the subjects; the Oketani massage group had an average milk production volume of 82.41 ml before Oketani massage and increased to 135.98 ml with a difference in increase of 53,56 ml (Anggraini & Dilaruri, 2022).
In A7, the dependent t-test showed a difference in fluency before and after the Oketani massage was performed on postpartum women (p=0.016)(Romlah & Rahmi, 2019).In A8, based on breast milk production, it shows that breast milk production is not smooth in most postpartum mothers before the Oketani massage (71.4%).After the Oketani massage, all postpartum mothers can produce milk smoothly (100%) (Yasni et al., 2020).Article A9 The study results show that breastfeeding frequency on the first day is higher, with a mean value of (5.25), compared to oxytocin massage, with a mean value of (4.52) and a p-value of 0.003.It indicates a significant difference in breastfeeding frequency between Oketani and oxytocin massage (Katili et al., 2022).
In A10, there were 35 (63.6%) less than 1 hour during the first breastfeeding after entering the recovery room, and 20 (36.4) more than 1 hour during the first breastfeeding after entering the recovery room in the intervention group.Milk production was much higher in the Oketani massage group compared to control group participants who only received care routinely.The length of breastfeeding demonstrates breastfeeding success, and the mother will feel satisfied with fulfilling the baby's needs (Mahdizadeh-Shahri et al., 2021).

Breast Milk Smoothness
Based on A7 (Romlah & Rahmi, 2019), Postpartum mothers who have received Oketani massage for 15-20 minutes have smoother breast milk supply.Smooth breast milk production might help postpartum women feel less anxious about providing for their newborns.The dependent t-test showed differences in smoothness before and after the Oketani massage was performed on postpartum women (p=0.016).

Breast Milk Dam
In A5 (Nababan et al., 2020) Oketani massage was performed 2.3 and 4 times to several respondents.Most respondents who had not received an Oketani massage experienced breast milk retention by 20 (57.14%), while those who had received Oketani massage did not experience breast milk dam by 15 (42.85%).After receiving Oketani massage therapy, all 35 respondents (100%) did not experience breast milk dam.
In A6, the intervention given was Oketani massage performed on the first postpartum day to the third day with a frequency of 1x a day.Observations were made from day 4 to day 7, and it revealed that of all respondents who underwent the Oketani massage intervention, 22 respondents (100%) have no history of breast milk dam (Kusumastuti, Umi Laelatul Qomar, 2018).
In A3 Oketani massage for postpartum mothers with breast milk dam, namely 7.73 with an SD of 1.163, then after the Oketani massage, the breast milk dam experienced by postpartum mothers experienced significant changes, namely the mean value = 2.93 with SD = 1.580 then from the results the T-test obtained postpartum mothers after having Oketani massage with a mean value = 4.800, SD = 1.46 (p = 0.000) with a significant level <0.05, in other words, Giving Oketani massage therapy to postpartum women is useful in minimizing breast milk retention, but in this article it was also found that from 15 respondents 2 respondents did not experience changes in the dam of breast milk (Jama & S, 2019).
In A4, the intervention group was given Oketani massage for 3 consecutive days for 30 minutes.The results obtained from observing the symptoms of breast milk dam were that in the Oketani massage group, 11 respondents (68.8%) did not experience symptoms of breast milk retention and 5 (31.3%) %) of respondents experienced 1 symptom (Dewita et al., 2022).

LIMITATIONS OF THE STUDY
Several articles did not explain how the Oketani massage technique was performed.

CONCLUSIONS AND SUGGESTIONS
Oketani massage can be utilized as an intervention to treat breast milk issues such as insufficient milk supply and lumpy breast milk.It can also be a therapy for preventing and treating breast milk dam in postpartum mothers.Oketani massage can be done with 8 manual massage techniques and lasts 30-45 minutes, 15-20 minutes each for each breast.Health workers are advised to teach the Oketani massage technique to pregnant women and postpartum mothers as a therapy to overcome breast milk problems.