Wahyuningsih D, et al. Belitung Nursing Journal.

2017 June;3(3):174-182
Accepted: 18 February 2017
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© 2017 The Author(s)

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ORIGINAL RESEARCH ISSN: 2477-4073

EFFECT OF MUSA BALBISIANA COLLA EXTRACT ON BREAST

MILK PRODUCTION IN BREASTFEEDING MOTHERS

Diyan Wahyuningsih1*, Syarief Taufik Hidayat2, Nur Khafidhoh3, Ari Suwondo4, Diyah
Fatmasari1, Kun Aristiati Susiloretni1
1
Magister Applied Midwifery, Health Polytechnic of Semarang, Semarang, Indonesia
2
Medical Staff Group of Obstetry Gynecology Departement, Dr. Kariadi Hospital, Semarang, Indonesia
3
Midwifery Department, Health Ministry Polytechnic of Semarang, Semarang, Indonesia
4
Health and Work Safety Department, Faculty of Public Health, Diponegoro University, Semarang, Indonesia

*Corresponding author:
Diyan Wahyuningsih, MTr.Keb
Magister Applied Midwifery, Health Ministry Polytechnic Semarang
Jl. Tirto Agung, Pedalangan, Banyumanik, Kota Semarang, Jawa Tengah, Indonesia (50268)
E-mail: [email protected]
ABSTRACT
Background: Musa balbisiana Colla, known as Jantung Pisang Klutuk or Pisang Batu, is considered as a
traditional food that can increase breast milk production. Little is known about its benefit in Indonesia. Thus, to
examine the impact of Musa balbisiana Colla on the production of breast milk is needed.
Objective: This study aims to examine the effect of the extract of banana flower (Musa balbisiana Colla) to
increase milk production of breastfeeding mothers.
Methods: This was a quasi-experimental study with pretest-posttest control group design. This study was
conducted in the working area of the Health Center (Puskesmas) of Pesantren II in January – February 2017.
There were 16 respondents were selected by accidental sampling, divided into intervention group (8
respondents) and control group (8 respondents). Randomization was performed to select the respondent in each
group. The quantity of milk production was measured based on the volume of milk production, while the quality
of milk production was based on the levels of prolactin in early (pre) and late (post) using Electro Chemi-
Luminescence Immunoassay (ECLIA) method. Independent t-test was used to analyze the data.
Results: Findings showed that the mean of the volume of the breast milk production in the experiment group
was 470.681 ml and in the control group was 364.650 ml with SD 113.502. The mean of prolactin levels in the
experiment group was 35.337 nanogram and in the control group was -38.381 nanogram. There was a
significant effect of consuming Musa balbisiana Colla extract on the volume of breast milk production (p-value
0.003) and prolactin levels (p-value 0.001) (<0.05).
Conclusion: There was a significant effect of banana flower (Musa balbisiana Colla) extract on breast milk
production and prolactin level in breastfeeding mothers. The findings of this study could be used to be
alternative daily menu for postpartum mothers and a solution for midwives to deal with those who have
inadequate production of breast milk and low prolactin levels.

Keywords: banana flower, Musa balbisiana Colla, milk production, prolactin, breastfeeding

Belitung Nursing Journal , Volume 3, Issue 3, May-June 2017 174

Editor’s Note: This article has been updated on 17 June 2020 in terms of minor changes in the reference format. The update is according to BNJ Policy on article correction.
INTRODUCTION Pesantren II showed that only four
Breast milk is the best food to be given to mothers (40%) breastfed exclusively and
babies, because it contains almost all the remaining six mothers (60%) did not
nutrients needed by the baby.1 Exclusive breastfeed exclusively with reasons that
breastfeeding for the baby during the first their milk came out only slightly and
6 months will reduce the risk of allergies, insufficient for the baby.
diarrhea, and obesity.1 The contains of In response to the inadequate
breast milk are the nutrient such as breastfeeding, the Health Center of
proteins (linoleic acid and folacin) that Pesantren II provided great efforts such as
play a role in the formation of brain cells to provide breast care among
that ultimately affect brain development, breastfeeding mothers in the purpose that
and immunoglobulin contained in breastmilk can produce smoothly, and to
colostrum which provide protection or give vitamin and facilitate breastfeeding
antibodies to fight infection until the and counseling about the importance of
infant immune system began to function.2 balance nutrition. However, these efforts
Inadequate breastfeeding is a threat had not been fully effective. So, another
to the development of the children.3 intervention is needed to deal with these
Barriers to exclusive breastfeeding among problems, particularly to increase
breastfeeding mothers are due to the need breastmilk production among
to return to work outside the home and breastfeeding mothers. Otherwise, if the
health related problems,4 lack of family babies do not have enough nutrient from
support,4 the perception that babies their mother’s milk, it can be a problem
continued to be hungry after for the baby’s development.3 Some of
breastfeeding, maternal health problems,5
5
mothers use complementary feeding for
fear of babies becoming addicted to breast their babies which might have risks of
milk pains in the breast,5 low education,6 diarrhea due to indigestion of baby who
low income,6 and insufficient breast milk.7 has not been able to digest food other than
Based on the data obtained from breast milk.11 In addition, it has the
Riskesdas 2013,8 exclusive breastfeeding possibility of bacterial contamination
coverage for infants aged 0-6 months in because of unsterile equipment, and other
Indonesia was 38%.8 According to the disadvantages such as the lack of adequate
data from the Lancet Series Breastfeeding infant nutrition, and allergies.
series 2016 indicated that the coverage of Therefore, midwives play roles to
exclusive breastfeeding in Indonesia was deal with this issue and make an effort to
increased to 65%.9 However, the scope of increase the production of breast milk of
exclusive breastfeeding in the setting of mothers. There are some of traditional
this study, Kediri East Java, decreased foods are recommended to increase milk
from 67% in 2012 to 64.5% in 2015.10 production, such as katuk leaves,12 leaves
Thus it indicated that the scope of of papaya,13 leaves of bangun-bangun,14
exclusive breastfeeding in Kediri has not and banana flower.15 These foods are
achieved the target of 80% yet. Scope of known by several previous studies that
the lowest exclusive breastfeeding in have laktogogum properties, which are
Kediri was in the area of the Health able to enhance the secretion and
Center (Puskesmas) of Pesantren II production of milk due to a high flavonoid
amounted to 57.4%.10 content that increase the production of the
Based on a preliminary study hormone of prolactin and oxytocin to
conducted by researchers by interviewing increase the volume of milk.12-15 The other
10 mothers in the area of Puskesmas ingredients are calories, protein, calcium

Belitung Nursing Journal , Volume 3, Issue 3, May-June 2017 175

and other nutrients, which are very good (8 respondents) and control group (8
for the milk glands in the breast milk respondents). Randomization was
secretion process. However, in this study, performed to select the respondent in each
the researchers did not use all these group. The inclusion criteria of the sample
traditional foods to be examined, but only were 1) mothers who did not take
using banana flower (Musa balbisiana supplements for breast milk, 2) no abstain
Colla), or called as kluthuk banana flower from food, and 3) willing to be a
in Indonesian term. respondent. The exclusion criteria were 1)
Banana flower is very cheap and postpartum mothers who had severe
easy to obtain and often processed into a anemia and bleeding, 2) mothers with a
wide variety of popular traditional cuisine history of having low body weight infants
in the public in Indonesia. This banana that should be treated in an incubator and
heart is generally considered to have a require special handling, 3) having infants
delicious, sweet and soft flavor. However, with labiopalatoskiziz, and 4) having
the benefits of this food have not been infants with a short frenulum.
known by the society in Indonesia,
especially to increase the breast milk. Instrument
According to the literature, the The quantity of milk production was
content of banana flower of kluthuk measured based on the volume of milk
includes: energy (31 kcal), protein (1.26 production, while the quality of milk
g), fat (0.35 g), carbohydrates (7.1 g), production was based on the levels of
calcium (30 mg), phosphorus (50 mg), prolactin in early (pre) and late (post) of
vitamin A (170 IU), vitamin B1 (0.05 prolactin levels using the method of
mg), vitamin C (10 mg), flavonoids (0.4 electro chemiluminescence immunoassay
g).16 Additionally, the high flavonoid in (ECLIA). ECLIA is considered as a
this banana blossom has laktogogum that promising method for analyzing
help in producing breast milk. However, hormones. In this study, the volume of
there is no study that has been conducted milk production was noted by each
in the working area of the Health Center respondent in the observation sheet started
of Pesantren II. Therefore, this study aims from the 5th day until 12th day of
to examine the effect of banana flower of postpartum, which was based on the
kluthuk to increase breast milk duration of breastfeeding per day. The
production. assumption used was the average amount
of breast milk is 600 ml per day (24 hours
METHODS or equal to 1,440 minutes) in the first
Design year.17 The level of prolactin was obtained
This study was a quasi-experimental study using blood sampling of each respondent
with pretest-posttest control group design, in the intervention group, which were
conducted in the working area of the taken before and after intervention. The
Health Center (Puskesmas) of Pesantren II blood samples were sent to the Prodia
in January – February 2017. Laboratory, and the results were also
noted in the observation sheet. The
Target Population and Sample observation sheet contained a table about
The target population in this study was the the duration of breastfeeding, respondents
postpartum mothers in the working area of wrote the time to start feeding,
Puskesmas Pesantren II. There were 16 breastfeeding and finished breastfeeding
respondents were recruited by accidental (within minutes).
sampling, divided into intervention group

Belitung Nursing Journal , Volume 3, Issue 3, May-June 2017 176

Intervention consent was performed by the researchers,
In this study, Musa balbisiana Colla was and each respondent was asked to read
used in the form of extract capsule. The and sign the written consent form.
researchers distributed 14 extract capsules
to each respondent in the intervention Data Analysis
group. Each of them was asked to take 2 Data were analyzed using Independent t-
capsules per night in 7 days, which started test to determine significant differences
from the 5th day until 12th day of between the two groups. Shapiro Wilk and
postpartum. There was no intervention for Levene’s test were performed to examine
the control group, which they could had the normality and homogeneity of the
daily food as they usually did. data.

Ethical Consideration RESULTS

Ethical permission for this study was Based on Table 1, the characteristics of
obtained from the ethical board of the the respondents in the intervention and
Health Ministry Polytechnic Semarang control group were mostly 21-30 years
number: DM.02.04 / IV.2 / 8.5 / 2017. In old, had senior high school background,
this study, researcher also got the worked as housewife, and had two and
permission from STiKes Ganesha Husada three children. There was no significant
Kediri and the Health Center of Pesantren difference of the characteristics of the
II before data collection. Informed respondents between both groups.

Table 1 Characteristics of the respondents (n=16 respondents)

Intervention Group Control Group p-value
Characteristic
Quantity % Quantity % Exact Fisher
Age
≤ 20 years 1 6.300 1 6.300
21 - 30 years 8 50.000 10 62.500 0.590*
> 30 years 7 43.800 5 31.300
Mother’s Education
Senior High 14 87.500 16 100.000
School 0.564*
University 2 12.500 0 0.000
Mother’s Job
Housewife 11 68.800 13 81.300
0.564*
Private employee 5 31.300 3 18.800
Parity
1 child 4 25.000 2 12.500
2 children 6 37.500 10 62.500 1.000*
3 children 6 37.500 4 25.000
*)No difference > 0.05

Table 2 Breastfeeding duration per day (the 5th day to 12th day of postpartum)
Mean of Breastfeeding
Groups
duration per day (Min)
Experiment group 235.300
Control group 182.300

Belitung Nursing Journal , Volume 3, Issue 3, May-June 2017 177

Table 2 shows that the mean of It could be seen that the average of
breastfeeding duration per day since the breastfeeding duration in the experiment
5th day to 12th day of postpartum was group was longer than it in the control
235.300 minutes in the experiment group group.
and 182.300 minutes in the control group.

Table 3 Mean of the volume of breast milk production after given intervention
Mean of the volume of breast milk Standard
Groups
production (ml) Deviation
Experiment group 470.681 65.637
Control group 364.650 113.502

Table 3 shows that the mean of the volume of breast milk production in the
volume of the breast milk production in experiment group was higher and more
the experiment group was 470.681 ml heterogeneous than the mean of the
with SD 65.637, while in the control volume of breast milk production in the
group was 364.650 ml with SD 113.502. control group.
This number showed that the mean of the

Table 4 Mean of the increase of the prolactin level after given intervention
Mean of the increase of the
Groups Standard Deviation
prolactin level (nanogram)
Experiment group 35.337 40.714
Control group -38.381 60.853

The quality of breast milk production was control group was -38.381 nanogram. It
measured based on the level of the was indicated that the mean of prolactin
prolactin level between the 5th day (pre) to level in the experiment group was higher
13th day (post). Table 4 shows that the than the mean in the control group. But
mean of prolactin level in the experiment the range of data between two groups was
group was 35.337 nanogram, and in the similar.

Table 5 Normality test for breast milk volume and prolactin level using Shapiro Wilk
Variable Groups p-value
Volume of breast milk production Experiment 0.671*
Control 0.081*
Prolactin level Experiment 0.814*
Control 0.064*
*)Normal distribution > 0.05

Table 5 shows the result of Shapiro Wilk, intervention and control group were in
which indicated that the volume of breast normal distribution with p-value > 0.05.
milk production and prolactin level in the

Table 6 Homogeneity test using Levene’s test

Variable p-value Levene’s Test
Volume of breast milk production 0.056*
Prolactin level 0.057*
*)Homogenous > 0.05

Belitung Nursing Journal , Volume 3, Issue 3, May-June 2017 178

The Levene’s test as shown in the Table 6 intervention and control group were
indicated that the volume of breast milk homogenous with p-value >0.05.
production and prolactin level in the

Table 7 Comparison test of confounding variables on breast milk production volume and prolactin levels
Volume of Breast milk
Prolactin level
Confounding production
variables Contingency Contingency
p-value p-value
Coefficient Coefficient
Age 0.812 0.412 0.816 0.406
Education 0.707 0.368 0.707 0.417
Job 0.707 0.368 0.707 0.417
Parity 0.811 0.426 0.816 0.406
*)Significant level <0.05

All confounding variables as shown in the breast milk production and prolactin level
table 7 had no effect on the volume of with p-value >0.05.

Table 8 The effect of musa balbisiana colla on the volume of breast milk production and prolactin level
(Independent t- Test)
Mean Interval
Variable T df p-value
Difference Lower Upper
Volume of breast milk production 3.914 14 0.003* 106.031 39.088 172.974

Prolactin level 4.261 14 0.001* 73.718 36.336 111.101

*)Significant level <0.05

Table 8 shows that there was a significant the experiment group and 182.300
effect of consuming Musa balbisiana minutes in the control group. It could be
Colla extract on the volume of breast milk seen that the average of breastfeeding
production with p-value 0.003 (<0.05), duration in the experiment group was
and the mean difference between longer than it in the control group. This
intervention and control groups was finding was in line with the previous study
106.031, ranged between 39.088 (lower) of Wahyuni,15 stated that an increase in
to 172.974 (upper). The data also showed the duration of breastfeeding significantly
that there was a significant impact of affected by consuming banana blossom
Musa balbisiana Colla extract on the for 7 days in a row. In this case, she
prolactin level with p-value 0.001 (<0.05). assumed that the more a mother breast-
The mean difference of prolactin level feeding, the higher the volume of milk
between both groups was 73.718, which produced in the body.15 However, the
ranged between 36.336 (lower) to 111.101 calculation of milk production volume in
(upper). this study was more accurate than in the
previous study, because the researchers
DISCUSSION consider the average duration of
The findings of this study revealed that breastfeeding per day. In this study, a
the mean of breastfeeding duration since Soetjiningsih’s formula17 to measure the
the 5th day to 12th day of intervention in volume of an average milk production per
postpartum period was 235.300 minutes in day in units of milliliters, assuming that

Belitung Nursing Journal , Volume 3, Issue 3, May-June 2017 179

normal milk production in quantity on level with with p-value 0.001 (<0.05). The
average is about 600 ml per day in the mean difference of prolactin level
first year. between both groups was 73.718, which
The results of this study also ranged between 36.336 (lower) to 111.101
showed that there was a significant effect (upper). This proved that the flavonoid in
of consuming Musa balbisiana Colla Musa balbisiana Colla has an influence
extract on the volume of breast milk towards hormone prolactin, like the study
production with p-value 0.002 (<0.05). said that the higher level of the prolactin,
This finding was consistent with the the better process of breast milk
previous study revealed that there was an production.15 In addition, flavonoid in
effect of banana blossom on the increase musa balbisiana colla is high enough,
of breast milk production.15 namely 0.4 gram per 100 gram. This study
According to Sulistyawati, foods proved that mean of prolactin level in the
during breastfeeding will affect the quality experiment group was 35.337 nanogram
or quantity of milk produced.18 To and in the control group was -38.381
breastfeeding exclusively, mothers should nanogram. It described that the mean of
receive additional food. If the mother's prolactin level in the experiment group
diet constantly does not meet adequate was higher than it in the control group.
nutrition, the breastmilk gland will not
work effectively. So, the finding of this Limitation of the study
study was really useful, which banana This study provides the insight of
flowers easily to find, and have several knowledge regarding the effect of musa
compounds that can increase the balbisiana colla on breast milk production
production and quality of milk. According in breastfeeding mothers. However,
to Mamuaja, in 100 grams of banana further study is needed to have bigger
blossom of kluthuk has 31 kcal calories sample size to generalize the finding of
and 30 mg calcium, 1.26 g protein, 170 IU this study.
of vitamin A, vitamin C 10 mg, 50 mg
phosphorus and 0.4g flavonoids.16 CONCLUSION
Flavonoid in the banana flower is an anti- From this study, it can be concluded that
progesterone in the mammary gland, thus there was a significant effect of banana
increasing the action of prolactin in blossom (Musa balbisiana Colla) extract
stimulating milk production.19 Reflex of on breast milk production and prolactin
prolactin hormone to produce milk is level in breastfeeding mothers. The
working when a baby sucks mother's findings of this study could be used to be
nipple in which there is a neurohormonal alternative daily menu for postpartum
stimulation ron the nipple and areola of mothers and a solution for midwives to
the mother. This impulse is forwarded to deal with those who have inadequate
the pituitary through nervosvagus, then to production of breast milk.
the anterior lobe. These lobes will secrete
the hormone prolactin, enter the Declaration of Conflicting Interest
bloodstream and to the glands of breast None declared.
milk maker. These glands will be
stimulated to produce breastmilk.18 Acknowledgement
On the other hand, the finding of This study has been supported by Health Ministry
this study also revealed that there was a Polytechnic Semarang, Indonesia.
significant impact of consuming Musa
balbisiana Colla extract on the prolactin Authorship Contribution
Authors have equal contribution on this study

Belitung Nursing Journal , Volume 3, Issue 3, May-June 2017 180

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