Relationships Among Factors Related to Childbirth and Breastfeeding Outcomes in Primiparous Women

ObjectivesTo explore the relationships among potentially modifiable factors related to childbirth and effective breastfeeding initiation at approximately 36 hours after birth and duration and exclusivity at hospital discharge, 2 weeks, 2 months, and 6 months after birth in primiparous women and to explore whether modifiable and nonmodifiable secondary factors and covariates influenced the relationships among factors related to childbirth and these breastfeeding outcomes.DesignA prospective, longitudinal, cohort study.SettingThe postpartum units of two general hospitals in eastern Canada.ParticipantsNinety-seven mother–infant dyads.MethodsWe recorded demographic, childbirth, obstetric history, and breastfeeding data through chart review. A breastfeeding observation was completed at approximately 36 hours after birth by unit nurses. Participants maintained breastfeeding logs in hospital and for 6 months after birth and completed three self-report questionnaires before discharge. We analyzed outcomes using backward stepwise linear and logistic regression.ResultsOne childbirth factor, labor induced with oxytocin, was negatively associated with effective initiation of breastfeeding, and none was related to breastfeeding duration and exclusivity at any time point. Maternal weight; professional support; and newborn’s gestational age at birth, 5-minute Apgar score, weight loss, LATCH score, and active feeds (newborn actively suckled at the breast) were significantly associated with breastfeeding outcomes.ConclusionInduction of labor with oxytocin should be used judiciously; when used, nurses must be hypervigilant to assess the mother–infant dyad for breastfeeding issues and to intervene to prevent or remediate them.     

初产妇与经产妇焦虑抑郁状态分析及干预

目的：分析初产妇、经产妇心理状态特点,以便采取更有效的干预措施。方法筛选2014年6月至2015年1月在咸阳市旬邑县妇幼保健院产科门诊产前检查的健康初产和经产妇各60名,孕周为28~40周。入组时用焦虑自评量表( SAS)、抑郁自评量表(SDS)对两组孕妇进行心理评定,并给1次支持性心理干预(40~60分钟),1周后再次用SAS、SDS对两组孕妇进行评定分析。结果经产妇干预前SAS(50.73±3.45)、SDS(49.13±3.86)评分明显高于初产妇SAS(42.45±2.08)、SDS(41.77±2.21),差异均有统计学意义(t值分别为-15.921、-12.817,均P<0.01);干预后两组SAS、SDS评分均比干预前明显降低,差异均有统计学意义(t值分别为14.999、15.413;15.724、15.832,均P<0.01);干预后经产妇 SAS(38.61±5.02)、SDS(39.10±3.03)评分明显高于初产妇SAS(34.88±3.31)、SDS(32.01±4.27),差异均有统计学意义(t值分别为-4.805、-10.489,均P<0.01)。结论初产妇和经产妇均伴有焦虑、抑郁情绪,干预前后经产妇抑郁、焦虑情绪均较初产妇明显,支持性心理干预能有效改善孕妇的不良情绪。     

互动式模拟分娩方式对分娩结局的影响

目的探讨孕晚期开展互动式模拟分娩方式对初产妇分娩结局的影响。方法将100例试产的初产妇采取自愿的原则分为两组,观察组实施互动式模拟分娩方式,对照组采用产前、产时常规护理方式,观察两组总产程、Apgar评分、产后出血及剖宫产率。结果观察组总产程9．2±2．3小时、hpgar评分〈7分者3例,产后出血168．5±44．6ml,剖宫产率28％,对照组总产程15．3±6．1小时,Apgar评分〈7分者10例,产后出血226．2±52．3ml,剖宫产率62％。两组比较经统计学处理差异有显著性（P〈O．05）。结论孕晚期实施互动式模拟分娩方式能显著改善分娩结局。     

产后康复治疗仪对减少产后乳胀的疗效观察

目的：探讨有效减少产后乳胀的方法。方法：两组初产妇R平均年龄20—30岁，无新生儿严重窒息与畸形，在母乳宣教，技术指导等方面一致的前提下，观察组采取产后康复治疗仪治疗。结果：观察组较对照组发生乳胀少。结论：产后康复治疗仪能够疏通乳腺管，减少产后乳胀的发生。     

初产妇配偶抑郁的发生率及其影响因素的研究

目的: 探讨初产妇配偶抑郁的发生率及其影响因素. 方法: 采用爱丁堡产后抑郁量表(EPDS)、一般情况调查表对130名初产妇配偶进行调查研究.结果: 初产妇配偶EPDS得分均值为7.95±3.60,抑郁发生率为10.8%;影响初产妇配偶抑郁的主要因素有5个,分别是父母对婴儿性别的期望、医疗费用、夫妻感情、计划怀孕、经济收入. 结论: 初产妇配偶抑郁发生率较高,影响因素是多方面的;应该重视对初产妇配偶群体的心理健康评估,加强他们的身心健康保健.     

初产孕妇产前焦虑与社会支持应对方式的相关性研究

目的了解初产孕妇产前焦虑现状,探讨社会支持、应对方式与焦虑的关系。方法采用一般情况调查问卷、焦虑自评量表、社会支持量表和简易应对方式量表,对263例初产孕妇进行问卷调查。结果本组孕妇的焦虑标准分为(40.35±7.24)分,高于国内常模(P0.05);90例(34.2%)孕妇发生不同程度的焦虑;焦虑总分与社会支持总分、积极应对方式得分呈负相关(r=-0.450、-0.315,P0.01),与消极应对方式正相关(r=0.364,P0.05)。结论 1/3初产孕妇临产前存在一定的焦虑,其受到的社会支持越多,应对方式越积极,焦虑情绪越轻。     

孕期健康教育对产褥期产妇饮食及行为的影响

目的探讨孕期健康教育对产褥期产妇饮食、行为的影响。方法根据产妇有无自愿参加孕期健康教育课程,将343例初产妇分为干预组163例和对照组180例。比较两组产妇产褥期饮食、行为的差异。结果干预组产妇饮食及行为优于对照组,两组比较,差异具有统计学意义(均P<0.05)。结论有针对性地开展孕期健康教育,可提高产妇的自我保健意识,改变不健康的饮食行为和生活习惯,提高母乳喂养率。