Aloe Vera Gel Compression as Breast Engorgement Pain Relief

Background : Breast engorgement is a condition where the breast becomes firm, diffuse, painful overfilling due to infrequent or ineffective removal of milk from the breasts. Engorgement usually begins around days 3 to 7 during the postpartum period when the breast milk starts to come out. Breast engorgement tends to experience by Primiparous patients. Purpose : This study aimed to determine the effects of Aloe vera gel compression on reducing breast engorgement pain on breastfeeding mother Methods : This was an experimental study with one group pretest-posttest. The analysis was performed in a Private midwifery Practice in Sarolangun. The sample of this study was twelve postpartum women who experienced breast engorgement. The intervention of this study was using aloe vera gel, as external usage with 10 mg for every square centimeter. The pain scale was measured twice, before and after the intervention. Pain scale measurement was using NRS ( Numeric Rating Scale) Results : paired T-test results p-value of 0.002 < 0.05 indicates that aloe vera compression brings positive impact on reducing breast engorgement pain scale in postpartum women Conclusion : Aloe vera compression can relieve pain associated with breast engorgement. Therefore, this intervention may be suggested to postnatal mothers for managing breast engorgement. experimental study with one group pretest-posttest design. The study was performed in a Private midwifery Practice. The population of this study was postpartum women on day 2 nd -10 th of the postpartum period who experienced breast engorgement. Breast engorgement was assessed using a six-point breast engorgement scale (SPES) postpartum

engorgement during the breastfeeding process. Some approaches for managing breast engorgement involve a combination of pharmacotherapy such as pain medications, progesterone gel (Gresh et al., 2019), and non-pharmacological management such as acupuncture, cabbage leaves, and cold packs (Zakarija-Grkovic & Stewart, 2020).
Aloe Vera is a herb that has been spread and cultivated across the world. This plant has some functions such as a natural fighter against all sorts of infections. Besides, Aloe vera is rich in antioxidants that efficiently help to treat all the digestive problems, heartburn, arthritis, wound healing, analgesics, etc. Besides, aloe vera contains antibacterial, antifungal, antiseptic, antibiotic, antiviral, anti-dandruff, antihelminthic, anti-inflammatory, white blood cell production, and laxative effect (Sushen et al., 2017).
Aloe vera contains anthraquinone which has aloin and emodin which can serve as an analgesic. Analgesic activity in aloe vera is also associated with enzymes carboxypeptidase and bradykinesia, which are effective in relieving pain. Pain reduction occurs through stimulation of the immune system body and decreases its prostaglandins responsible for pain (Mwale & Masika, 2010) The previous study showed that there are statistically significant differences in breast engorgement pain before and after treatment between the herbal, which contains some traditional herb and hot compress groups. The traditional herb includes Plai or Cassumunar ginger (Zingiber cassumunar Roxb.), turmeric (Curcuma longa L.), and camphor (Ketsuwan et al., 2018a). Turmeric and ginger also contains antiseptic, antibiotic, and antiinflammatory

OBJECTIVE
The objective of this study was to determine the effect of aloe vera gel compression in reducing breast engorgement pain in breastfeeding mothers.

METHODS
This was an experimental study with one group pretest-posttest design. The study was performed in a Private midwifery Practice. The population of this study was postpartum women on day 2 nd -10 th of the postpartum period who experienced breast engorgement. Breast engorgement was assessed using a six-point breast engorgement scale (SPES) Ethical clearance was issued by the ethical committee of Prima Nusantara Bukittinggi Health Institute. Inclusion criteria of this study were normal postpartum women (without any complication during the postpartum period), who did not get any analgesics or drugs before breast engorgement treatments for at least 6 hours., no contraindications to breastfeeding and did not have an allergic history of aloe vera. The exclusion criteria of this study were women who experienced a postpartum complication.
The sample of this study was taken by using the Lemeshow formula. Twelve postpartum women who experienced breast engorgement was being the sample of this study. A consecutive sampling technique was applied here. Postpartum women who met the inclusion criteria were selected until either the required sample size was achieved as a respondent.
The intervention of this study was giving aloe vera gel to a mother who was diagnosed with breast engorgement. Aloe vera which was used in this study was 98% aloe vera gel and has a mother safe label. This was external usage with 10 mg for every square centimeter. The gel was applied to the women's breasts for 30 minutes. After the application, the aloe vera gel was cleaned by using tissue and warm water.
The pain scale was measured two times before and after the intervention. NRS (Numeric Rating Scale) was used to measure the pain scale. The data was then analyzed by using paired sample t-test with the SPSS program to see the difference between the pretest and post-test scores with α = 0.05 and 95% confidence interval (CI). Before using a paired sample t-test, it is assumed that the data is normally distributed. The normality distribution was measured by the Shapiro-Wilk test (≤ 50%). Based on table 1; the number of postpartum women who had enrolled in this study was 12 cases. A flow chart of the number of participants is shown in table 1. Women were predominated of reproductive age (20-35 years old). All women have one child, and 10 of 12 women experience breast engorgement between day 4th-10th of postpartum. Based on table 2, it was found that the average pain scale before aloe vera gel intervention was 6.542 with a minimum score was 6, and the maximum score was 7. Based on table 3, it was found that the average pain scale after aloe vera gel intervention was 2.417 with a minimum score was two and a maximum score was 3. before being given aloe vera compression, the average breast pain scale is 6,542, with a standard deviation of 0,3343. In comparison, the average breast pain scale after being given breast pain scale is 2,417 with a standard deviation of 0,3589. The paired T-test results p-value of 0.002 < 0.05 indicates aloe vera compression effect on reducing breast engorgement pain scale in postpartum women.

DISCUSSION
The study showed that breast engorgement pain score before aloe vera compression is shown an upward trend. Engorgement is defined as swelling and distension of the breasts, which cause pain. It is a common early complaint after delivery. There is much variation of symptoms reported for engorgement (Berens, 2015).
After aloe vera gel compression, the study showed that the pain scale of breast engorgement is significantly decreased. Aloe vera contains anthraquinone which has aloin, and emodin, which can serve as an analgesic. Analgesic activity in aloe vera is also associated with enzymes carboxypeptidase and bradykinesia, which are useful in relieving pain. Reduction of pain occurs through stimulation of the immune system body and decrease its prostaglandins responsible for pain (Eghdampour et al., 2013). This research is supported by previous research by Ratih Indah Sari (2019): Effectiveness of Aloe Vera Compression in Reducing Breast Engorgement Pain conducted in Harapan Baru Public Health Center. The result of this study showed that Aloe vera compression is effective in decreasing the pain intensity of breast engorgement in postpartum mothers (Sari et al., 2019) Similar research was performed by Emilda in 2017: The Effect of Aloe vera Compression on Reducing Breast Pain Scale in Postpartum. The result showed that aloe vera was effective in reducing the pain scale of the breast in postpartum (Emilda, 2017).
This study is also in line with the previous research which conducted by Oswati Hasanah (2017). The study analyzed aloe vera compression effect on reducing Grade of Phlebitis due to Intravenous Therapy in Children. The study stated that aloe vera is effective in lowering phlebitis grades (p=0.000) (Hasanah et al., 2017).
Another study conducted by Farideh Eghdampour observed the aloe vera effect on accelerating episiotomy wound healing. The result showed a statistically significant difference between control and experimental groups so that the use of Aloe vera and Calendula ointment considerably increases the speed of episiotomy wound healing.
Another previous study explaining the analgesic effects of the herbal plan was conducted by Ketsuwan. In his study: Effect of Herbal Compresses for Maternal Breast Engorgement at Postpartum, Ketsuwan proved that there were differences in breast engorgement pain before and after treatment, between the herbal and hot compress groups (Ketsuwan et al., 2018b).
According to the researcher's opinion, analgesic content in aloe vera has a significant effect on pain relief in breast engorgement women. A cooler sensation of aloe vera gel also gives calming effect for women.

CONCLUSION
There was a reduction in pain in mothers with breast engorgement from before being given aloe vera gel and after being given aloe vera gel. Aloe vera gel is proven to be effective in reducing breast engorgement pain