Case Report of Midwifery Care at Mrs.

E P1A0 Post Partum Day 6 with

Engorment at PMB Halida Asao

Elsya Octaviany Moita1,* Siti Istiana 2

1
Student of the Midwife Profession Education Department, Muhammadiyah Semarang University
2
Lecturer of Midwifery Department , Muhammadiyah Semarang University
*
Email: elsyaoctavianymoita@gmail.com

ABSTRACT
During the puerperium there are changes and adaptations to the reproductive system, breasts, and others. These
changes aim to restore the organ as it was before pregnancy. In the breast is related to the process of lactation and
breastfeeding.
In the course of the puerperium, complications or complications may occur during breastfeeding. One of the problems
or complicates breastfeeding that can occur is engorment. conducting midwifery care for Mrs. E with engagement
according to applicable standards using a midwifery management approach. The case study used in this data collection
is a descriptive observation located at PMB Halida Asao using the 7-step format of varney midwifery care with data
collection using primary data and secondary data. After obstetric care is done, the mother already understands the
cause of engorment, the mother is willing to do breast care (breast massage, warm compresses, cold comres), willing
to breastfeed on demand and exclusive breastfeeding. After assessment, interpretation of data, potential diagnosis,
anticipation of immediate action, planning, implementation and evaluation on Mrs. E with engagement there is no gap
between theory and case study implementation.

Keywords: engorment, postpartum

1. INTRODUCTION the Infant Mortality Rate (AKB) is lower than 12/1000

The puerperium period is the period after labor is
completed to 6 weeks or 42 days. During the
puerperium, the reproductive organs will slowly undergo
changes like the state before pregnancy.changes in
reproductive organs are called involution. Care during
the puerperium period needs attention because about
60% of maternal mortality occurs in this period [1]
Postpartum care is needed in this period because it is
a critical period for both mother and baby. An estimated
60% of maternal deaths from pregnancy occur after
delivery and 50% of puerperal deaths occur within the
first 24 hours [2]
According to the World Health Organization
(WHO), every day worldwide about 730 women die
from complications during pregnancy or childbirth. In
2015 MMR reached 303,000 during pregnancy and
childbirth. Sustainable Development Goals (SDGs) have
targets, namely the Maternal Mortality Rate (MMR) is
targeted to be lower than 70/100,000 live deliveries and
live deliveries [3]
Postpartum danger signs (puerperium) are abnormal
signs that indicate a danger or complication that can
occur during the puerperium, if not reported or
undetected can cause maternal death. Postpartum danger
signs are postpartum hemorrhage, infection in the
postpartum period, foul-smelling lochea (smell from the
vagina), uterine sub-involution (disturbed uterine
reduction), abdominal and pelvic pain, excessive
dizziness and weakness, headache, epigastric pain,
vision blurred, mother's body temperature more than 37
degrees Celsius, red and painful breasts, loss of appetite
for a long time, swelling of the face and extremities
(Marni, 2014)
The occurrence of breast milk dams caused by the
release of milk is not smooth, because babies do not
breastfeed often enough to their mothers. This disorder
can be more severe if the mother rarely breastfeeds her
baby, as a result the baby does not get exclusive milk
and if not treated immediately it will cause breast milk
dam in the breast, breast milk damming can occur due to
narrowing of the lacteferi duct or by the glands not midwife by obtaining BBL: 3200 grams, body length:
emptied completely or due to abnormalities in the nipple 50 cm normal condition.
so that swelling of the breast due to increased venous
and lymph flow causes damming of breast milk and pain
accompanied by an increase in body temperature.
Based on this background, the authors were
3. CLINICAL FINDINGS
interested in taking the case of Obstetric Care at Mrs. E
P1A0 Postpartum Day 6 with Engorment at PMB General condition is quite good, Compostmentic
Halida Asao. consciousness, Blood pressure: 115/77 mmHg,
Respiration: 22 times/min, Pulse: 70 times/min,
Temperature: 39.2 oC, Weight: 69 kg. Height 157 cm, lila
26 cm. In the physical examination, results are obtained
2. PATIEN IDENTITY within normal limits. In obstetric status, it is found in
the breast palpable hard or there is a dam of breast milk.
Patient named Patient named Mrs. E, age 19 years. Supporting examinations are not carried out.
His last education was high school. He works privately,
address Asao Village. The main complaint is that the
mother said her breasts were swollen, and painful. In the
past medical history, current health and family health
have never experienced declining diseases such as
hypertension, diabetes militus, infectious diseases such
as HIV / AIDS, TUBERCULOSIS, and degenerative
diseases such as tumors, cancer in the reproductive
organs. In the history of childbirth, the mother said that
the normal delivery on July 5, 2023 was helped by the

4. TIMELINE
Time Subjective Obyektive Assesment Planning

11 . 07. 2023 Mom said her General condition is Mrs. E age 19 1. Explain the results of the examination to
07.00 WIB breasts were quite good, years P1A0 Post the mother that she has a breast milk dam
swollen, and Compostmentic Partum day 6 with Evaluation: the mother has understood the
painful consciousness, engorment results of the examination
Blood pressure: 2. Explain to the mother that breast swelling
115/77 mmHg, occurs because breast milk is not in milk
adequately, so that the rest of the milk
Respiration: 22
collects in the ductal system which results
times/min, Pulse:
in swelling. In addition, because the use of
70 times/min, tight B.H is also common to cause
Temperature: 39.2 segmental engorgement, as well as unclean
oC,
Weight: 69 kg. putting can cause blockage of the ducts.
Height 157 cm, lila Evaluation: the mother has understood
26 cm. In the what is explained by the midwife
physical 3. Explain to the mother about doing breast
examination, results care
are obtained within Evaluation: the mother has understood
normal limits. In about breast care described by the midwife
obstetric status, it is 4. Recommend to the mother to do cold
found in the breast compresses to reduce static veins and
reduce pain. When done intermittently
palpable hard or
with hot compresses, to smooth breast
there is a dam of
blood flow
breast milk. Evaluation: the mother has understood and
 Supporting
examinations are
not carried out
5. DISCUSSION
The subjective data review on Mrs. E was carried
out on July 11, 2023 at 07.00 WITA at the PMB Halida
Asao. In the subjective data, the patient's identity
contains name, age, religion, education, occupation, and
address. The patient's name needs to be studied to create
trust between the caregiver and the patient and
distinguish if there are similarities in name with other
patients; Age is studied to determine the risk associated
with age, because if the mother's age is less than 20
years or more than 35 years is included in the risk factor
in the puerperium. Mrs.E is 19 years old, this is
obviously that age is not a high risk. This is because at
the age of the mother is not mature enough so that there
is a lack of knowledge about how to breastfeed,
breastfeeding techniques and lactation management is
inadequate.
According to [5] The main complaint history will
provide important information to determine the
differential diagnosis and provide an overview of the
is willing to be advised by the midwife
5. Encourage mothers to breastfeed on
demand
Evaluation: the mother has understood and
is willing to be explained by the midwife
6. Encourage mothers to breastfeed
exclusively.
Evaluation: the mother has understood and
is willing
7. Giving paracetamol drug therapy 500 mg
taken 3x1
Evaluation: the mother has understood and
is willing according to the advice of the
midwife
8. Tell the mother that the midwife will make
another visit after 3 days to evaluate the
condition of the mother and baby.
Evaluation: the mother has understood and
is willing
complaints that the patient thinks are most important.
Anamnesis complaints should be recorded and
presented according to the patient's own words and
should not be disguised with medical words. When
conducting the study, the authors recorded what patients
said without adding medical terms that led to a
diagnosis. Mrs. E said that swelling in the breast became
an obstacle in providing exclusive breastfeeding.
One of the things that can cause obstacles in
exclusive breastfeeding is the presence of breast
problems. One of the problems in the breast that often
occurs is breast milk dam or breast swelling. Breast
milk dams are dams of milk due to narrowing of the
active ducts or glands that are not emptied completely.
Breast swelling often occurs on the second to tenth day
postpartum. Most patients feel swollen, red, hard,
painful and hot breasts. The causes of breast milk dams
include ineffective frequency of milk discharge, this can
be caused by several things, including the non-
implementation of hospitalization so that there is
separation of mother and child, and the existence of
improper and effective breastfeeding techniques [6]
Strategies that can be done to prevent breast
swelling pharmacologically can be given symptomatic
therapy as analgesics such as paracetamol and mother
profen to reduce breast swelling pain [4]. Non-
pharmacologically, including acupuncture, breast care,
alternating hot and cold compresses, breast care can
help facilitate breast milk expenditure and prevent and
treat breast problems. However, breast care requires
preparation and equipment and requires a long time for
compressing and massaging each stage, so cabbage leaf
compresses can be used as a comfortable breast swelling
treatment and can be used alone by mothers. Besides
being practical and applicable, preparation requires little
time and money [7]
Based on previous research [6] that breast mass
intervention for 3 days with a duration of 15 minutes.
Before the breast masase of 16 postpartum mothers
there were 71.3% or 13 postpartum mothers who were
categorized as having breast milk dams and after
lactation there was a decrease in breast milk dams from
71.3% to 17.7%. Conclusion There is an effect of
lactation period on breast milk dam with a p-value of
0.007.
Based on other research Gustirini, Ria (2021)
that is one of the efforts to prevent breast milk dams,
namely with breast care or breast care. Breast care aims
to improve blood circulation and prevent blockage of
the milk production channel so as to facilitate milk
production. Tactile stimulation during breast care can
stimulate the hormones prolactin and oxytocin that help
babies get breast milk [8]
6. CONCLUSION AND ADVICE
Subjective data on July 11, 2023 on Mrs. E said
her breasts were swollen, and painful. Mrs. F is 19 years
old. The objective data obtained are general condition is
quite good, Compostmentic awareness, Blood pressure:
115/77 mmHg, Respiration: 22 times/min, Pulse: 70
times/min, Temperature: 39.2 oC, Weight: 69 kg. Height
157 cm, lila 26 cm. In the physical examination, results
are obtained within normal limits. In obstetric status, it
is found in the breast palpable hard or there is a dam of
breast milk. Supporting examinations are not carried
out.
The needs given are explaining the causes of
maternal complaints, providing breast care,
recommending breastfeeding on demand, and providing
paracetamol drug therapy, recommending exclusive
breastfeeding and advising mothers to warm compresses
and cold compresses on the breasts.
Dihopefully, postpartum mothers and their
families will increase their insight so that they can
detect early if there are complications and can minimize
the risks. For the University of Muhammadiyah
Semarang Can develop the material that has been given
both in lectures and field practices and also add
references so that they can be used as an evaluation in
providing midwifery care to postpartum in accordance
with minimum service standards. For PMB Halida
Asao, healthy can be an input in handling cases or
carrying out obstetric care, especially for postpartum
mothers in handling engagement problems.
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