Departments of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois; George Washington University Biostatistics Center, Washington, DC; Department of Obstetrics and Gynecology, Yale University, New Haven, Connecticut; University of Alabama at Birmingham, Birmingham, Alabama; University of Utah Health Sciences Center, Salt Lake City, Utah; Stanford University, Stanford, California; Columbia University, New York, New York; Brown University, Providence, Rhode Island; University of Texas Medical Branch, Galveston, Texas; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas; The Ohio State University, Columbus, Ohio; MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio; University of Texas Southwestern Medical Center, Dallas, Texas; University of Pennsylvania, Philadelphia, Pennsylvania; Duke University, Durham, North Carolina; and the University of Pittsburgh, Pittsburgh, Pennsylvania; for the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
Obstet Gynecol. 2020 Mar;135(3):583-590. doi: 10.1097/AOG.0000000000003697.
To estimate whether maternal sense of control in labor is associated with breastfeeding at 4-8 weeks postpartum.
This is a secondary analysis of data from a multicenter randomized controlled trial of elective induction of labor at 39 weeks of gestation in low-risk nulliparous women. In this trial, women completed the Labor Agentry Scale, a validated measure of women's feelings of control over the childbirth process, 6-96 hours after delivery. The Labor Agentry Scale score, which is higher with more perceived control during childbirth, was analyzed both as a continuous and a categorical variable (quintiles). Self-reported breastfeeding at 4-8 weeks postpartum was categorized as exclusive breastfeeding, breastfeeding and formula feeding, or exclusive formula feeding. Women were included in this analysis if they labored, filled out a Labor Agentry Scale questionnaire, had a neonate who survived until the postpartum visit, and provided information on infant feeding. Multinomial logistic regression was used to adjust for confounders.
Of 5,185 women, 32.9% (n=1,705) were exclusively breastfeeding, 31.2% (n=1,620) were breastfeeding and formula feeding, and 35.9% (n=1,860) were exclusively formula feeding 4-8 weeks after delivery. Overall Labor Agentry Scale score ranged from 34 to 203 (median 167, interquartile range 145-182). The median Labor Agentry Scale score was 169 (interquartile range 151-183) for women exclusively breastfeeding, 166 (interquartile range 142-182) for women who were breastfeeding and formula feeding, and 164 (interquartile range 142-181) for women who were only formula feeding (P<.001). In the unadjusted multinomial model, women with Labor Agentry Scale scores in the lowest two quintiles (ie, those with lower perceived control during childbirth) were less likely to be exclusively breastfeeding (as compared with those exclusively formula feeding) than women in the highest Labor Agentry Scale quintile. When controlling for confounders, however, this association was no longer significant.
After adjustment for confounders, perceived control during childbirth was not associated with breastfeeding at 4-8 weeks postpartum among nulliparous women.
ClinicalTrials.gov, NCT01990612.
评估产妇分娩时的控制感是否与产后 4-8 周的母乳喂养有关。
这是一项对低危初产妇在 39 周进行选择性引产的多中心随机对照试验数据的二次分析。在该试验中，女性在分娩后 6-96 小时内完成了分娩代理权量表，这是一种衡量女性对分娩过程控制感的有效测量工具。分娩代理权量表的得分越高，意味着分娩过程中的感知控制感越强，该量表得分既作为连续变量也作为分类变量（五分位数）进行分析。产后 4-8 周的自我报告母乳喂养情况分为纯母乳喂养、母乳喂养和配方奶喂养、纯配方奶喂养。如果产妇分娩、填写分娩代理权量表问卷、新生儿存活至产后访视并提供婴儿喂养信息，则将其纳入本分析。采用多项逻辑回归调整混杂因素。
在 5185 名女性中，32.9%（n=1705）为纯母乳喂养，31.2%（n=1620）为母乳喂养和配方奶喂养，35.9%（n=1860）为纯配方奶喂养，产后 4-8 周时的喂养方式。总体分娩代理权量表得分范围为 34 至 203（中位数 167，四分位距 145-182）。纯母乳喂养的女性分娩代理权量表中位数为 169（四分位距 151-183），母乳喂养和配方奶喂养的女性为 166（四分位距 142-182），仅配方奶喂养的女性为 164（四分位距 142-181）（P<.001）。在未调整的多项逻辑回归模型中，分娩代理权量表得分最低的两个五分位数（即分娩时感知控制感较低）的女性与仅配方奶喂养的女性相比，更不可能纯母乳喂养（与仅配方奶喂养相比）。然而，在控制混杂因素后，这种关联不再显著。
在调整混杂因素后，初产妇分娩时的感知控制感与产后 4-8 周的母乳喂养无关。
ClinicalTrials.gov，NCT01990612。
