个性化干预对剖宫产产妇母乳喂养行为的影响
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摘要
目的探讨个性化干预对剖宫产妇女产后母乳喂养率、母乳喂养行为和母乳喂养满意度的影响。方法前瞻性纳入2018年7月1日～8月30日在四川大学华西第二医院住院行剖宫产分娩的孕妇,采用随机数字表法将研究对象分为干预组(n=171)和对照组(n=170),干预组实施产前与产后相结合的个性化干预,对照组实施常规护理。记录两组对象基本临床资料、出院时及产后42 d母乳喂养情况并比较两组间差异。结果两组研究对象年龄、民族、麻醉类型、术前进食时间等临床资料差异均无统计学意义(P>0.05)。产后42 d失访17例,此时干预组163例,对照组161例。干预组在出院时、产后42 d的纯母乳喂养率、母乳喂养满意度、计划母乳喂养时长均高于对照组,且差异有统计学意义(P<0.05)。对照组出院时及产后42 d的乳房胀痛发生率及程度、乳头皲裂发生率、24 h配方奶添加次数、奶瓶使用率、喂养问题发生率均高于干预组,且差异有统计学意义(P<0.05)。两组对象出院时,母乳喂养知识得分均高于入院时,但干预组得分高于对照组(P<0.001)。结论产前与产后相结合的个性化干预可提高剖宫产妇母乳喂养知识水平和母乳喂养满意度,改善母乳喂养行为,进而提高纯母乳喂养率。
Objective To investigate the effects of individualized intervention on postpartum breast-feeding behavior and satisfaction after cesarean section(CS). Methods 341 pregnant women who had cesarean section in West China Second Hospital of Sichuan University from 1st July to 30th August in 2018 were randomly divided into intervention group(171 cases) and control group(170 cases). The participants in experimental group received individualized intervention through the combination of prenatal and postnatal. The participants in control group received routine nursing care. The basic clinical data and breastfeeding information at discharge and day 42 postpartum were compared between the two groups. Results There were no significant differences in age, ethnicity, anesthesia type, preoperative feeding time between the two groups(P>0.05). At the time of discharge and day 42 postpartum, the rate of exclusive breastfeeding, breastfeeding satisfaction and planned breastfeeding duration in the intervention group were higher than those in the control group(P<0.05). The incidence and degree of breast distending pain, the incidence of cracked nipples, the times of adding formula milk in 24 h, the rate of using feeding bottle and the incidence of feeding problems were all higher in the control group than those in the intervention group(P<0.05). The knowledge scores of breastfeeding in both groups were higher at discharge than at admission, and the score was higher in the intervention group than that in the control group at the time of discharge. Conclusion The combination of prenatal and postnatal individualized intervention can significantly improve the knowledge, behavior and satisfaction of breastfeeding.
Objective To investigate the effects of individualized intervention on postpartum breast-feeding behavior and satisfaction after cesarean section(CS). Methods 341 pregnant women who had cesarean section in West China Second Hospital of Sichuan University from 1st July to 30th August in 2018 were randomly divided into intervention group(171 cases) and control group(170 cases). The participants in experimental group received individualized intervention through the combination of prenatal and postnatal. The participants in control group received routine nursing care. The basic clinical data and breastfeeding information at discharge and day 42 postpartum were compared between the two groups. Results There were no significant differences in age, ethnicity, anesthesia type, preoperative feeding time between the two groups(P>0.05). At the time of discharge and day 42 postpartum, the rate of exclusive breastfeeding, breastfeeding satisfaction and planned breastfeeding duration in the intervention group were higher than those in the control group(P<0.05). The incidence and degree of breast distending pain, the incidence of cracked nipples, the times of adding formula milk in 24 h, the rate of using feeding bottle and the incidence of feeding problems were all higher in the control group than those in the intervention group(P<0.05). The knowledge scores of breastfeeding in both groups were higher at discharge than at admission, and the score was higher in the intervention group than that in the control group at the time of discharge. Conclusion The combination of prenatal and postnatal individualized intervention can significantly improve the knowledge, behavior and satisfaction of breastfeeding.
引文
[1] 曾娟,褚静,高燕,等.剖宫产产妇产后母乳喂养率调查与持续性支持干预研究.河北医药,2017,39(2):318-320.
[2] SOBTI J,MATHUR GP,GUPTA A.WHO’s proposed global strategy for infant and young child feeding:a viewpoint.J Indian Med Assoc,2002,100(8):502-504.
[3] HOBBS AJ,MANNION CA,MCDONALD SW,et al.The impact of caesarean section on breastfeeding initiation,duration and difficulties in the first four months postpartum.BMC Pregnancy Childbirth,2016,16:90[2019-04-19].https://doi.org/10.1186/s12884-016-0876-1
[4] 张秋君,史云菊.612例产妇母乳喂养率影响因素分析.中国妇幼保健,2013,28(30):5095-5096.
[5] 邓丽.阴道分娩与剖宫产对产妇母乳喂养情况比较.川北医学院学报,2013,28(1):71-73.
[6] PRIOR E,SANTHAKUMARAN S,GALE C,et al.Breastfeeding after cesarean delivery:a systematic review and meta-analysis of world literature.Am J Clin Nutr,2012,95(5):1113-1135.
[7] SU LL,CHONG YS,CHAN YH,et al.Antenatal education and postnatal support strategies for improving rates of exclusive breast feeding:randomised controlled trial.BMJ,2007,335(7620):596[2019-4-19].https://doi.org/10.1136/bmj.39279.656343.55.
[8] MCFADDEN A,GAVINE A,RENFREW MJ,et al.Support for healthy breastfeeding mothers with healthy term babies.Cochrane Database Syst Rev,2017,2:D1141[2019-04-19].https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001141.pub5/full.
[9] ACOG Committee Opinion No.361:Breastfeeding:maternal and infant aspects.Obstet Gynecol,2007,109(2 Pt 1):479-480.
[10] SHI L,ZHANG J.Recent evidence of the effectiveness of educational interventions for improving complementary feeding practices in developing countries.J Trop Pediatr,2011,57(2):91-98.
[11] 肖红,龚良晨,罗美华,等.健康教育对提高初产妇母乳喂养相关知识认知行为的评价.中国妇幼保健,2011,26(24):3778-3779.
[2] SOBTI J,MATHUR GP,GUPTA A.WHO’s proposed global strategy for infant and young child feeding:a viewpoint.J Indian Med Assoc,2002,100(8):502-504.
[3] HOBBS AJ,MANNION CA,MCDONALD SW,et al.The impact of caesarean section on breastfeeding initiation,duration and difficulties in the first four months postpartum.BMC Pregnancy Childbirth,2016,16:90[2019-04-19].https://doi.org/10.1186/s12884-016-0876-1
[4] 张秋君,史云菊.612例产妇母乳喂养率影响因素分析.中国妇幼保健,2013,28(30):5095-5096.
[5] 邓丽.阴道分娩与剖宫产对产妇母乳喂养情况比较.川北医学院学报,2013,28(1):71-73.
[6] PRIOR E,SANTHAKUMARAN S,GALE C,et al.Breastfeeding after cesarean delivery:a systematic review and meta-analysis of world literature.Am J Clin Nutr,2012,95(5):1113-1135.
[7] SU LL,CHONG YS,CHAN YH,et al.Antenatal education and postnatal support strategies for improving rates of exclusive breast feeding:randomised controlled trial.BMJ,2007,335(7620):596[2019-4-19].https://doi.org/10.1136/bmj.39279.656343.55.
[8] MCFADDEN A,GAVINE A,RENFREW MJ,et al.Support for healthy breastfeeding mothers with healthy term babies.Cochrane Database Syst Rev,2017,2:D1141[2019-04-19].https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001141.pub5/full.
[9] ACOG Committee Opinion No.361:Breastfeeding:maternal and infant aspects.Obstet Gynecol,2007,109(2 Pt 1):479-480.
[10] SHI L,ZHANG J.Recent evidence of the effectiveness of educational interventions for improving complementary feeding practices in developing countries.J Trop Pediatr,2011,57(2):91-98.
[11] 肖红,龚良晨,罗美华,等.健康教育对提高初产妇母乳喂养相关知识认知行为的评价.中国妇幼保健,2011,26(24):3778-3779.