国际上母乳喂养工作的研究现状

国际上母乳喂养工作的研究现状杨菁，徐望明综述王顺芳审校（湖北医科大学附属第一医院）多年来，母乳喂养率的下降已在世界范围内产生了不良影响，危及到儿童的健康和生存条件。因此，ＷＨＯ和联合国儿童基金会（ＵＮＩＣＥＦ）一直致力于促进母乳喂养并解决可能影响母乳...     

哪些疾病的产妇不宜母乳喂养

哪些疾病的产妇不宜母乳喂养天津市中心妇产科医院（３０００５２）姚天一母乳为婴儿最理想的食物，它除含有婴儿生长发育所需的各种营养物质外还含有多种抗病物质。因此，主张母乳喂养已成为世界性关注的热点，ＷＨＯ要求２０００年母乳喂养率达到８０％，但若母亲患感染...     

院内纯母乳喂养新生儿体重监测

院内纯母乳喂养新生儿体重监测沈阳铁路局沈阳医院（１１０００５）喻平邱恕娴创建爱婴医院实施母乳喂养在我国已得到普遍开展，成为妇幼保健工作的重要内容之一。但产后三天内母乳能否满足新生儿的需要，对新生儿的体重有否影响是母乳喂养中的一个重要问题。为此，我们对...     

纯母乳喂养易导致婴儿贫血

母乳一直被认为是婴儿最好的食物，但医学专家提醒，母乳是贫铁食品，长期纯母乳喂养可能导致婴儿缺铁性贫血。     

早吸吮和乳房排空对纯母乳喂养的影响

２３９对母婴早吸吮、乳房排空与产后４个月内纯母乳喂养关系的观察结果表明：早吸吮可使婴儿更快地学会正确的吸吮姿势，使母亲增强纯母乳喂养的信心。乳房排空能使乳汁分泌增多，有助于４个月内纯母乳喂养率的提高。此外母亲学会排空乳房也为日后可能出现的母婴暂时分离提供纯母乳喂养的可能性。因此，产后采取早吸吮、乳房排空的措施有利于纯母乳喂养，值得提倡。     

常居与流动产妇5年纯母乳喂养调查分析

为提高母乳喂养率 ,我们对辖区内常居和流动产妇的母乳喂养状况进行了调查分析 ,现报道如下。1　资料与方法　　收集我院辖区内 1996～ 2 0 0 0年常居产妇与流动产妇分娩后 1～ 4个月纯母乳喂养情况 (产妇年龄 2 0～ 40岁 ,新生儿Ａｐｇａｒ评分 8～ 10分 ) ,并随机抽取 1999～ 2 0 0 0年辖区内的常居与流动产妇各 5 0例进行母乳喂养知识知晓情况和妨碍坚持母乳喂养因素的调查。　　调查内容采用走访提问的方式获得 ,统计学方法采用“标准化率的比较”和“趋势 χ2 分析”进行分析。2　结果2 .1　 5年间常居产妇和流动产妇母乳喂养情况 (见…     

黄疸和母乳喂养

母乳性黄疸由美国Arias于1960年首先报道,近年来将母乳性黄疸分为两型,即早发型母乳性黄疸(母乳喂养性黄疸)和迟发型母乳性黄疸(母乳性黄疸).临床医师对迟发型较熟悉,但对早发型尚认识不足.参阅国外近年文献对母乳性黄疸尤其是早发型的发病机制、诊治、预防及研究进展进行综述.     

黄疸和母乳喂养

母乳性黄疸由美国Arias于1960年首先报道，近年来将母乳性黄疸分为两型，即早发型母乳性黄疸(母乳喂养性黄疸)和迟发型母乳性黄疸(母乳性黄疸)。临床医师对迟发型较熟悉，但对早发型尚认识不足。参阅国外近年文献对母乳性黄疸尤其是早发型的发病机制、诊治、预防及研究进展进行综述。     

影响母乳喂养的因素

影响母乳喂养的因素上海市第一妇婴保健院（２０００４０）朱丽萍母乳为人类生命早期的最佳营养品与免疫剂，母乳喂养是喂养婴儿最安全、最好的方法。近年来，国际上已将保护、促进和支持母乳喂养作为妇幼卫生工作的一个重要内容，将母乳喂养提到保护儿童生存和权利的高度...     

The little things: perceptions of breastfeeding support

OBJECTIVE: To describe how maternal-child staff nurses support breastfeeding mothers during the postpartum hospital stay and how these mothers perceive the support received from the nurses. DESIGN: Ethnographic. SETTING: Data were collected at a community hospital in southeastern Florida. PARTICIPANTS: Unstructured interviews were conducted with seven maternal-child nurses caring for breastfeeding mothers. The investigator observed 12 nurses' interactions with breastfeeding mothers and newborns. Eight breastfeeding mothers were interviewed, using a semistructured guide, in the hospital before discharge and at 2 and 6 weeks postpartum. RESULTS: Nurses supported breastfeeding mothers by providing information and interpersonal support. Breastfeeding mothers expected the nurses to support their feeding efforts by providing information, encouragement, and interpersonal support. CONCLUSION: Health care providers can help breastfeeding mothers, but the support offered must be the kind that mothers want.     

A training program on exclusive breastfeeding in maternity wards.

OBJECTIVES: To estimate whether a 3-day training program for health professionals was followed by changes in maternity ward practices and in the rate of exclusive breastfeeding. METHODS: A retrospective study in the maternity ward of a French university hospital involved two cross-sectional samples of 323 mother-infant pairs in 1997 and 324 in 2000. RESULTS: The rate of exclusive breastfeeding at discharge increased from 15.8% (12.0-20.2) in the before sample to 35.2% (30.0-40.6) in the after sample (P<0.01). This result persisted in the multivariable analysis [adjusted odds ratio, 2.74 (1.72-4.37)]. Infants in the before sample were less likely to be breastfed within 1 h of birth (9.2% vs. 16.9%, P=0.01), to room-in 24 h/day (56.6% vs. 72.6%, P<0.01), and were more likely to receive formula supplementation (77.6% vs. 54.0%, P<0.01). CONCLUSIONS: A training program for health professionals can be effective in improving maternity ward practices and increasing exclusive breastfeeding rate at discharge.     

Neurobehavioral functioning and breastfeeding behavior in the newborn

OBJECTIVE: To determine whether central nervous system functioning has an effect on the normal, term infant's ability to breastfeed in the first day following birth. DESIGN: Breastfeeding behaviors and neurobehaviors were evaluated at birth and at 24 hrs of age in two groups of neonates. One group of neonates was born to mothers who received epidural analgesia during labor, and one group was born to mothers who received no pain medication. Breastfeeding behavior was evaluated using the Preterm Infant Breastfeeding Behavior Scale, and the infant's neurobehaviors were evaluated using the Neurologic and Adaptive Capacity Score. PARTICIPANTS: Fifty-six breastfeeding mother-newborn dyads. All mothers were healthy multiparae who gave birth vaginally to normal, full-term, healthy newborns. MAIN OUTCOME MEASURES: Newborns were observed for rooting, latch-on, sucking, swallowing, activity state, and neurobehavior. RESULT: Analysis of the data indicated that the higher the infant scored in relation to neurobehavioral functioning, the higher the infant scored on breast-feeding behaviors. CONCLUSION: When determining physiologically what is important for the infant to successfully latch on and feed, it appears that an intact and functioning central nervous system may be one of the crucial elements.     

Duration of breastfeeding for mothers of twins

OBJECTIVE: To describe the incidence and duration of breastfeeding for mothers of twins and identify factors that affected this duration. DESIGN: Secondary analysis of data from a larger longitudinal predictive study of maternal attachment in mothers of twins. SETTING: Paper and pencil questionnaires once during pregnancy and twice in the first 6 months postpartum. PARTICIPANTS: 123 women recruited from a national support group for mothers of twins. MAIN OUTCOME MEASURES: Mothers' Information Tool, Edinburgh Postnatal Depression Scale, Rosenberg Self-Esteem Scale, and the Index of Breastfeeding Status. RESULTS: 110 (89.4%) of the sample initiated breastfeeding or initiated a milk supply by pumping. Percentage of breast milk feedings at time 2 predicted whether or not a woman was still breastfeeding at time 3 (odds ratio = 3.63, p < .001). CONCLUSION: A high percentage of breastfeeding initiation was found despite the increased care burden that has been described for mothers of twins. Mothers who continued to breastfeed at time 3 provided a high percentage of the twins' milk feedings as breast milk. The results suggest that mothers who are able to persist with the difficulties of establishing a milk supply for twins and feeding two infants are able to continue providing a high percentage of the infants' feedings as breast milk.     

Psychosocial correlates of exclusive breastfeeding: A systematic review

Background

the World Health Organization recommends that all infants worldwide are exclusively breastfed for the first 6 months of life for optimal health and development. However, very few women worldwide are meeting this recommendation. Psychosocial factors have been identified as potentially modifiable factors implicated in a woman's ability to successfully exclusively breastfeed, however there is very limited research examining these factors specifically for exclusive breastfeeding to 6 months duration.

Methods

a search of psychological, nursing and medical databases was conducted in June 2011 for studies published from 2000 to 2011 examining psychological correlates of exclusive breastfeeding to four to 6 months duration.

Results

nine papers from eight studies were found to be eligible for the review. Psychological factors have been reported to be highly predictive of exclusive breastfeeding outcomes. Research to date shows that psychosocial factors are not only importantly implicated in exclusive breastfeeding duration but they can also be changed through intervention and experiences.

Conclusions

while there is a wealth of literature on the role of psychosocial factors in breastfeeding, there is very limited research specifically examining the role of psychosocial factors of exclusive breastfeeding to 6 months duration. Interpreting the results of the available literature is difficult due to the various methodologies and definitions of exclusive breastfeeding and small sample sizes. Further research, specifically, longitudinal cohort studies are needed which examine psychological determinants of exclusive breastfeeding and infant feeding methods from pregnancy through to 6 months postpartum.     

The role of psychosocial factors in exclusive breastfeeding to six months postpartum

Objective

to investigate the psychosocial variables associated with the ability to exclusively breastfeed to six months postpartum. Additionally, to evaluate a conceptual model of psychosocial correlates of exclusive breastfeeding duration.

Design

online, retrospective questionnaire.

Setting

the questionnaire was placed online and participants accessed it through social networking sites including groups relating to breastfeeding, motherhood and parenting. Participants were also able to share the link with their own networks. This online setting facilitated recruitment of a wide range of Australian and international participants.

Participants

174 women aged 18 years and older who had given birth between six months to two years prior. Participants completed an online questionnaire, which asked them to report on three time points: pre-pregnancy, during pregnancy and during the first six months postpartum. Data were collected from June to December 2011.

Measurements

psychometrically validated tools such as the breastfeeding Self-Efficacy Scale, Body Attitude Questionnaire, Depression Anxiety and Stress Scale, Fetal Health Locus of Control Scale, and the brief COPE scale were used to measure psychosocial variables. Additional scales were developed by the researchers and met scale reliability criteria.

Findings

correlation analyses, t-tests and path analysis were used to statistically analyse the data. Results showed that women who exclusively breast fed to six months postpartum exhibited higher intention to exclusively breastfeed, breastfeeding self-efficacy, comfort breastfeeding in public, perceived physical strength and reported less perceived breastfeeding difficulties. Path analyses indicated that breastfeeding self-efficacy was a strong significant predictor of both exclusive breastfeeding intention and duration. Maternal attitude towards pregnancy (both during pregnancy and postpartum), psychological adjustment and early breastfeeding difficulties were also found to be significant predictors of exclusive breastfeeding intention and duration.

Key conclusions

psychosocial factors are likely to play a significant role in the maintenance of exclusive breastfeeding for six months post-birth. Future research should adopt a prospective study design to examine the influence of psychosocial factors systematically and rigorously.

Implications for practice

longitudinal, prospective studies are needed to further examine the role of psychosocial factors on exclusive breastfeeding outcomes. Interventions, which involve improving psychosocial factors such as breastfeeding self-efficacy, may improve exclusive breastfeeding outcomes.     

Mother-Infant Breastfeeding Progress Tool: a guide for education and support of the breastfeeding dyad

OBJECTIVE: To describe the development of the Mother-Infant Breastfeeding Progress Tool to be used at the bedside by nurses to guide ongoing support and education for the mother-baby dyad. DESIGN: Cross-sectional study. SETTING: Community hospital in a Midwestern city. PARTICIPANTS: Sixty-two English-speaking mother-infant dyads. METHODS: Three nurse raters (two per session) independently scored the eight characteristics on the Mother-Infant Breastfeeding Progress Tool during 81 breastfeeding sessions. MAIN OUTCOME MEASURE: Percent agreement between raters and suggested modifications for the Mother-Infant Breastfeeding Progress Tool. RESULTS: The results support the use of the tool as a checklist for assessment of the breastfeeding mother-infant dyad to guide education and support. CONCLUSIONS: The interrater agreement was high for individual items of the Mother-Infant Breastfeeding Progress Tool. The Mother-Infant Breastfeeding Progress Tool is useful as a checklist for assessing maternal and infant breastfeeding progress, though additional research is needed to support the validity of the tool.     

Randomized controlled trial to determine effects of prenatal breastfeeding workshop on maternal breastfeeding self-efficacy and breastfeeding duration

OBJECTIVE: To determine the effects of a prenatal breastfeeding workshop on maternal breastfeeding self-efficacy and breastfeeding duration. DESIGN: Randomized controlled trial. SETTING: Large tertiary hospital in Ontario, Canada. PARTICIPANTS: 110 primiparous women expecting a single child, an uncomplicated birth, and planning to breastfeed. Intervention: 2.5-hour prenatal breastfeeding workshop based on adult learning principles and self-efficacy theory. MAIN OUTCOME MEASURE: Maternal breastfeeding self-efficacy and the numbers of days and amount of breastfeeding were measured at four and eight weeks postpartum. RESULTS/DATA ANALYSIS: Over time, maternal breastfeeding self-efficacy scores increased in both groups. Women who attended the workshop had higher self-efficacy scores and a higher proportion were exclusively breastfeeding compared to women who did not attend the workshop. There was little difference in the average number of days of breastfeeding, but the intervention group had less weaning. CONCLUSIONS: The workshop increased maternal breastfeeding self-efficacy and exclusive breastfeeding.