Neifert M R, Seacat J M, Jobe W E
Pediatrics. 1985 Nov;76(5):823-8.
With the present increased incidence of breast-feeding, clinicians need to be prepared to identify and manage problems in lactation. Most problems are related to insufficient knowledge, inappropriate routines, and lack of confidence and are easily managed or prevented by prenatal education, anticipatory guidance, and adequate support. Increasing evidence exists that primary causes of lactation failure also occur and can preclude successful lactation, even among highly motivated women. Three cases are presented in which lactation failure is believed to stem from insufficient glandular tissue within the breasts. Supportive history for this entity include absence of typical breast changes with pregnancy and failure of postpartum breast engorgement to occur. Associated physical findings included a unilateral underdeveloped breast in each woman and palpable patchy areas of glandular tissue in one case. Breast diaphanography, or transillumination, substantiated clinical findings in the two cases in which it was performed. Both multiparous women had a previous unsuccessful breast-feeding experience, whereas the primiparous woman had immediate family members with a history of lactation failure. All three women benefited psychologically from the interpretation that lactation failure was not due to their breast-feeding performance, and each elected to continue nursing long-term despite the need for formula supplement. These cases are presented to emphasize that primary causes of lactation failure do exist and to alert clinicians to the historical and physical findings suggestive of inadequate glandular tissue as an etiology of previously unexplained lactation failure. Preserving the "every woman can nurse" myth contributes to perpetuating a simplistic view of lactation and does a disservice to the small percentage of women with primary causes of unsuccessful lactation.
随着目前母乳喂养率的上升，临床医生需要做好准备，以识别和处理哺乳过程中的问题。大多数问题与知识不足、不适当的习惯以及缺乏信心有关，通过产前教育、预期指导和充分的支持很容易得到处理或预防。越来越多的证据表明，即使在积极性很高的女性中，也会出现导致泌乳失败的主要原因，这些原因可能会妨碍成功哺乳。本文介绍了三例泌乳失败被认为源于乳房内腺体组织不足的病例。支持这一情况的病史包括孕期乳房无典型变化以及产后乳房未出现充盈。相关的体格检查发现包括每名女性均有一侧乳房发育不全，其中一例可触及散在的腺体组织区域。在进行乳房透照检查的两例中，该检查证实了临床发现。两名经产妇既往均有母乳喂养失败的经历，而初产妇的直系亲属有泌乳失败史。尽管需要补充配方奶，但所有三名女性都从关于泌乳失败并非因其母乳喂养表现的解释中获得了心理上的益处，并且每个人都选择长期继续哺乳。介绍这些病例是为了强调泌乳失败的主要原因确实存在，并提醒临床医生注意那些提示腺体组织不足是既往不明原因泌乳失败病因的病史和体格检查发现。维持“每个女性都能哺乳”的神话会导致对泌乳的简单化看法持续存在，并且对一小部分因主要原因导致母乳喂养失败的女性不利。
