*Corresponding author: sheylanajwa@gmail. com

A Model for Hypogalactia Treatment Using ElectricalAcupoint to Increase Breast Milk Volume and ImproveProlactin Content

Sheyla Najwatul Maula1,*, Melyana Nurul Widyawati1, and Suryono Suryono2

1Post Graduate Applied Science Midwifery Program, Poltekkes Kemenkes Semarang – Indonesia2Physics Department, Faculty of Mathematics and Natural Sciences, Universitas Diponegoro, Semarang – Indonesia

Abstract. Hypogalactia is one of the problems for breastfeeding mothers that accounts for 63%. Nowadays,efforts have been done to prevent hypogalactia pharmacologically. However, this approach often comeswith side effects for the mothers. This research proposes the implementation of non-pharmacologicalelectrical acupoint method via activation of neurological, bio-mechanical, and psychological systems. It isaimed at proving the method’s efficacy in improving breast milk volume and prolactin level. The model ofelectrical acupoint is carried out at 0. 5 watt frequency of scale 3 for 10 minutes at acupoints SI1, ST36 andSP6. Paired t-test statistical test was then conducted to differentiate the effects of electrical acupointtreatment on breastfeeding mothers. Results show significant differences (p<0. 05) after implementation ofelectrical acupoint. This significant difference is proven from the unpaired t-test which indicated differentresults of pre-and post-treatment. This means that electrical acupoint improves breast milk volume by anaverage of 70. 915 mL and prolactin level by around 313. 47 ng/Ml. It can then be inferred that the use ofelectrical acupoint readily handles the problem of hypogalactia.

Keywords: Electrical Acupoint; Hypogalactia; breast milk volume; and prolactin level.

1 INTRODUCTIONBreastfeeding is a post-natal critical period. Any delay inadministering breastfeeding may cause problems inlactation processes correlated to the conditions of anxietythat is detrimental to both mothers and their babies[1].Breastfeeding problems such as hypogalactia is due to alate phase of lactogenesisII caused by stress, congenitaldysplasia, dietary issues, and lack of zinc[2].Hypogalactia is marks by minimum breast milkproduction that requires intervention on the meridianpoint with stimuli.

Breast milk production with the help of electric pumpwithout any stimuli results in low satisfaction level andeffectiveness, along with insignificant increase in breastmilk volume[3]. Pharmacological methods have beenattempted to deal with hypogalactia like in the use ofmetoclopramide, carbamazepine and domperidone thathave proven to be effective. However, their use oftencome with side effect that non-pharmacological methodsare sought after as probable alternatives to minimize sideeffects[4, 5].

On the other hand, traditional Chinese medicationviews hypogalactia as due to the presence of qi bloodcloths. Electrical acupoint is one of the latest technologiesin health. This technology is not yet widely used instimulating breast milk production. Acupoint is

implemented based on the principle of activating specificpoints in the meridian that in turn serve as stimuli in thebody to smoothen the flow of qi and blood, and hence,improve breast milk production[6]. Body meridian itselfis thought of as oscillating systems that interact with oneanother. When stimuli are positioned in the meridian line,they naturally activate the body system mechanism[7].

Electrotherapy using electrical acupoint caneffectively increase the volume of breast milk comparedto the other methods available. This is possible as thetechnique used in acupoint stimuli is flowing lowfrequency electricity along the meridian line directlyconnected to targeted organs and the hypothalamus in thebrain. This low frequency electricity improves bodyresponse as there is a balancing of qi as the meridian line,and hence, harmony among body organs is activated[8].

Bio-chemistry mechanism stimuli are injected viaelectrical acupoint into meridian points and they havefour times faster response with the help of activatedimpulses to the brain, especially the neuro-hormonalpituitary-adrenocortical axis complex. The feedback ofthis mechanism is relaxation response and lower cortisolproduction, which is one of the causes of hypogalactia.Relaxation is the result of physiological response of thebody against acupoint stimuli, by improving endorphinand serotonin transmittance to the brain and the otherorgans via the nerves and the meridian[9].

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© The Authors, published by EDP Sciences. This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (http://creativecommons.org/licenses/by/4.0/).

Response against low frequency electrical stimuli onacupoint points not only affects the body’s hormonalmechanism, but also the nearest local tissues around theacupoint, along the meridian. Those stimuli trigger thesecretion of neurotransmitters and opioids that releaseneuropeptide hormones to serve as stimuli for thehypothalamus and the pituitary gland. The feedback ofthis mechanism maintains the consistence of nitrite oxide(NO) and cyclic guanosine monophosphate (cGMP) in thelocal mechanism and the hormonal mechanism, withincrease prolactin secretion for improvement of breastmilk secretion[7]. The human body has an inherent abilityto naturally maximize physical processes withoutrequiring the use of drugs which otherwise come with sideeffects. In low carbon building, the use of electronicinstrumentation can facilitate performance so as toincrease productivity in the industrial world [10, 11].

2 METHODThis is a truly experimental research using randomizedcontrolled trials (RCTs) design of phase III clinical test.It was carried out in 6 working areas of Puskesmas(community health center) Semarang City in Indonesia.Two research groups were involved, i. e. intervention andcontrol. The intervention group consists of breastfeedingmothers undergoing electrical acupoint treatment andmassage therapy, while the control comprisesbreastfeeding mothers undergoing only massage therapy.Both group members were measured for their breast milkvolume, and their prolactin content.

Population of the 6 working areas consists of 269people. During the research, 229 respondents were in theexclusion criterion. Other than that, 4 respondents had tobe dropped out. This means that there were 36 subjectsmeet the inclusion criteria of this research. They thenunderwent intervention using electrical acupoint andmassage therapy according to the manual book for 2weeks.

This research applied hypogalactia treatment usingelectrical acupoint involving acupoint points ST36, SI1

and SP6. Electrotherapyacupoint (SI1) does not onlyincrease breast milk production, but it also improvesprolactin content. Low frequency electrical stimuli (0. 5W) in electrical acupoint are applied on the skin surfaceusing stainless steel electrodes on scale 3 for 10 secondsfor each acupoint.

Prolactin content is analyzed using laboratory bloodserum sample for both pre and post tests. Other than that,breast milk volume is evaluated by pumping for both preand post tests. Results of this pre and post tests showimprovement in terms of more breast milk volume, andbetter prolactin content. Therefore, it can be concludedthat Ho is rejected, whereas Ha is accepted. Those dataindicate that the effect of implementing electricalacupoint to increase breast milk volume, and gain properprolactin content is significant.

Data of this research are compared for pre and post testvalues using mean difference in order to show the

discrepancies between the two. Results show that themean difference for breast milk volume and prolactincontent for the intervention group is higher, compared tothat of the control group.

Interpretations from data of breast milk volume andprolactin content before and after the implementation ofelectrical acupoint show significant mean values with pvalue (>0. 05).

3 RESULT ANALYSESUnivariate analysis was used to characterize research

subjects in terms of age, educational level, employment,parity, and breastfeeding history. Results of that analysisreveal descriptions of frequency, mean, and standarddeviation. Respondents’ mean age is found to behomogeneous with p value = 0. 508. Univariate analysistest was also carried out for results of breast milk volumeand prolactin content in order to analyze frequencydistribution of each measurement.

Meanwhile, for bivariate analysis, statistical test wasconducted prior to normality and homogeneity tests.Normality test employed skewness calculation.Dependent bivariate analysis then proceeded for normaldata distribution using parametric testing (paired t-test),whereas abnormal data distribution made use of non-parametric testing (Wilcoxon test).

On the other hand, independent bivariate analysisproceeded for normal data distribution using parametrictesting (unpaired t-test), while abnormal data distributionemployed non-parametric testing (Mann-Whitney test).Homogeneity tests for both prior to and after treatmentreveal that each group is homogeneous (p>0. 05). Resultsof bivariate analysis have been analyzed formeasurements of breast milk volume and prolactincontent. Further analysis then compared results, bothamong variables and among groups.

Analysis for breast milk volume both prior to and aftertreatment using electrical acupoint for intervention andcontrol groups is depicted in Figure 1.

Figure 1. Frequency distribution of breast milk volume beforeand after electrical acupoint treatment.

It can be inferred from Figure 2 that for theintervention group, mean breast milk volume prior totreatment is 5. 11 mL, and it increases to 155. 83 mL aftertreatment. In the meantime, the control group indicates

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mean breast milk volume of 7. 06 mL prior to treatment.Therefore, mean breast milk volume after treatmentincreases to a mean of 75. 22 mL.

Lactation process itself is affected by complexhormonal mechanisms including reproduction hormones(estrogen, progesterone, placental lactogenic, prolactin,and oxytocin), as well as metabolic hormones(glucocorticoid, insulin, growth hormone, and thyroid).Reproduction hormones directly involves in lactation inmammary gland, while metabolic hormones indirectlyinfluences lactation via endocrine and nutritional responseto the breast glands. Producing and secreting breast milkrequires balanced coordination among sensory,autonomous, and hormonal responses to stimulate theperiphery nerves, central mechanism, and myoephitelcells[12].

Analysis for prolactin content both prior to and aftertreatment using electrical acupoint for intervention andcontrol groups is depicted in Figure 2.

Figure 2. Frequency distribution of prolactin content beforeand after electrical acupoint treatment.

It can be interpreted from Figure 2 that bothintervention and control group experience significantincreases in prolactin content before and after treatment.Mean prolactin content for the intervention group prior totreatment was 294. 38 ng/mL, and was increased to 870.83 ng/mL after treatment. Meanwhile, the control groupsaw an increase from 295. 65 ng/mL to 701. 70 ng/mL.

Early lactation stimulates more prolactin productionthat in turn affects breast milk production. Prolactinhormone produces breast milk by triggering contractionamong myoephitel cells in the breast as a response tosuction of the nipple, thanks to neurogenic reflexes sentto the hypothalamus via medulla spinalis[13].Breastfeeding by providing stimuli via mu or kappareceptor increases prolactin secretion. These stimuli canbe obtained from the use of electrical acupoint thattriggers secretion of mu receptor that is associated withcGMP[14].

Results of analysis of difference in stress level, breastmilk volume and prolactin content before and afterelectrical acupoint treatment are given in Table 1.Table 1. Differences in breast milk volume and prolactin

content before and after treatment.

NoGroup

MeanPre-test

MeanPost-test

MeanDiff Unit P value

Intervention

1

a.Breast MilkVolume

5. 11± 2.026

155. 8±29. 8 150. 72 mL 0. 000**

b.ProlactinContent

294. 38±585870. 8±202.

0576. 45 ng/mL 0. 000**

2

Controla.Breast Milk

Volume7. 06±3,670 75. 22±14. 6 68. 16 mL 0. 000*

b.ProlactinContent

295. 65±508. 18

701. 70±141. 43

406. 04 ng/dL 0. 000**

*Paired t-test with p value < 0. 05, ** Wilcoxon test with p value < 0. 05

Based on Table 1, it can be concluded that bothintervention and control groups experience significantincrease in breast milk volume and prolactin content, priorto and after treatment with p=<0. 05. Hence, the effect ofelectrical acupoint treatment in increasing breast milk andimproving prolactin content is significant. Thisconclusion is supported by results from mean differenceevaluation for the intervention group which proves tohave higher mean difference compared to the controlgroup.

Results of analysis of differences in breast milkvolume and prolactin content before and after electricalacupoint treatment are given in Table 2.

Table 2. Differences in breast milk volume and prolactin contentbefore and after electrical acupoint treatment betweenthe groups.

Variable Group Before After MeanDiff.

P valueMean±SD Mean±SD pre post

BreastMilkVolume

Intervention 5. 11±2.026

155. 8±29. 8 97. 61 0.057**

0.000*

Control 7. 06±3.670

75. 22±14. 6 44. 22

ProlactinContent

Intervention 294.38±585

870. 8±202.09

359. 79 0.874**

0.015*

Control 295.65±508

701. 70±141.43

267. 15

*Unpaired t-test with p value> 0. 05, **p value<0. 005, **Mann-Whitney test with p value>0. 05, ***pvalue<0. 05

Based on Table 2, it can be concluded that breast milkvolume before and after electrical acupoint treatmentshows significant mean difference. This is proven with pvalue of unpaired t-test at 0. 057 before treatment (>0.05), and 0. 000 after treatment (<0. 05). Those valuesindicate changing results after treatment. Mean differencevalues also reveal greater margins for the interventiongroup, compared to the control group.

Meanwhile, for prolactin content, results showsignificant mean difference before and after treatmentwith electrical acupoint. This is proven with p value ofMann-Whitney test at 0. 874 before treatment (>0. 05) and0. 015 after treatment (<0. 05). Those values indicatechanging results after treatment. Mean difference valuesalso reveal greater margins for the intervention group,compared to the control group.

According to the meridian theory, stimulated pointsalong the meridian line affects and triggers the functionsof local tissues. Acupoint mediates the secretion of nitrideoxide (NO) that is known to improve local condition andthe circulation of cyclic monophosphate guanosine(cGMP). This process helps improve physicalperformance by suppressing molecules that cause bloodcloths. Continuous application of pressure effectivelyimproves relaxation, regional blood circulation,

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parasympathetic nerves activation, reduced tissueadhesion, and lower neuromuscular stimulus[15].

Nitride Oxide (NO) is one of the most importantmessage carrying molecules, just like neurotransmitter is,with the mechanisms and functions widespread across thebody. Secretion of NO an nNOS is consistently higher onacupoint points in the skin due to stimuli with lowfrequency electricity. Increased NO results from manysources including the NO-ergic neural system that isassociated with the function of acupoint in terms ofstimulation with low frequency electricity. Latest studiesrevealed that low frequency electricity stimuli do not onlyaffect acupoint points but also along the meridian line ofthe body (around 1. 0 mm). Application of low frequencyelectricity results in neurovascular alteration in the wholebody within tens of seconds, which is then followed bychanges in secondary bio-chemistry that in turn triggerstertiary endocrine changes within a few days orweeks[16].

Neuropeptide plays an important role in the brainfunction mechanism. Neuropeptide is secreted fromperiphery electrical stimuli that are beneficial to humanhealth. Concerning lactation, brain function is governedby the chemical mechanisms of neurotransmitter andneuropeptide. The very latest research involvinglaboratory mice show that electrical stimuli at certainfrequencies applied to particular points in the body arecapable of releasing neuropeptide and triggeringphysiological effects for healing processes. In that case,the electrical stimuli on the mice induce the releases ofargininevasoperine and oxytocin into incubation media.Other than that, secretion of peptide opioid effectivelyreduces pain and eases secretion of breast milk. Thismeans that neuropeptide can be modulated by externalstimuli[12, 17].

5. CONCLUSIONThe method of hypogalactia treatment using electricalacupoint effectively increases breast milk volume andimproves prolactin content. Paired t-test statistical test hasbeen conducted to differentiate the effects of electricalacupoint treatment on breastfeeding mothers. Resultsshow significant differences (p<0. 05) afterimplementation of electrical acupoint against breast milkvolume and prolactin content. The treatment method inthis research involves application of low frequencyelectrical stimuli to activate meridian line at acupointpoints ST1, SP6 and ST36. The feedback gained from thisapplication provides both local effects and overallhormonal mechanical responses from the body. Localeffects increase concentration of Nitride Oxide (NO) andimprove the circulation of cyclic monophosphateguanosine (cGMP), as well as opioid and neuropeptide Y.Overall hormonal mechanical responses activate thehypothalamus pituitary adrenal axis that in turn increasescortisol content and modulates the transmittance ofendorphin and serotonin to the brain and certain organsvia the nerves. The feedback from this anteriorhypophysis helps secretes prolactin hormone. Therefore,

electrical acupoint has been proven to be capable oftreating the problem of hypogalactia.

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