Patel Roshni R, Liebling Rachel E, Murphy Deirdre J
Division of Obstetrics and Gynaecology, St. Michael's Hospital, University of Bristol, Bristol, United Kingdom.
Birth. 2003 Dec;30(4):255-60. doi: 10.1046/j.1523-536x.2003.00255.x.
Operative delivery rates are currently rising in many countries, but the effects of this factor on the initiation and duration of breastfeeding are unclear. The purpose of this study was to evaluate breastfeeding success after instrumental vaginal delivery or cesarean section at full dilatation, and to investigate whether timing of discharge after operative delivery affects breastfeeding rates.
A prospective cohort study was conducted of 393 women with term, singleton, live, cephalic pregnancies who required delivery in theater during the second stage of labor between February 1999 and February 2000. Postal questionnaires were mailed to participants at 6 weeks and 1 year. Logistic regression models were used to explore the relationships between infant feeding and mode of delivery, controlling for factors previously correlated with breastfeeding success.
Rates of exclusive breastfeeding at discharge and 6 weeks postpartum were 70 and 44 percent, respectively. No significant differences occurred when instrumental vaginal delivery was compared with cesarean section, adjusted OR 0.84 (95% CI 0.50, 1.41) and 1.15 (95% CI 0.69, 1.93) respectively. Breastfeeding rates after failed instrumental delivery were similar to those after immediate cesarean section, adjusted OR 0.99 (95% CI 0.72, 1.38) and 1.28 (95% CI 0.91, 1.78). Women who had a longer in-patient stay after cesarean section were more likely to achieve exclusive breastfeeding at hospital discharge (78% vs 66%, p = 0.03).
Method of operative delivery in the second stage of labor does not appear to influence initiation or duration of exclusive breastfeeding. A longer inpatient stay may help cesarean-delivered women to initiate breastfeeding.
目前许多国家手术分娩率正在上升，但这一因素对母乳喂养开始及持续时间的影响尚不清楚。本研究的目的是评估器械助产阴道分娩或宫口开全时剖宫产术后的母乳喂养成功率，并调查手术分娩后出院时间是否会影响母乳喂养率。
对1999年2月至2000年2月间在第二产程需要在产房分娩的393例足月、单胎、活产、头位妊娠妇女进行了一项前瞻性队列研究。在6周和1年时向参与者邮寄了邮政问卷。采用逻辑回归模型探讨婴儿喂养与分娩方式之间的关系，并对先前与母乳喂养成功相关的因素进行控制。
出院时和产后6周的纯母乳喂养率分别为70%和44%。器械助产阴道分娩与剖宫产相比无显著差异，校正后的比值比分别为0.84（95%可信区间0.50, 1.41）和1.15（95%可信区间0.69, 1.93）。器械助产失败后的母乳喂养率与立即剖宫产相似，校正后的比值比分别为0.99（95%可信区间0.72, 1.38）和1.28（95%可信区间0.91, 1.78）。剖宫产术后住院时间较长的妇女在出院时更有可能实现纯母乳喂养（78%对66%，p = 0.03）。
第二产程的手术分娩方式似乎不会影响纯母乳喂养的开始或持续时间。较长的住院时间可能有助于剖宫产妇女开始母乳喂养。
