Ingram Jenny, Johnson Debbie, Greenwood Rosemary
Institute of Child Health, University of Bristol, Education Centre, Upper Maudlin Street, Bristol BS2 8AE, UK.
Midwifery. 2002 Jun;18(2):87-101. doi: 10.1054/midw.2002.0308.
to determine whether a specific 'hands-off' breastfeeding technique, based on the physiology of suckling and clinical experience, if taught to mothers in the immediate postnatal period, improves their chances of breastfeeding successfully and reduces the incidence of problems. To investigate the factors associated with breastfeeding at two and six weeks postpartum using logistic regression analysis.
a non-randomised prospective cohort phased intervention study.
subjects recruited from one postnatal ward in St. Michael's Hospital, Bristol from October 1996 to November 1998.
1400 South Bristol mothers who were breastfeeding on discharge from hospital. Three hundred and ninety-five of these mothers were scored for efficiency of using the breastfeeding technique.
a 'hands-off' breastfeeding technique was taught to midwives in hospital who subsequently taught mothers in their care.
frequencies of exclusive and 'any breastfeeding' at two and six weeks from questionnaires sent to mothers at home, and incidence of breastfeeding problems.
significant increases were observed in the proportion of mothers exclusively breastfeeding at two weeks (P < 0.001) and six weeks (P=0.02) and in 'any breastfeeding' rates (P=0.005) at two weeks after the technique intervention. The incidence of mothers feeling that they did 'not have enough milk' (perceived milk insufficiency) decreased significantly after the breastfeeding technique had been taught (P=0.02). Logistic regression analysis produced a model which showed that mothers with high scores for the 'hands-off' technique were significantly more likely to be breastfeeding at six weeks compared with those who did not use all the elements of the technique (OR 2.4; CI 1.3, 4.3). Factors associated with continuing to breastfeed at two and six weeks postpartum were also investigated using logistic regression. At two weeks, the significant factors associated with breastfeeding included mothers feeling that they had a 'plentiful milk supply' (OR 3.3; CI 2.1, 5.3), not using a dummy (OR 2.6; CI 1.6, 4.0), not giving the baby any other fluid in hospital (OR 2.4; CI 1.5, 3.8) and receiving enough support for breastfeeding from hospital staff (OR 2.1; CI 1.3, 3.5). By six weeks, in addition to these factors, the encouragement from a supportive partner, other family members and health professionals in enabling women to continue to breastfeed was found to show the largest associations with the maintenance of breastfeeding [(OR 37.2; CI 17.3, 80.2) for all three encouraging (327/817; 40% of breastfeeders) compared with no encouragement (67/817; 8% of breastfeeders)].
in the immediate postnatal period, if mothers are taught good breastfeeding technique by midwives in a 'hands-off' style, which enables mothers to position and attach their babies for themselves, and which is based on a physiological approach, breastfeeding rates are increased and the incidence of perceived milk insufficiency decreases. Successful breastfeeding in the early weeks was associated both with practices and support in hospital and with factors at home including not using dummies and having a supportive partner, family and health professionals who are encouraging breastfeeding.
teaching mothers how to breastfeed in a 'hands-off' way is important in empowering mothers to 'do it for themselves' and in improving breastfeeding rates. Widespread adoption of consistent good practice is achievable following a brief workshop teaching session. Using the 'breastfeeding score checklist' may help midwives to assess a breastfeed more accurately and determine which aspects need improving. Health professionals should aim to educate all key family members, whenever an opportunity arises both during pregnancy and postnatally, in the benefits of breast milk for babies in the first few months of life and how to encourage and support a mother in the early weeks of breastfeeding.
基于哺乳生理学和临床经验确定一种特定的“不干预”母乳喂养技巧，若在产后即刻教给母亲，是否能提高其成功母乳喂养的几率并降低问题发生率。使用逻辑回归分析调查产后两周和六周时与母乳喂养相关的因素。
一项非随机前瞻性队列分阶段干预研究。
1996年10月至1998年11月从布里斯托尔圣迈克尔医院的一个产后病房招募受试者。
1400名南布里斯托尔的母亲，她们在出院时正在进行母乳喂养。其中395名母亲的母乳喂养技巧使用效率被评分。
在医院向助产士传授“不干预”母乳喂养技巧，助产士随后教给自己护理的母亲。
通过向家中母亲发送问卷，了解产后两周和六周时纯母乳喂养及“任何形式母乳喂养”的频率，以及母乳喂养问题的发生率。
在技巧干预后，观察到产后两周纯母乳喂养的母亲比例（P < 0.001）和六周时纯母乳喂养的母亲比例（P = 0.02）以及产后两周“任何形式母乳喂养”率（P = 0.005）均显著增加。在传授母乳喂养技巧后，感觉自己“奶水不足”（感知到的乳汁不足）的母亲发生率显著下降（P = 0.02）。逻辑回归分析得出一个模型，显示“不干预”技巧得分高的母亲在六周时进行母乳喂养的可能性显著高于未使用该技巧所有要素的母亲（比值比2.4；可信区间1.3, 4.3）。还使用逻辑回归研究了产后两周和六周时与持续母乳喂养相关的因素。产后两周，与母乳喂养相关的显著因素包括母亲感觉自己“奶水充足”（比值比3.3；可信区间2.1, 5.3）、不使用安抚奶嘴（比值比2.6；可信区间1.6, 4.0）、在医院不给婴儿喂其他液体（比值比2.4；可信区间1.5, 3.8）以及从医院工作人员那里获得足够的母乳喂养支持（比值比2.1；可信区间1.3, 3.5）。到六周时，除了这些因素外，发现伴侣、其他家庭成员和健康专业人员给予的鼓励使女性能够继续母乳喂养，这与维持母乳喂养的关联最大[所有三种鼓励情况（327/817；母乳喂养者的40%）的比值比为37.2；可信区间17.3, 80.2，相比无鼓励情况（67/817；母乳喂养者的8%）]。
在产后即刻，如果助产士以“不干预”方式教给母亲良好的母乳喂养技巧，使母亲能够自行给婴儿定位和衔接乳头，且基于生理学方法，母乳喂养率会提高，感知到的乳汁不足发生率会降低。早期成功母乳喂养既与医院的做法和支持有关，也与家庭因素有关，包括不使用安抚奶嘴以及有鼓励母乳喂养的伴侣、家人和健康专业人员。
以“不干预”方式教母亲如何母乳喂养对于使母亲能够“自己做到”以及提高母乳喂养率很重要。经过简短的工作坊教学后，广泛采用一致的良好做法是可行的。使用“母乳喂养评分清单”可能有助于助产士更准确地评估一次母乳喂养情况并确定哪些方面需要改进。健康专业人员应旨在抓住孕期和产后的任何机会，向所有关键家庭成员宣传母乳在婴儿生命最初几个月的益处，以及如何在母乳喂养的早期几周鼓励和支持母亲。
