Blair Anna, Cadwell Karin, Turner-Maffei Cindy, Brimdyr Kajsa
Healthy Children Project, 327 Quaker Meeting House Road, East Sandwich, MA 02537, USA.
Breastfeed Rev. 2003 Jul;11(2):5-10.
In recognition of the irrefutable disadvantages of not breastfeeding to the mother, baby, society and the environment, increasing the duration of breastfeeding has become a focus of national and international health objectives. However, many mothers experience such painful sore nipples that they stop breastfeeding before they intended. The purpose of this study is to examine the relationship between various aspects of optimal breastfeeding (e.g. the positioning of the baby at the mother's breast, the positioning of the baby's head and mouth, the breastfeeding dynamic and the latching process) using a guided assessment and documentation tool and the breastfeeding mother's level of reported pain on a five-point verbal descriptor scale. Ninety-five healthy postpartum breastfeeding mothers who sequentially reported sore nipples within ten days of giving birth to healthy, term babies in a hospital in Latvia participated in the study. Each mother's midwife observed, assessed and documented a breastfeed using a guidance assessment form, the Lactation Assessment Tool (LAT). Each mother scored her own pain during breastfeeding. Four attribute categories were scored and examined as related to the pain levels of the mother: the baby's face position (chin and nose and head position, cheekline, lip flange and angle of mouth opening); the baby's body position (height at the breast, body rotation and body in relation to mother's body); the breastfeeding dynamic (change in breastfeeding pattern (suck vs swallow) and movement of mother's breast) and the latching process of the baby (root, gape, seal and suck). No significant difference was found between the mother's level of reported pain and the assessed head position, body position or breastfeeding dynamic attributes of the baby. However, more optimal latching process behaviour of the baby (rooting, gaping, sealing, and sucking behaviour) are slightly related to lower levels of reported pain (r(88) = -0.09, p > 0.05). This should serve to remind clinicians that no one aspect of positioning may be more critical than another. Assessment of breastfeeding should be comprehensive and should begin before the infant is at the breast. Early stages of the infant's breast seeking behaviours should be observed as well as the actual feeding.
鉴于不进行母乳喂养对母亲、婴儿、社会和环境存在不可否认的弊端，延长母乳喂养时间已成为国家和国际卫生目标的重点。然而，许多母亲经历乳头疼痛难忍，以至于在她们预期之前就停止了母乳喂养。本研究的目的是使用一种指导性评估和记录工具，检查最佳母乳喂养的各个方面（例如婴儿在母亲乳房处的姿势、婴儿头部和嘴巴的位置、母乳喂养动态和衔接过程）与母乳喂养母亲在五点语言描述量表上报告的疼痛程度之间的关系。95名健康的产后母乳喂养母亲参与了该研究，她们在拉脱维亚一家医院生下健康足月儿后的十天内相继报告乳头疼痛。每位母亲的助产士使用一种指导性评估表格——泌乳评估工具（LAT），对一次母乳喂养进行观察、评估和记录。每位母亲对自己母乳喂养期间的疼痛进行评分。对与母亲疼痛程度相关的四个属性类别进行评分和检查：婴儿的面部位置（下巴、鼻子和头部位置、脸颊线条、唇缘和嘴巴张开角度）；婴儿的身体位置（在乳房处的高度、身体旋转以及相对于母亲身体的位置）；母乳喂养动态（母乳喂养模式的变化（吸吮与吞咽）以及母亲乳房的移动）以及婴儿的衔接过程（寻乳、张口、含接和吸吮）。在母亲报告的疼痛程度与评估的婴儿头部位置、身体位置或母乳喂养动态属性之间未发现显著差异。然而，婴儿更优化的衔接过程行为（寻乳、张口、含接和吸吮行为）与报告的较低疼痛程度略有相关（r(88) = -0.09，p > 0.05）。这应提醒临床医生，姿势的任何一个方面可能都不比另一个方面更关键。母乳喂养的评估应该是全面的，并且应该在婴儿接触乳房之前就开始。应该观察婴儿寻乳行为的早期阶段以及实际喂养情况。
