School of Nursing, University of Hong Kong, Hong Kong.
J Midwifery Womens Health. 2013 Jan-Feb;58(1):25-32. doi: 10.1111/j.1542-2011.2012.00254.x. Epub 2013 Jan 14.
Few women who reside in Hong Kong exclusively breastfeed, and one-half stop breastfeeding within the first few months. There is little research in this population on the association between intrapartum interventions and breastfeeding duration.
A sample of 1280 mother-infant pairs were recruited from the obstetric units of 4 public hospitals in Hong Kong and followed prospectively for 12 months or until the infant was weaned. The outcome variables for this analysis were the duration of any and exclusive breastfeeding. Predictor variables were 4 intrapartum interventions: receipt of opioid pain medication, induction versus spontaneous labor, epidural administration, and mode of birth. We used Cox proportional hazards modeling to assess the impact of intrapartum interventions on the duration of any and exclusive breastfeeding, and we constructed Kaplan-Meier survival curves to evaluate the cumulative impact of multiple intrapartum interventions on breastfeeding outcomes.
Bivariate analysis showed that induction of labor (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.09-1.41), opioid pain medication (HR, 1.21; 95% CI, 1.06-1.37), and having an emergency cesarean birth (HR, 1.22; 95% CI, 1.01-1.48) were associated with a shorter duration of any breastfeeding. Induction of labor (HR, 1.23; 95% CI, 1.08-1.39) and having an emergency cesarean birth (HR, 1.25; 95% CI, 1.05-1.51) were associated with a shorter duration of exclusive breastfeeding. After controlling for known confounding variables, there was no longer any association between individual intrapartum interventions and the duration of any or exclusive breastfeeding. The median duration of breastfeeding for participants who experienced a natural birth with no intrapartum interventions was 9 weeks compared with 5 weeks for participants who experienced at least 3 intrapartum interventions.
Clinicians working with new breastfeeding mothers should focus on providing additional support to mothers who experience a difficult labor and birth with multiple interventions to improve their breastfeeding experiences.
在香港，很少有女性完全母乳喂养，且有一半的女性会在产后头几个月停止母乳喂养。在该人群中，关于分娩期干预措施与母乳喂养持续时间之间的关系的研究甚少。
从香港 4 家公立医院的产科病房招募了 1280 对母婴对，并对其进行了为期 12 个月或直至婴儿断奶的前瞻性随访。本分析的结局变量为任何母乳喂养和纯母乳喂养的持续时间。预测变量为 4 项分娩期干预措施：使用阿片类止痛药、诱导分娩与自然分娩、硬膜外麻醉和分娩方式。我们使用 Cox 比例风险模型评估分娩期干预措施对任何母乳喂养和纯母乳喂养持续时间的影响，并构建 Kaplan-Meier 生存曲线评估多种分娩期干预措施对母乳喂养结局的累积影响。
单变量分析显示，引产（风险比 [HR]，1.24；95%置信区间 [CI]，1.09-1.41）、使用阿片类止痛药（HR，1.21；95% CI，1.06-1.37）和紧急剖宫产（HR，1.22；95% CI，1.01-1.48）与母乳喂养持续时间较短有关。引产（HR，1.23；95% CI，1.08-1.39）和紧急剖宫产（HR，1.25；95% CI，1.05-1.51）与纯母乳喂养持续时间较短有关。在控制了已知的混杂变量后，分娩期干预措施与任何母乳喂养或纯母乳喂养的持续时间之间不再存在关联。未经历分娩期干预措施的自然分娩参与者的母乳喂养中位数持续时间为 9 周，而经历至少 3 项分娩期干预措施的参与者的母乳喂养中位数持续时间为 5 周。
与新的母乳喂养母亲合作的临床医生应专注于为经历困难分娩和分娩时经历多种干预措施的母亲提供额外支持，以改善她们的母乳喂养体验。
