Department of Child Psychiatry, Son Espases Hospital, Valldemossa road, 07120, Palma de Mallorca, Spain.
Baleares Medical Research Council (IdISBa), Valldemossa road, 07120, Palma de Mallorca, Spain.
Int Breastfeed J. 2021 Jan 6;16(1):8. doi: 10.1186/s13006-020-00348-y.
Emotional distress in mothers inhibits the let-down reflex, thus affecting breastfeeding self-efficacy. A breastfeeding mother may have to cope with both physical discomfort and psychological distress. However, literature on initiatives to improve breastfeeding rates has focused mainly on providing community-based peer support, or social policies. The aim of this review is to assess evidence on the effectiveness of a broad range of psychological interventions to facilitate breastfeeding for mothers facing difficulties around the time of delivery.
The review of the literature is derived from a search on Cochrane Library, PubMed, EBSCOhost, and PsycINFO for papers published since 1980. The approach was to explore quantitative and qualitative parameters. Quantitative parameters included breastfeeding initiation, duration, and composition. Qualitative parameters recorded the evaluation of maternal perceptions on breastfeeding success. The high heterogeneity of the studies led to a narrative review; 20 selected papers that report on breastfeeding outcomes and psychological programs met the inclusion criteria.
The evidence on breastfeeding support through psychotherapy is heterogeneous and scant. Out of the included studies, 11 were randomized controlled trials, two were non-randomised trials, and two used a quasi-experimental design. None of the studies reported an increase in adverse breastfeeding outcomes. Three studies failed to report an association between psychological procedures and improved breastfeeding outcomes. A literature review showed that 17 (85%) analyses support stress-releasing techniques to facilitate breastfeeding.
This review suggests that relaxation interventions carefully tailored to address perinatal emotional distress may lead to important health benefits, including improvement in breastfeeding outcomes. There is also some indication that psychotherapy support while breastfeeding may have more impact than routine counselling. Conversely, this review did not find an association between self-hypnosis and breastfeeding outcomes. Data from this study can be used in designing prevention programs and future research with appropriate theoretical underpinning.
母亲的情绪困扰会抑制奶阵反射，从而影响母乳喂养的自我效能。哺乳期母亲可能既要应对身体不适，又要应对心理困扰。然而，提高母乳喂养率的文献主要集中在提供基于社区的同伴支持或社会政策上。本综述的目的是评估广泛的心理干预措施在促进分娩时面临困难的母亲进行母乳喂养的有效性。
文献综述源自 Cochrane 图书馆、PubMed、EBSCOhost 和 PsycINFO 自 1980 年以来发表的论文搜索。方法是探索定量和定性参数。定量参数包括母乳喂养的开始、持续时间和成分。定性参数记录了对母乳喂养成功的母亲感知的评估。由于研究的高度异质性，导致采用叙述性综述；20 篇符合纳入标准的报告母乳喂养结果和心理方案的选定论文。
通过心理治疗支持母乳喂养的证据是异质和稀少的。在纳入的研究中，11 项为随机对照试验，2 项为非随机试验，2 项使用准实验设计。没有一项研究报告母乳喂养不良结果增加。三项研究未能报告心理程序与改善母乳喂养结果之间的关联。文献综述显示，17 项（85%）分析支持释放压力技术以促进母乳喂养。
本综述表明，精心设计的针对围产期情绪困扰的放松干预措施可能会带来重要的健康益处，包括改善母乳喂养结果。还有一些迹象表明，与常规咨询相比，母乳喂养时的心理治疗支持可能更有影响。相反，本综述没有发现自我催眠与母乳喂养结果之间的关联。本研究的数据可用于设计预防计划和未来具有适当理论基础的研究。
