Wood Natsuko K, Woods Nancy F, Blackburn Susan T, Sanders Elizabeth A
Natsuko K. Wood is a graduate from University of Washington School of Nursing, Division of Hematology, Seattle, WA. She can be reached via email at
MCN Am J Matern Child Nurs. 2016 Sep-Oct;41(5):299-307. doi: 10.1097/NMC.0000000000000264.
The purpose of this review was to evaluate breastfeeding interventions trialed to date and recommend directions for future needs in breastfeeding research.
A literature review was conducted using PubMed, CINAHL Plus, and PsycINFO databases to identify studies that evaluated efficacy or effectiveness of breastfeeding interventions on breastfeeding initiation, duration, or exclusivity as a primary, secondary, or tertiary outcome. Combinations of search terms included breastfeeding, feeding behavior, prenatal/patient education, health promotion, social support, perinatal/prenatal/intrapartum/postnatal care, and postpartum period.
Six studies were included in this review, using PRISMA guidelines. Acquisition of knowledge and skills, emotional support by healthcare providers, and self-efficacy over maternal confidence in her ability to breastfeed were factors the intervention studies relied on to affect breastfeeding practices. Although these factors were addressed in the studies, breastfeeding mothers had difficulty transferring what they gained from interventions into their real-life breastfeeding practices as evidenced by the highest drop-off rate of exclusive breastfeeding in the early postpartum.
There were conceptual limitations to the reviewed studies: (1) lack of understanding of maternal perception of infant behavior and (2) perceived insufficient milk as a remaining primary reason for breastfeeding discontinuation. There were methodological limitations: (1) lack of theory-based interventions and (2) lack of intervention fidelity. Future studies involving breastfeeding should focus on the causes of the problems driven by theory-based interventions integrated with intervention fidelity.
本综述的目的是评估迄今为止试验过的母乳喂养干预措施，并为母乳喂养研究的未来需求推荐方向。
使用PubMed、CINAHL Plus和PsycINFO数据库进行文献综述，以识别将母乳喂养干预措施对母乳喂养开始、持续时间或纯母乳喂养率的疗效或有效性作为主要、次要或三级结局进行评估的研究。检索词组合包括母乳喂养、喂养行为、产前/患者教育、健康促进、社会支持、围产期/产前/产时/产后护理以及产后阶段。
本综述采用PRISMA指南纳入了六项研究。知识和技能的获取、医护人员的情感支持以及母亲对自己母乳喂养能力的自我效能感是干预研究中影响母乳喂养行为所依赖的因素。尽管这些因素在研究中得到了探讨，但母乳喂养的母亲难以将她们从干预措施中获得的知识应用到实际的母乳喂养实践中，产后早期纯母乳喂养率下降幅度最大就证明了这一点。
所综述的研究存在概念上的局限性：（1）对母亲对婴儿行为的认知缺乏了解；（2）认为母乳不足仍然是停止母乳喂养的主要原因。存在方法上的局限性：（1）缺乏基于理论的干预措施；（2）缺乏干预保真度。未来涉及母乳喂养的研究应关注基于理论的干预措施与干预保真度相结合所引发问题的原因。
