爱母分娩工程初探——产程系列服务模式

爱母分娩工程的核心是产时分娩的管理，除医疗技术水平为重要因素外，改善产科系列服务模式，加强孕妇夫妇有关培训与健康教育，加强保健与临床的结合，对爱母分娩工程的作用亦是举足轻重的。广东省妇幼保健院试运行产时分娩管理新模式、产科系列服务新模式，提高了产科质量和社会效益及经济效益。     

创建爱婴市 强化爱婴行动

深圳市从１９９３年开展创建爱婴医院、争创爱婴市活动。主要做法：提高认识,加强领导,全面推进爱婴行动;部门协作,齐抓共管,形成社会系统工程;儿童优先,母亲安全,促进医院产科改革;建章立制,规范管理,巩固和发展－创建成果;进入社区,进入家庭,促进妇幼保健工作。到１９９６年底,全市有１０张以上产科床位的医疗保健机构３５间已全部通过市、省和国家爱婴医院三级评审;住院期间和４个月的母乳喂养率分别提高到９６．２％和５２．６％;孕产妇和婴儿死亡率分别降至１２．９／１０万和１３．４‰。     

社区爱婴行动对母乳喂养促进作用的研究

为了解社区爱婴行动对母乳喂养的促进作用,江苏省在南京市及镇江市社区内开展了多种爱婴活动,并在项目活动开始时及结束时进行了问卷调查。结果表明,终末调查与基础调查相比,产妇出院前２４ｈ内纯母乳喂养率和调查前２４ｈ内纯母乳喂养率均有明显上升,母亲在孕期及出院后接受母乳喂养健康教育的比例均有明显提高,母亲认为４个月内婴儿应该开始添加辅食的比例及４个月内婴儿实际添加辅食者的比例均有明显下降。提示社区爱婴行动确实大大促进了母乳喂养率的提高。     

Impact of Baby‐Friendly Hospital Practices on Breastfeeding in Hong Kong

Abstract: Background: The World Health Organization (WHO) developed the Baby‐Friendly Hospital Initiative to improve hospital maternity care practices that support breastfeeding. In Hong Kong, although no hospitals have yet received the Baby‐Friendly status, efforts have been made to improve breastfeeding support. The aim of this study was to examine the impact of Baby‐Friendly hospital practices on breastfeeding duration. Methods: A sample of 1,242 breastfeeding mother‐infant pairs was recruited from four public hospitals in Hong Kong and followed up prospectively for up to 12 months. The primary outcome variable was defined as breastfeeding for 8 weeks or less. Predictor variables included six Baby‐Friendly practices: breastfeeding initiation within 1 hour of birth, exclusive breastfeeding while in hospital, rooming‐in, breastfeeding on demand, no pacifiers or artificial nipples, and information on breastfeeding support groups provided on discharge. Results: Only 46.6 percent of women breastfed for more than 8 weeks, and only 4.8 percent of mothers experienced all six Baby‐Friendly practices. After controlling for all other Baby‐Friendly practices and possible confounding variables, exclusive breastfeeding while in hospital was protective against early breastfeeding cessation (OR: 0.61; 95% CI: 0.42–0.88). Compared with mothers who experienced all six Baby‐Friendly practices, those who experienced one or fewer Baby‐Friendly practices were almost three times more likely to discontinue breastfeeding (OR: 3.13; 95% CI: 1.41–6.95). Conclusions: Greater exposure to Baby‐Friendly practices would substantially increase new mothers’ chances of breastfeeding beyond 8 weeks postpartum. To further improve maternity care practices in hospitals, institutional and administrative support are required to ensure all mothers receive adequate breastfeeding support in accordance with WHO guidelines. (BIRTH 38:3 September 2011)     

Hospital Practices that Increase Breastfeeding Duration: Results from a Population‐Based Study

ABSTRACT: Background: A high percentage (83%) of mothers in Colorado initiate breastfeeding; but in keeping with national breastfeeding trends, many of them discontinue breastfeeding within the first few months. The objective of this study was to determine the effects of hospital practices on breastfeeding duration and whether the effects differed based on maternal socioeconomic status. Methods: Pregnancy Risk Assessment Monitoring System data were used to calculate breastfeeding duration rates for all Colorado mothers in 2002 to 2003. Breastfeeding duration rates were determined for recipients of each of nine hospital practices included in the survey compared with rates for nonrecipients. Practices that significantly increased breastfeeding duration rates were combined and then stratified by socioeconomic status. Results: Breastfeeding duration was significantly improved when mothers experienced all five specific hospital practices: breastfeeding within the first hour, breastmilk only, infant rooming‐in, no pacifier use, and receipt of a telephone number for use after discharge. Two‐thirds (68%; 95% CI: 61–75) of mothers who experienced all five successful practices were still breastfeeding at 16 weeks compared with one‐half (53%; 95% CI: 49–56) of those who did not. Breastfeeding duration was improved independent of maternal socioeconomic status. Only one in five mothers (18.7%) experienced all five supportive hospital practices. Mothers who experienced the five supportive hospital practices were significantly less likely to stop breastfeeding due to any of the top reasons given for stopping (p < 0.001). Conclusions: Implementation of the five hospital practices supportive of breastfeeding significantly increased breastfeeding duration rates regardless of maternal socioeconomic status. (BIRTH 34:3 September 2007)     

The impact of the UK Baby Friendly Initiative on maternal and infant health outcomes: A mixed‐methods systematic review

Global evidence demonstrates that adherence to the Baby Friendly Initiative (BFI) has a positive impact on multiple child health outcomes, including breastfeeding initiation and duration up to 1 year post‐partum. However, it is currently unclear whether these findings extend to specific countries with resource‐rich environments. This mixed‐methods systematic review aims to (a) examine the impact of BFI implementation (hospital and community) on maternal and infant health outcomes in the United Kingdom (UK) and (b) explore the experiences and views of women receiving BFI‐compliant care in the UK. Two authors independently extracted data including study design, participants, and results. There is no UK data available relating to wider maternal or infant health outcomes. Two quantitative studies indicate that Baby Friendly Hospital Initiative implementation has a positive impact on breastfeeding outcomes up to 1 week post‐partum but this is not sustained. There was also some evidence for the positive impact of individual steps of Baby Friendly Community Initiative (n = 3) on breastfeeding up to 8 weeks post‐partum. Future work is needed to confirm whether BFI (hospital and community) is effective in supporting longer term breastfeeding and wider maternal and infant health outcomes in the UK. A meta‐synthesis of five qualitative studies found that support from health professionals is highly influential to women's experiences of BFI‐compliant care, but current delivery of BFI may promote unrealistic expectations of breastfeeding, not meet women's individual needs, and foster negative emotional experiences. These findings reinforce conclusions that the current approach to BFI needs to be situationally modified in resource‐rich settings.     

Teenage pregnancies in Mozambique: the experience of “Servicios Amigos dos Adolescentes” clinics in Beira

The purpose of this article is to provide insights into the demand for pregnancy-related health services by adolescent girls and young women in Mozambique. We analysed the patient registers for the first year of operation (2014) of the Servicios Amigos dos Adolescentes (SAAJ) [Friendly Services for Adolescents] clinics in Beira, Mozambique. These registers provide details of the service demands of, and services provided to the 8 290 adolescent girls and young women who accessed the 6 SAAJ clinics in 2014. Analysis of that record, with disaggregation of the patients according to age (9 years or less; 10–14; 15–19; 20–24; 25 and older), show that 3 021 (36%) were pregnant or had previously been pregnant; most being girls in the 15–19 age band (59%). Being pregnant or having been pregnant previously was associated with dropping out of school. Of all the girls and women, 60% agreed to HIV testing and counselling; the HIV prevalence rate amongst this group was 4–5% amongst adolescents and 25% amongst women 25 years and older. A minority of the girls and women who were pregnant or had been pregnant previously agreed to HIV testing and counselling. Notwithstanding the limitations for analysis, the results were alarming: substantially high HIV prevalence rates were indicated (2% amongst 10–14 year old girls; 8% amongst 15–19 year olds; 10% amongst 20–24 year olds; and 28% amongst >24 year olds). The data from the SAAJ clinics and results pertain only to conditions in Beira. However, as the first empirical assessment of pregnancy-related service demand amongst adolescent girls and young women in the country and involving a relatively large sample, we contend that this study affirms the need for expansion of sexual and reproductive health (SRH) services, including HIV services, for adolescent girls and young women in Mozambique.     

未婚流产女青年对医疗保健服务满意度与需求现况分析

目的:了解未婚人工流产女青年对医疗机构服务的满意度和服务需求,为探索青少年友好服务相关措施提供依据。方法:采用匿名问卷调查形式对在医院计划生育门诊接受人工流产手术的未婚女青年1 225例进行调查。结果:①服务满意度:对服务人员的满意度比对候诊时间和就诊环境高,达60%;20岁以下者对就诊环境满意度(45.60%)比20～24岁满意度(50.00%)低,20～24岁组对候诊时间的满意度(37.40%)比20岁以下的(45.60%)低;9.0%未婚人工流产女青年认为医务人员对其存在歧视或者态度冷淡。②需求:对性生殖健康知识最希望了解的前三位为:怀孕与避孕、性生理保健及人工流产后保健;③服务:对于流产希望获得的相关服务主要为人工流产后保健指导、避孕指导、心理咨询指导等;对服务的希望是获得保护隐私(65.96%),性保健知识宣教(36.49%),工作人员友好(35.27%)等。结论:未婚女青年对目前人工流产服务的环境、候诊时间的满意度相对较低,对接受人工流产的相关服务内涵及要求相对较高,提示需要建立满足青春期性生殖保健的友好服务模式。     

妇幼保健机构实施青少年友好服务的可行性研究

目的:分析全国妇幼保健机构现有的青春期门诊现状,探索实施青少年友好服务的可行性.方法:采用信函调查的方式,从财政资源、硬件条件、服务提供情况、物资与健康教育材料、信息系统、青年参与、相关制度与政策支持、人力资源八个方面来综合评价.结果:青春期门诊的开设情况不理想,区域间发展不均衡;多数三级和二级妇幼保健机构尚不具备青少年友好服务实施的可行性.结论:环境布置对青少年友好服务、多种信息宣传方式、面向青少年的多种服务模式以及青年参与青春期门诊的设计和运营可以有效提高友好服务实施的可行性.     

加强领导 积极创建爱婴市

联合国儿童基金会对厦门市进行爱婴市评估时给予了高度评价，认为“厦门所取得的成绩可以向其他国家和地区推广”。他们的经验是各级政府高度重视、各职能部门紧密配合，共同参与、严格执行《母乳代用品销售管理办法》、认真搞好女职工保健、宣传部门积极介入，同时建立完善的社区妇幼保健体系，该市母乳喂养率从创建爱婴医院前的５７．５％上升至１９９７年４月的９３．５％，其中纯母乳喂养率达５３．３％，所有综合性医院，中心卫生院均通过了爱婴医院评估，其中７２．０％的医院接受并一次性通过了国家级评估