Henderson A, Stamp G, Pincombe J
School of Nursing and Midwifery, University of South Australia, GPO 2471, Adelaide, SA 5001, Australia.
Birth. 2001 Dec;28(4):236-42. doi: 10.1046/j.1523-536x.2001.00236.x.
Although lactation experts suggest that a correct positioning and attachment technique reduces breastfeeding problems and enhances long-term breastfeeding, evidence from randomized trials is lacking. The objective of this study was to evaluate the effect of postpartum positioning and attachment education on breastfeeding outcomes in first-time mothers.
A randomized trial was performed in a public hospital in Adelaide, South Australia, where 160 first-time mothers were randomly allocated to receive either structured one-to-one education (experimental group) or usual postpartum care (control group) within 24 hours of birth. The primary outcome was breastfeeding at 6 weeks and 3 and 6 months postpartum; other outcomes were nipple pain and trauma in hospital and at 6 weeks and 3 and 6 months, and satisfaction with breastfeeding.
No significant differences occurred in breastfeeding rates between the groups at each endpoint, although a trend in the direction of lower rates was seen at each endpoint in the experimental group. This group reported less nipple pain on days 2 (p = 0.004) and 3 (p = 0.04), but this was not sustained on follow-up. No differences were observed in nipple trauma in hospital or in self-reported nipple pain and/or trauma at the three endpoints. Experimental group women were less satisfied with breastfeeding at 3 and 6 months postpartum when using a one-item measure; however, a multiple-item measure showed no significant differences at the three endpoints.
The intervention did not increase breastfeeding duration at any assessment time or demonstrate any differences between the groups on secondary outcomes. The trend toward lower breastfeeding rates in the experimental group suggests a need for a larger trial to evaluate whether or nor postpartum positioning and attachment education may negatively affect breastfeeding.
尽管哺乳专家认为正确的姿势和含接技巧可减少母乳喂养问题并促进长期母乳喂养，但缺乏随机试验的证据。本研究的目的是评估产后姿势和含接教育对初产妇母乳喂养结局的影响。
在南澳大利亚阿德莱德的一家公立医院进行了一项随机试验，160名初产妇在分娩后24小时内被随机分配接受一对一的结构化教育（实验组）或常规产后护理（对照组）。主要结局是产后6周、3个月和6个月时的母乳喂养情况；其他结局包括住院期间以及产后6周、3个月和6个月时的乳头疼痛和损伤，以及对母乳喂养的满意度。
各终点时两组的母乳喂养率无显著差异，尽管实验组在各终点时均有较低母乳喂养率的趋势。该组在第２天（p = 0.004）和第３天（p = 0.04）报告的乳头疼痛较少，但随访时未持续。在住院期间的乳头损伤以及三个终点时自我报告的乳头疼痛和/或损伤方面未观察到差异。使用单项测量时，实验组女性在产后3个月和6个月时对母乳喂养的满意度较低；然而，多项测量显示在三个终点时无显著差异。
该干预措施在任何评估时间均未增加母乳喂养持续时间，且在次要结局方面两组之间未显示出任何差异。实验组母乳喂养率较低的趋势表明需要进行更大规模的试验，以评估产后姿势和含接教育是否可能对母乳喂养产生负面影响。
