Teich Alice S, Barnett Josephine, Bonuck Karen
1 Department of Family and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine , Bronx, New York.
Breastfeed Med. 2014 Jan-Feb;9(1):9-15. doi: 10.1089/bfm.2013.0063. Epub 2013 Dec 4.
This study examined women's perceptions of early infant feeding experiences and identified early postpartum barriers to successful breastfeeding.
We conducted semistructured exit interviews at 6 months postpartum with a subsample of participants (n=67) enrolled in two randomized controlled trials of breastfeeding promotion. Study arms included (1) routine pre- and postnatal visits with an International Board Certified Lactation Consultant (IBCLC) (LC group), (2) electronically prompted guidance from prenatal care providers (EP group), (3) EP+LC combined, and (4) standard of care (control group). Interview transcripts were coded using grounded theory and analyzed in MAXqda. Code matrices were used to identify early postpartum breastfeeding barriers and were further examined in relation to treatment group using a mixed methods analysis.
The majority of the participants reported experiencing at least one barrier to breastfeeding. Barriers to breastfeeding were more commonly reported in the early postpartum than late postpartum period. The most common barrier during the early postpartum period was the perception of inadequate milk supply ("lactational") (n=18), followed by problems with latch, medical problems that were perceived as precluding breastfeeding, and medical staff and hospital practices. Participants frequently reported that the IBCLCs assisted them in anticipating, managing, and overcoming these barriers.
Our findings underscore the importance of integrating IBCLCs into routine pre- and postpartum care because they provide critical support that effectively addresses early postpartum barriers to breastfeeding.
本研究调查了女性对早期婴儿喂养经历的看法，并确定了产后早期成功母乳喂养的障碍。
我们对参与两项母乳喂养促进随机对照试验的部分参与者（n = 67）在产后6个月进行了半结构化出院访谈。研究组包括：（1）由国际认证泌乳顾问（IBCLC）进行常规产前和产后访视（LC组）；（2）由产前护理提供者提供电子提示指导（EP组）；（3）EP + LC组合；（4）标准护理（对照组）。访谈记录采用扎根理论编码，并在MAXqda中进行分析。编码矩阵用于识别产后早期母乳喂养障碍，并使用混合方法分析进一步研究与治疗组的关系。
大多数参与者报告至少经历过一种母乳喂养障碍。产后早期比晚期更常报告母乳喂养障碍。产后早期最常见的障碍是认为乳汁供应不足（“泌乳”）（n = 18），其次是衔乳问题、被认为妨碍母乳喂养的医疗问题以及医护人员和医院的做法。参与者经常报告IBCLC帮助他们预测、管理和克服这些障碍。
我们的研究结果强调了将IBCLC纳入常规产前和产后护理的重要性，因为他们提供了关键支持，有效地解决了产后早期母乳喂养的障碍。
