Rowe-Murray Heather J, Fisher Jane R W
The Key Centre for Women's Health in Society, School of Population Health, University of Melbourne, Victoria, Australia.
Birth. 2002 Jun;29(2):124-31. doi: 10.1046/j.1523-536x.2002.00172.x.
Documented barriers to the implementation of Step 4 of the Baby Friendly Hospital Initiative, which relates to early initiation of breastfeeding, have not considered the impact of operative intervention in delivery on achievement of the goal. This study was designed to test the hypothesis that hospital practices in the immediate postpartum period that are associated with operative intervention in delivery can affect first mother-infant contact and initiation of breastfeeding.
In a prospective, longitudinal study, a sociodemographically representative sample of 203 primiparous women was recruited. Participants were interviewed at 2 days postpartum in metropolitan hospitals in Melbourne, Australia, and medical records were inspected. At 8 months postpartum 81 percent of participants completed a postal questionnaire. Three mode-of-delivery groups (spontaneous vaginal delivery, instrumentally assisted vaginal delivery and cesarean section) and 4 hospital-of-delivery groups (including one accredited Baby Friendly Hospital) were compared.
Two way ANOVA revealed that women who had a cesarean section experienced a significant delay in initiating breastfeeding compared with women giving birth vaginally, with or without instrumental assistance (p < 0.001). Significant differences in this aspect of care were also observed among hospitals, with the Baby-Friendly hospital performing significantly better than the other three hospitals (p < 0.001). An effect due to mode of delivery alone was demonstrated that could not be abolished by differences in hospital practices (p = 0.231). Nevertheless, shorter elapsed time between birth and initiation of breastfeeding was not significantly associated with continuation of breastfeeding at 8 months postpartum (p = 0.642).
The findings confirmed that cesarean section was a significant barrier to the implementation of Baby Friendly Hospital Initiative Step 4 and that hospital practices were amenable to changes that enabled its implementation regardless of the mode of delivery.
有记录表明，“爱婴医院倡议”第四步（涉及早期母乳喂养）实施过程中存在的障碍未考虑分娩手术干预对实现该目标的影响。本研究旨在检验这一假设，即分娩手术干预相关的产后即刻医院做法会影响母婴首次接触及母乳喂养的开始。
在一项前瞻性纵向研究中，招募了203名初产妇的社会人口统计学代表性样本。参与者在澳大利亚墨尔本的大都市医院产后2天接受访谈，并检查病历。产后8个月时，81%的参与者完成了邮寄问卷。比较了三个分娩方式组（自然阴道分娩、器械辅助阴道分娩和剖宫产）和四个分娩医院组（包括一家获得认证的爱婴医院）。
双向方差分析显示，与经阴道分娩的女性相比，剖宫产的女性开始母乳喂养的时间显著延迟，无论是否有器械辅助（p<0.001）。不同医院在这方面的护理也存在显著差异，爱婴医院的表现明显优于其他三家医院（p<0.001）。仅分娩方式的影响得到证实，且不受医院做法差异的影响（p = 0.231）。然而，出生至开始母乳喂养的时间较短与产后8个月母乳喂养的持续情况无显著关联（p = 0.642）。
研究结果证实，剖宫产是“爱婴医院倡议”第四步实施的重大障碍，且医院做法可通过改变来实现该步骤的实施，无论分娩方式如何。
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