Factors Related to The Implementation of Early Breastfeeding by Midwives at Datu Sanggul Rantau Hospital

Early initiation of breastfeeding is program of Indonesian Government. Early breastfeeding has not been widely practiced, <30% for South Kalimantan and 21% for Tapin District. The implementation of early initiation of breastfeeding by midwives at Datu Sanggul Rantau Hospital is influenced by age, education level, years of service, midwife training and socialization of implementation of early breastfeeding initiation. This study aims was to analyze the factors associated with implementation of early initiation of breastfeeding by midwives at Datu Sanggul Rantau Hospital. The study was cross sectional, with 32 midwives in PONEK, maternity and nicu at Datu Sanggul Rantau Hospital. The variables were age, education level, years of service, training and socialization. Data were analyzed using Chi square. The results showed socialization was related with p value of 0.004. Unrelated factors were age p value 0.660, education level p value 0.496, years of service p value of 0.761, and training p value 0.314. Simultaneously, age, education level, years of service, training and socialization are not related to the implementation of early breastfeeding initiation with p value 0, 083. The conclusion is there is a significant relationship between socialization and the implementation of early initiation of breastfeeding at Datu Sanggul Rantau Hospital.


INTRODUCTION
Early Initiation of Breastfeeding (IMD) is the process of allowing a baby on his own instinct to breastfeed immediately within the first hour after birth, along with contact between the baby's skin and the mother's skin. 10 Early breastfeeding initiation policy has been socialized in Indonesia since August 2007. 2 The World Health Organization (WHO) has recommended that all babies get colostrum, namely breast milk on the first and second days to fight various infections and get exclusive breastfeeding for 6 months. 3 The prevalence of early initiation of breastfeeding in Indonesia is still low, namely 39%. This figure is still far behind when compared to other developing countries such as Oman (85%), Sri Lanka (75%), and Philippines (54%). 4 This shows that the IMD program in Indonesia has not been implemented optimally. According to the Health Profile of the Republic of Indonesia (RI) in 2017, nationally the percentage of newborns who received an IMD was 73, 06 %. This figure has surpassed the target of strategic plan (plan strategy) in 2017 which is 44% of the Province with a percentage of the highest newborn gets IMD is Aceh (97.31%) and the province with the lowest percentage were Papua (15%). 5 Based on the 2017 Basic Health Research data, the IMD achievement of South Kalimantan Province is less than 30% and is in 26th place out of 34 Provinces in Indonesia, while the national coverage of the IMD figure is 34.5%. Therefore, the IMD coverage targeted in the 2015-2019 Ministry of Health's Strategic Plan Program states that the percentage of newborns receiving IMD must be 50%, so serious efforts are needed to increase the success of the IMD program. Based on data obtained from the Tapin District Health Office in 2019, the coverage of IMD implementation is only 21% even though the targeted IMD implementation coverage is 80%. 6 The success of the IMD program does not only require the role of mothers, but also the role of health workers. Childbirth assistants such as midwives and/or nurses are health workers who have the most role in implementing IMD because mothers cannot perform IMD without the help and facilities of midwives or other birth attendants. The success of midwives and nurses in providing positive interventions to mothers is influenced by basic knowledge and skills regarding theory and problem solving skills. 7 Implementation of IMD by midwives at Datu Sanggul Rantau Regional Hospital is influenced by many factors, including midwife's age, education level, years of service, midwife training and socialization of early breastfeeding initiation. According to Raya (2008) the age of health workers is related to the implementation of IMD. Age affects a person's acceptance of new information. Moreover, IMD is a new science for older health workers. Age of health workers plays a role in the implementation of IMD and ASI, so the knowledge is wider. At the age of 24-35 years is a productive age, health workers have high idealism in implementing IMD and exclusive breastfeeding. 8 Midwife education related to the implementation of the IMD. 9 According to YB Mantra in Wawan (2010), education can influence a person's behavior in supporting health. According to Nursalam (2003) in Wawan (2010), in general, the higher a person's education, the easier it is to receive information. 10 According to Anderson (1994), the longer the work experience is, the more skilled a person is, someone who has worked for a long time has a broader insight and a lot of experience that will play a role in shaping the behavior of officers. 11 Until now, research that analyzes the factors associated with the implementation of IMD by midwives at Datu Sanggul Rantau Regional Hospital has not been widely carried out, while the IMD coverage in Tapin Regency is still low. The research objective is un to analyze the factors associated with the implementation of Early Initiation of Breastfeeding (IMD) by Midwives at Datu Sanggul Rantau Regional Hospital in 2020.

METHOD
This study used an analytic observational study with a cross-sectional design. The study population was all midwives who worked in the ponek room, maternity and the NICU, both civil servants and contracts. Based on data obtained from the Personnel Division of the Datu Sanggul Rantau Regional Hospital, the number of midwives in this room was 33 people. The sample size was 32 people from the total population. 12 The independent variables in this study include age, education level, years of service, socialization and training. While the dependent variable is the implementation of early breastfeeding initiation (IMD) by midwives at Datu Sanggul Rantau Regional Hospital. To test the related variables used the chi square test with a confidence level of 95%, then all variables will be tested simultaneously with the F test using the 95% confidence level. DOI: 10.20527/jbk.v7i1.9929

RESULTS AND DISCUSSION
The relationship between the midwife's age and the implementation of early breastfeeding initiation (IMD) To determine the relationship between the independent variable (midwife's age) and the dependent variable (implementation of early breastfeeding initiation) can be seen in table 1 below: The results of the analysis in Table 1 shows that the results of the test statistic Chi Square to know the relationship of age midwife with the implementation of early initiation of breastfeeding (IMD) in Datu Hospital Rantau bun with ά = 0,05 in can be p-value of 0.660. The value was not statistically significant ( p value > 0,05 ) and can be interpreted that there is no correlation between age midwife with the implementation of early initiation of breastfeeding (IMD) in Datu Hospital bun Rantau.
The results of this study differed from the results of research conducted by Raya (2008) , which showed that the age of health workers was related to the implementation of IMD 8 . The meaningless relationship between research subjects and the implementation of IMD by midwives at the Datu Sanggul Rantau Regional Hospital in this study is probably because the proportion between adolescents (≤25 years) is not much different, so that between adolescent (≤2 5 years) and adults (>25 years) have the same opportunity in implementing IMD.
Age is not a determining factor for a person's good performance. Age is natural or in other words binding / attached to someone, in this case the respondent. As you get older, your ability, endurance, memory will decrease at a time. Without training, learning and experience will certainly not improve a person's quality. The results of this study are in line with the research of Dayati (2011) which shows that there is no significant relationship between midwife age and the implementation of IMD. 13

The relationship between the midwife's education level and the implementation of early breastfeeding initiation (IMD)
The results of statistical tests on the relationship between education level and the dependent variable (implementation of early breastfeeding initiation) can be seen in the table below: The results of the analysis in Table 2 show that the results of the test statistic Chi Square to know the relationship of age midwife with the implementation of IMD in Datu Hospital Rantau bun with ά = 0 , 05 in can be pvalue of 0.496. The value was not statistically significant (p value > 0,05) and can be interpreted that there is no relationship of education level midwife with the implementation of early initiation of breastfeeding (IMD) in Datu Hospital bun Rantau.
In line with the research conducted by Budi Puji Nastiti (2013), that maternal education is not related to the practice of IMD in the working area of the Pangkah Community Health Center, Tegal Regency. 14 The results of this study are the same as the results of research conducted by Bet Idhya (2012) that the level of education of midwives is not related to the implementation of IMD in private practice midwives in Bukittingi City. 15 Education is the process of building fundamental skills intellectually and emotionally towards nature and humans 16 .
Education makes a person motivated to be curious, seek experience so that the information received will become knowledge. 17 From the results of the research, theory and related research, researchers assume that the higher the education of a mother, the more maternal knowledge will be about early initiation of breastfeeding so that the mother will initiate early breastfeeding for her newborn baby. Likewise, on the other hand, the low level of education of a mother makes the mother's knowledge lower, especially regarding IMD.
The results of this study are in line with research by Dayati (2011) which shows that there is no significant relationship between midwife education and the implementation of IMD. This could occur because the older the midwife tendency to implement the higher IMD supported by the maturity and experience of. 13 According to UU RI no. 20 of 2003 concerning the national education system, education is a conscious and planned effort to prepare students through guidance and training activities for their role in the future. This definition emphasizes formal education and appears to be closer to the operation of education. The higher the education of a person, the easier it is to receive information so that the more knowledge has -on the other hand, less education will hinder the development of one's attitude towards newly introduced values. Table 2 shows the education of respondents D1-D3 who implemented IMD 56.3%. After the "Chi Square" statistical test was carried out, the difference was not significant or in other words that there was no relationship between education and IMD implementation practices by midwives at Datu Sanggul Rantau Regional Hospital in 2020. This is in line with Hajrah's research (2012), which states that there is no There is a significant relationship between education and the behavior of midwives in implementing IMD. 11 This probably happened because most of the respondents had attended training related to maternal and child health, especially those related to IMD. Thus, the formal education of the midwife is not related to IMD.

The relationship between the midwife's tenure and the implementation of early breastfeeding initiation (IMD)
The results of statistical tests on the relationship between the midwife's tenure and the dependent variable (implementation of early breastfeeding) can be seen in the table below: (IMD) in Datu Sanggul Rantau Regional Hospital with ά = 0 , 05 in can be p-value of 0.761. The value was not statistically significant ( p value > 0 , 05 ) and can be interpreted that there is no connection with the implementation of the work period midwife early initiation of breastfeeding (IMD) in Datu Sanggul Rantau Regional Hospital.
The results of this study differ from research conducted ol er Astuti (2013) found no effect of anatara experience of nurses and midwives on the implementation of the IMD in Hospital Dr. H. Soewondo Kendal. 18 Experience is the best teacher. The adage can be interpreted that experience is a source of knowledge or experience is a way to obtain the truth of knowledge. Therefore, the experience of nurses and midwives can be used as an effort to gain knowledge. This is done by repeating the experience gained in solving problems faced in the past. 19 The results showed that the longer a person worked, the more experience was not a factor related to the implementation of IMD at Datu Sanggul Rantau Regional Hospital. Work experience is knowledge or skills that a person has known and mastered as a result of an act or job that has been carried out for a certain period of time.
According Ranupandojo (1984) suggested the work experience is a measure of the length of time or duration of action has been taken one can understand the task -the task of a job and have did well. The period of service is the time when people have worked in an office, agency, and so on. The longer a person works, the more skilled and experienced they will be in carrying out work. 20 Based on the results of the study, there is a relationship between length of work and IMD Implementation Practices by Midwives at the PONED Health Center Cirebon Regency in 2014. This result is not in line with Hajrah's (2012) research which states that there is no relationship between knowledge and behavior of midwives in Berau Regency in 2012. 11 The long working period of the midwife has resulted in a lot of experience and broader insight so that it is very supportive in implementing IMD. In this study there was no association between employment period or length of work with the implementation of the IMD to possible early because they already have a midwife dissemination of the importance IMD where she worked.

The relationship between midwife training and the implementation of early breastfeeding initiation (IMD)
The results of statistical tests on the relationship between midwife training and the dependent variable (implementation of early breastfeeding) can be seen in the table below: The results of the analysis in table 4 show that the results of the Chi Square statistical test to determine the relationship between midwife training and the implementation of early breastfeeding initiation (IMD) at Datu Sanggul Rantau Regional Hospital with ά = 0.05 got a p value of 0.314. This value is statistically insignificant (p value> 0.05) and it can be interpreted that there is no relationship between midwife training and the implementation of early breastfeeding initiation (IMD) at Datu Sanggul Rantau Regional Hospital.
The results of this study are different from research conducted by Mohamad et al (2015), which shows that there is a significant relationship between training and the implementation of IMD. The OR ( odds ratio ) value of 2.959 means that midwives who have attended training are 2.959 times more likely to carry out IMD compared to those who have never attended training. 21 .
The results of this study are different from the research conducted by Dayati (2011) which states that there is a significant relationship between training and the implementation of IMD. Midwives who have

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Attended IMD training will have learning experiences that will be applied in assisting childbirth. 13 Likewise, Sumiyati's research (2011) shows that there is a significant relationship between the incidence of implementing IMD between midwives who attended training and midwives who did not participate in IMD training. 22 Training is an effort or process, a method of action, an activity to provide, maintain, improve abilities and skills with methods that prioritize practice so that they are proficient or accustomed to doing a task or job. The results of this study are also inconsistent with the research of Nani (2011) which states that there is a significant relationship between training and the implementation of IMD. 23 In this study, there was no relationship between training and practice Implementation of IMD by midwives in Datu Sanggul Rantau Hospital Region because midwive who never took part in the training but do IMD may be because they already have a midwife dissemination of the importance IMD where she worked. Training is a tool to help workers understand practical knowledge and its application, in order to improve the skills, skills and attitudes that someone needs in an effort to achieve goals.
According to Dayati (2011), it was explained that respondents who had attended training to provide maternal and child health services in the village tended to be better. With training midwives can add knowledge and knowledge, especially in midwifery services. So it is clear that midwives who have attended training tend to have higher performance than midwives who have never attended training. As the results of the statistical test, the training of village midwives can predict their performance. 13 According to John R Schermerhorn in Moekijat (1996) training is a series of activities that provide opportunities to acquire and improve workrelated skills. 24 The relationship between midwife socialization and the implementation of early breastfeeding initiation (IMD ) The results of statistical tests on the relationship between midwives' socialization and the dependent variable (implementation of early breastfeeding) can be seen in the table below in Table 5: The results of the analysis in table 5 show that the results of the Chi Square statistical test to determine the relationship between midwife socialization and the implementation of early breastfeeding initiation (IMD) at Datu Sanggul Rantau Regional Hospital with ά = 0.05 got a p value of 0.004. This value is statistically significant (p value <0.05) and it can be interpreted that there is a relationship between midwife socialization and the implementation of early breastfeeding initiation (IMD) at Datu Sanggul Rantau Regional Hospital. But Table 5 shows a negative relationship, which means that respondents who have never received more socialization carry out IMD (65.6%). This data is caused by other factors, namely the respondents have received a lot of training (Table 4).
The results of the study are in line with research conducted by Dayati (2011), which states that there is a significant relationship between socialization and the implementation of IMD. Midwives who have received socialization about IMD understand the importance of IMD and apply it in helping deliveries. 13 The results of this study are the same as the results of research conducted by Bet Idhya (2012) which states that socialization is related to the implementation of IMD in private practice midwives in Bukittingi City. 15 The relationship between age, education level, years of service, training and socialization simultaneously on th

implementation of early breastfeeding initiation (IMD)
To determine the effect simultaneously in a study using the F test. The simultaneous test results (F test) are presented in table 6 below:  Table 6 above, the calculated F value is 2,217 with the level of sig / significance = 0.083. Because the probability (0.083) is much larger than α = 0 , 05 , it can be said that the factors of age, education level, years of training and socializing together / simultaneously does not affect the implementation of the IMD in Datu Sanggul Rantau Regional Hospital.

CONCLUSION
The results of the research analysis showed that there is no significant relationship between midwife's age, midwife's education level, midwife's tenure, and midwife training with the implementation of early breastfeeding initiation (IMD) at Datu Sanggul Rantau Regional Hospital with a p-value of midwife's age of 0.660, midwife's education level of p value of 0.496, midwife's tenure p value of 0.761, midwife training p value of 0.314. Then there was a significant relationship between midwife socialization and the implementation of early breastfeeding initiation (IMD) at Datu Sanggul Rantau Regional Hospital with a pvalue of 0.004. Simultaneously there is no significant relationship between age, education level, years of service, training and socialization with the implementation of early breastfeeding initiation (IMD) at Datu Sanggul Rantau Regional Hospital.