Empowering Post-Cesarean Breastfeeding: A Dual-Intervention Protocol for Flat Nipples and lactation massage via Breastfeeding Tracker Application

Abstract

Cesarean section may lead to delayed breast milk production due to postoperative pain, anesthesia effects, and limited maternal mobility. Inverted nipples can further aggravate this condition. They interfere with infant latch and can result in suboptimal breast stimulation, inadequate milk production, and poor milk ejection. This study aimed to describe the use of the Hoffman technique and breast massage to improve breast milk production. The Breastfeeding Tracker application was used for monitoring in post-cesarean section mothers with inverted nipples. This study used a descriptive design with a case study approach using postpartum nursing care carried out for post-SC mothers at Hermina Hospital, Depok, from April 6 to 8, 2026. The nursing diagnosis was ineffective breastfeeding related to inverted nipples. The intervention included the Hoffman technique and breast massage to stimulate the release of prolactin and oxytocin. This aimed to enhance milk production and ejection. Monitoring, conducted using the Breastfeeding Tracker application, objectively documented lactation progress. By the third day, evaluation showed an increase in milk production from 0 mL to 2 mL, indicated by visible milk ejection. The infant’s ability to breastfeed also improved. This was demonstrated by a better latch, more effective sucking and swallowing reflexes, a 10–15 minute feeding duration, and a calm state after breastfeeding. In conclusion, the Hoffman technique and breast massage are effective in improving breast milk production and breastfeeding performance in post-cesarean section mothers. Nurses are recommended to use these interventions and the Breastfeeding Tracker application for continuous lactation monitoring.