产后泌乳启动延迟的现状及其干预措施分析
摘要
目的了解目前国内外产妇产后泌乳启动延迟的发生情况,分析可用的干预措施,为临床护理人员进行早期泌乳干预,促进纯母乳喂养提供理论依据。方法通过查阅近年来的国内外相关文献,对泌乳启动延迟的概念、国内外现状、危害以及目前的干预措施进行综述。结果产后泌乳启动延迟在国外发生率为10.1%~58.0%,国内发生率9.5%~33.8%,不同国家、种族、不同研究人群,发生率不同。产后泌乳启动延迟可致母乳喂养中断,增加新生儿病理性体质量下降风险。目前对泌乳启动延迟的干预措施包括早接触早吸吮、应用吸奶器、中医治疗、药物治疗、仪器理疗等。结论产后泌乳启动延迟的发生率高,严重阻碍纯母乳喂养的实施,产科护理人员应积极鼓励产妇,增强产妇母乳喂养效能,加强泌乳相关的健康教育,采取多种措施及早干预泌乳。
引文
[1]沈晓桦,夏杰,胡丽,等.纯母乳喂养现状与影响因素研究进展[J].中国实用护理杂志,2017,33(3):223-226.DOI:10.3760/cma.j.issn.1672-7088.2017.03.017.
[2]Heymann J,Raub A,Earle A.Breastfeeding Policy:AGlobally Comparative Analysis[J].Bull World Health Organ,2013,91(6):398-406.DOI:10.2471/BLT.12.109363.
[3]刘晓琴,张晓宁.集束化干预在提高初产妇纯母乳喂养成功率中的应用[J].齐鲁护理杂志,2015(14):28-30.DOI:10.3969/j.issn.1006-7256.2015.14.013.
[4]徐雪芬,胡引.阶段性电话回访对初产妇产褥期纯母乳喂养的影响研究[J].中国实用护理杂志,2017,33(3):191-193.DOI:10.3760/cma.j.issn.1672-7088.2017.03.008.
[5]Haile Z T,Chavan B B,Teweldeberhan A,et al.Association Between Gestational Weight Gain and Delayed Onset of Lactation:The Moderating Effects of Race/Ethnicity[J].Breastfeed Med,2017,12:79-85.DOI:10.1089/bfm.2016.0134.
[6]Nommsen-Rivers L A,Chantry C J,Peerson J M,et al.Delayed Onset of Lactogenesis Among First-time Mothers is Related to Maternal Obesity and Factors Associated with Ineffective Breastfeeding[J].Am J Clin Nutr,2010,92(3):574-584.DOI:10.3945/ajcn.2010.29192.
[7]Chapman D J,Perez-Escamilla R.Maternal Perception of the Onset of Lactation Is a Valid,Public Health Indicator of Lactogenesis Stage II[J].J Nutr,2000,130(12):2972-2980.
[8]De Bortoli J,Amir L H.Is Onset of Lact ation Delayed in Women with Diabetes in Pregnancy?A Systematic Review[J].Diabet Med,2016,33(1):17-24.DOI:10.1111/dme.12846.
[9]Fein S B,Labiner-Wolfe J,Shealy K R,et al.Infant Feeding Practices Study II:Study Methods[J].Pediatrics,2008,122(Suppl 2):S28-S35.DOI:10.1542/peds.2008-1315c.
[10]Scott J A,Binns C W,Oddy W H.Predictors of Delayed Onset of Lactation[J].Matern Child Nutr,2007,3(3):186-193.DOI:10.1111/j.1740-8709.2007.00096.x.
[11]Hruschka D J,Sellen D W,Stein A D,et al.Delayed Onset of Lactation and Risk of Ending Full Breast-feeding Early in Rural Guatemala[J].J Nutr,2003,133(8):2592-2599.
[12]Matias S L,Nommsen-Rivers L A,Creed-Kanashiro H,et al.Risk Factors for Early Lactation Problems Among Peruvian Primiparous Mothers[J].Matern Child Nutr,2010,6(2):120-133.DOI:10.1111/j.1740-8709.2009.00195.x.
[13]朱鹏,陶芳标,蒋晓敏,等.孕期应激生活事件、体质量增加及分娩方式对初产妇泌乳启动延迟的影响[J].卫生研究,2010,39(4):478-482
[14]薛瑶纯,徐琼,刘莉,等.广州市女性分娩后的膳食摄入情况及泌乳启动延迟相关影响因素分析[J].华南预防医学,2015,41(3):218-223.DOI:10.13217/j.scjpm.2015.0218.
[15]苏秀颜,尤丽媚,苏颖仪.社区妇女产后泌乳情况调查及下乡随访指导护理[J].护理实践与研究,2016,13(24):130-132.DOI:10.3969/j.issn.1672-9676.2016.24.054.
[16]姜珊,段一凡,庞学红,等.2013年中国乳母下奶延迟流行状况及其影响因素[J].中华预防医学杂志,2016,50(12):1061-1066.DOI:10.3760/cma.j.issn.0253-9624.2016.12.008.
[17]司曼丽,顾平,张爱霞,等.妊娠期糖尿病产妇泌乳启动延迟的相关因素分析[J].护理学杂志,2017,32(8):19-21.DOI:10.3870/j.issn.1001-4152.2017.08.019.
[18]Brownell E,Howard C R,Lawrence R A,et al.Delayed Onset Lactogenesis II Predicts the Cessation of any or Exclusive Breastfeeding[J].J Pediatr,2012,161(4):608-614.DOI:10.1016/j.jpeds.2012.03.035.
[19]Mc Cann M F,Baydar N,Williams R L.Breastfeeding Attitudes and Reported Problems in a National Sample of WICParticipants[J].J Hum Lact,2007,23(4):314-324.DOI:10.1177/0890334407307882.
[20]Michel M P,Gremmo-Feger G,Oger E,et al.Pilot Study of Early Breastfeeding Difficulties of Term Newborns:Incidence and Risk Factors[J].Arch Pediatr,2007,14(5):454-460.
[21]Dewey K G,Nommsen-Rivers L A,Heinig M J,et al.Risk Factors for Suboptimal Infant Breastfeeding Behavior,Delayed Onset of Lactation,and Excess Neonatal Weight Loss[J].Pediatrics,2003,112(3 Pt 1):607-619.DOI:10.1542/peds.112.3.607.
[22]Pakseresht S,Pourshaban F,Khalesi Z B.Comparing Maternal Breastfeeding Self-efficacy During First Week and Sixth Week Postpartum[J].Electron Physician,2017,9(2):3751-3755.DOI:10.19082/3751.
[23]Busch D W,Logan K,Wilkinson A.Clinical Practice Breastfeeding Recommendations for Primary Care:Applying a Tri-core Breastfeeding Conceptual Model[J].J Pediatr Health Care,2014,28(6):486-496.DOI:10.1016/j.pedhc.2014.02.007.
[24]汪新菊,舒新莲,王乐霞.规范化健康教育对剖宫产术后母乳喂养的影响研究[J].中国全科医学,2012,15(34):4009-4011.DOI:10.3969/j.issn.1007-9572.2012.34.026.
[25]Bunik M,Shobe P,O’Connor M E,et al.Are 2 Weeks of Daily Breastfeeding Support Insufficient to Overcome the Influences of Formula?[J].Acad Pediatr,2010,10(1):21-28.DOI:10.1016/j.acap.2009.09.014.
[26]Bonuck K,Stuebe A,Barnett J,et al.Effect of Primary Care Intervention on Breastfeeding Duration and Intensity[J].Am J Public Health,2014,104 Suppl 1:S119-S127.DOI:10.2105/AJPH.2013.301360.
[27]Wouk K,Lara-Cinisomo S,Stuebe A M,et al.Clinical Interventions to Promote Breastfeeding by Latinas:A Metaanalysis[J].Pediatrics,2016,137(1):e20152423.DOI:10.1542/peds.2015-2423.
[28]Bonuck K A,Trombley M,Freeman K,et al.Randomized,Controlled Trial of a Prenatal and Postnatal Lactation Consultant Intervention on Duration and Intensity of Breastfeeding Up to 12 Months[J].Pediatrics,2005,116(6):1413-1426.DOI:10.1542/peds.2005-0435.
[29]Chapman D J,Morel K,Bermudez-Millan A,et al.Breastfeeding Education and Support Trial for Overweight and Obese Women:A Randomized Trial[J].Pediatrics,2013,131(1):e162-e170.DOI:10.1542/peds.2012-0688.
[30]Grassley J S,Sauls D J.Evaluation of the Supportive Needs of Adolescents During Childbirth Intrapartum Nursing Intervention on Adolescents’Childbirth Satisfaction and Breastfeeding Rates[J].J Obstet Gynecol Neonatal Nurs,2012,41(1):33-44.DOI:10.1111/j.1552-6909.2011.01310.x.
[31]Flaherman V J,Lee H C.“Breastfeeding”by Feeding Expressed Mother’s Milk[J].Pediatr Clin North Am,2013,60(1):227-246.DOI:10.1016/j.pcl.2012.10.003.
[32]Chapman D J,Young S,Ferris A M,et al.Impact of Breast Pumping on Lactogenesis Stage II After Cesarean Delivery:A Randomized Clinical Trial[J].Pediatrics,2001,107(6):E94.DOI:10.1542/peds.107.6.e94.
[33]Meier P P,Engstrom J L,Janes J E,et al.Breast Pump Suction Patterns that Mimic the Human Infant During Breastfeeding:Greater Milk Output in Less Time Spent Pumping for Breast Pump-dependent Mothers with Premature Infants[J].J Perinatol,2012,32(2):103-110.DOI:10.1038/jp.2011.64.
[34]Froh E B,Hallowell S,Spatz D L.The Use of Technologies to Support Human Milk&Breastfeeding[J].J Pediatr Nurs,2015,30(3):521-523.DOI:10.1016/j.pedn.2015.01.023.
[35]韩琦,李成国,江春燕,等.耳穴贴压对产后泌乳量及血清泌乳素的影响[J].上海针灸杂志,2013,32(3):189-190.DOI:10.3969/j.issn.1005-0957.2013.03.189.
[36]Luo Q,Hu Y,Zhang H.Effects of Point Massage of Liver and Stomach Channel Combined with Pith and Trotter Soup On Postpartum Lactation Start Time[J].J Obstet Gynaecol,2017,37(7):1-5.DOI:10.1080/01443615.2017.1309366.
[37]张慧,胡引,周菲菲,等.以肝胃经为主穴按摩对产后泌乳Ⅱ期的影响[J].中华护理杂志,2015,50(9):1043-1046.DOI:10.3761/j.issn.0254-1769.2015.09.003.
[38]金亚蓓.针灸治疗产后缺乳症62例[J].中国针灸,2005,25(2):138.DOI:10.3321/j.issn:0255-2930.2005.02.031.
[39]贾润萍,吕蔚萍.催乳药膳促进剖宫产术后乳汁分泌的疗效观察[J].现代中西医结合杂志,2011,20(23):2935-2936.DOI:10.3969/j.issn.1008-8849.2011.23.051.
[40]Zuppa A A,Sindico P,Orchi C,et al.Safety and Efficacy of Galactogogues:Substances that Induce,Maintain and Increase Breast Milk Production[J].J Pharm Pharm Sci,2010,13(2):162-174.DOI:10.18433/J3DS3R.
[41]Gabay M P.Galactogogues:Medications that Induce Lactation[J].J Hum Lact,2002,18(3):274-279.DOI:10.1177/089033440201800311.
[42]Jones W,Breward S.Use of Domperidone to Enhance Lactation:What Is the Evidence?[J].Community Pract,2011,84(6):35-37.
[43]Grzeskowiak L E,Lim S W,Thomas A E,et al.Audit of Domperidone Use as a Galactogogue at an Australian Tertiary Teaching Hospital[J].J Hum Lact,2013,29(1):32-37.DOI:10.1177/0890334412459804.
[44]Osadchy A,Moretti M E,Koren G.Effect of Domperidone On Insufficient Lactation in Puerperal Women:A Systematic Review and Meta-analysis of Randomized Controlled Trials[J].Obstet Gynecol Int,2012,2012:642893.DOI:10.1155/2012/642893.
[45]陈最萍.产后康复治疗仪促进乳汁分泌的效果观察[J].中华现代护理杂志,2009,15(29):3057-3058.DOI:10.3760/cma.j.issn.1674-2907.2009.29.043.
[46]惠素琴,宗继伟.通乳颗粒配合Hbc-2000综合治疗仪治疗气血亏虚型产后乳汁不足的疗效[J].国际护理学杂志,2016,35(9):1290-1292.DOI:10.3760/cma.j.issn.1673-4351.2016.09.048.[本文编辑陈伶俐]
[2]Heymann J,Raub A,Earle A.Breastfeeding Policy:AGlobally Comparative Analysis[J].Bull World Health Organ,2013,91(6):398-406.DOI:10.2471/BLT.12.109363.
[3]刘晓琴,张晓宁.集束化干预在提高初产妇纯母乳喂养成功率中的应用[J].齐鲁护理杂志,2015(14):28-30.DOI:10.3969/j.issn.1006-7256.2015.14.013.
[4]徐雪芬,胡引.阶段性电话回访对初产妇产褥期纯母乳喂养的影响研究[J].中国实用护理杂志,2017,33(3):191-193.DOI:10.3760/cma.j.issn.1672-7088.2017.03.008.
[5]Haile Z T,Chavan B B,Teweldeberhan A,et al.Association Between Gestational Weight Gain and Delayed Onset of Lactation:The Moderating Effects of Race/Ethnicity[J].Breastfeed Med,2017,12:79-85.DOI:10.1089/bfm.2016.0134.
[6]Nommsen-Rivers L A,Chantry C J,Peerson J M,et al.Delayed Onset of Lactogenesis Among First-time Mothers is Related to Maternal Obesity and Factors Associated with Ineffective Breastfeeding[J].Am J Clin Nutr,2010,92(3):574-584.DOI:10.3945/ajcn.2010.29192.
[7]Chapman D J,Perez-Escamilla R.Maternal Perception of the Onset of Lactation Is a Valid,Public Health Indicator of Lactogenesis Stage II[J].J Nutr,2000,130(12):2972-2980.
[8]De Bortoli J,Amir L H.Is Onset of Lact ation Delayed in Women with Diabetes in Pregnancy?A Systematic Review[J].Diabet Med,2016,33(1):17-24.DOI:10.1111/dme.12846.
[9]Fein S B,Labiner-Wolfe J,Shealy K R,et al.Infant Feeding Practices Study II:Study Methods[J].Pediatrics,2008,122(Suppl 2):S28-S35.DOI:10.1542/peds.2008-1315c.
[10]Scott J A,Binns C W,Oddy W H.Predictors of Delayed Onset of Lactation[J].Matern Child Nutr,2007,3(3):186-193.DOI:10.1111/j.1740-8709.2007.00096.x.
[11]Hruschka D J,Sellen D W,Stein A D,et al.Delayed Onset of Lactation and Risk of Ending Full Breast-feeding Early in Rural Guatemala[J].J Nutr,2003,133(8):2592-2599.
[12]Matias S L,Nommsen-Rivers L A,Creed-Kanashiro H,et al.Risk Factors for Early Lactation Problems Among Peruvian Primiparous Mothers[J].Matern Child Nutr,2010,6(2):120-133.DOI:10.1111/j.1740-8709.2009.00195.x.
[13]朱鹏,陶芳标,蒋晓敏,等.孕期应激生活事件、体质量增加及分娩方式对初产妇泌乳启动延迟的影响[J].卫生研究,2010,39(4):478-482
[14]薛瑶纯,徐琼,刘莉,等.广州市女性分娩后的膳食摄入情况及泌乳启动延迟相关影响因素分析[J].华南预防医学,2015,41(3):218-223.DOI:10.13217/j.scjpm.2015.0218.
[15]苏秀颜,尤丽媚,苏颖仪.社区妇女产后泌乳情况调查及下乡随访指导护理[J].护理实践与研究,2016,13(24):130-132.DOI:10.3969/j.issn.1672-9676.2016.24.054.
[16]姜珊,段一凡,庞学红,等.2013年中国乳母下奶延迟流行状况及其影响因素[J].中华预防医学杂志,2016,50(12):1061-1066.DOI:10.3760/cma.j.issn.0253-9624.2016.12.008.
[17]司曼丽,顾平,张爱霞,等.妊娠期糖尿病产妇泌乳启动延迟的相关因素分析[J].护理学杂志,2017,32(8):19-21.DOI:10.3870/j.issn.1001-4152.2017.08.019.
[18]Brownell E,Howard C R,Lawrence R A,et al.Delayed Onset Lactogenesis II Predicts the Cessation of any or Exclusive Breastfeeding[J].J Pediatr,2012,161(4):608-614.DOI:10.1016/j.jpeds.2012.03.035.
[19]Mc Cann M F,Baydar N,Williams R L.Breastfeeding Attitudes and Reported Problems in a National Sample of WICParticipants[J].J Hum Lact,2007,23(4):314-324.DOI:10.1177/0890334407307882.
[20]Michel M P,Gremmo-Feger G,Oger E,et al.Pilot Study of Early Breastfeeding Difficulties of Term Newborns:Incidence and Risk Factors[J].Arch Pediatr,2007,14(5):454-460.
[21]Dewey K G,Nommsen-Rivers L A,Heinig M J,et al.Risk Factors for Suboptimal Infant Breastfeeding Behavior,Delayed Onset of Lactation,and Excess Neonatal Weight Loss[J].Pediatrics,2003,112(3 Pt 1):607-619.DOI:10.1542/peds.112.3.607.
[22]Pakseresht S,Pourshaban F,Khalesi Z B.Comparing Maternal Breastfeeding Self-efficacy During First Week and Sixth Week Postpartum[J].Electron Physician,2017,9(2):3751-3755.DOI:10.19082/3751.
[23]Busch D W,Logan K,Wilkinson A.Clinical Practice Breastfeeding Recommendations for Primary Care:Applying a Tri-core Breastfeeding Conceptual Model[J].J Pediatr Health Care,2014,28(6):486-496.DOI:10.1016/j.pedhc.2014.02.007.
[24]汪新菊,舒新莲,王乐霞.规范化健康教育对剖宫产术后母乳喂养的影响研究[J].中国全科医学,2012,15(34):4009-4011.DOI:10.3969/j.issn.1007-9572.2012.34.026.
[25]Bunik M,Shobe P,O’Connor M E,et al.Are 2 Weeks of Daily Breastfeeding Support Insufficient to Overcome the Influences of Formula?[J].Acad Pediatr,2010,10(1):21-28.DOI:10.1016/j.acap.2009.09.014.
[26]Bonuck K,Stuebe A,Barnett J,et al.Effect of Primary Care Intervention on Breastfeeding Duration and Intensity[J].Am J Public Health,2014,104 Suppl 1:S119-S127.DOI:10.2105/AJPH.2013.301360.
[27]Wouk K,Lara-Cinisomo S,Stuebe A M,et al.Clinical Interventions to Promote Breastfeeding by Latinas:A Metaanalysis[J].Pediatrics,2016,137(1):e20152423.DOI:10.1542/peds.2015-2423.
[28]Bonuck K A,Trombley M,Freeman K,et al.Randomized,Controlled Trial of a Prenatal and Postnatal Lactation Consultant Intervention on Duration and Intensity of Breastfeeding Up to 12 Months[J].Pediatrics,2005,116(6):1413-1426.DOI:10.1542/peds.2005-0435.
[29]Chapman D J,Morel K,Bermudez-Millan A,et al.Breastfeeding Education and Support Trial for Overweight and Obese Women:A Randomized Trial[J].Pediatrics,2013,131(1):e162-e170.DOI:10.1542/peds.2012-0688.
[30]Grassley J S,Sauls D J.Evaluation of the Supportive Needs of Adolescents During Childbirth Intrapartum Nursing Intervention on Adolescents’Childbirth Satisfaction and Breastfeeding Rates[J].J Obstet Gynecol Neonatal Nurs,2012,41(1):33-44.DOI:10.1111/j.1552-6909.2011.01310.x.
[31]Flaherman V J,Lee H C.“Breastfeeding”by Feeding Expressed Mother’s Milk[J].Pediatr Clin North Am,2013,60(1):227-246.DOI:10.1016/j.pcl.2012.10.003.
[32]Chapman D J,Young S,Ferris A M,et al.Impact of Breast Pumping on Lactogenesis Stage II After Cesarean Delivery:A Randomized Clinical Trial[J].Pediatrics,2001,107(6):E94.DOI:10.1542/peds.107.6.e94.
[33]Meier P P,Engstrom J L,Janes J E,et al.Breast Pump Suction Patterns that Mimic the Human Infant During Breastfeeding:Greater Milk Output in Less Time Spent Pumping for Breast Pump-dependent Mothers with Premature Infants[J].J Perinatol,2012,32(2):103-110.DOI:10.1038/jp.2011.64.
[34]Froh E B,Hallowell S,Spatz D L.The Use of Technologies to Support Human Milk&Breastfeeding[J].J Pediatr Nurs,2015,30(3):521-523.DOI:10.1016/j.pedn.2015.01.023.
[35]韩琦,李成国,江春燕,等.耳穴贴压对产后泌乳量及血清泌乳素的影响[J].上海针灸杂志,2013,32(3):189-190.DOI:10.3969/j.issn.1005-0957.2013.03.189.
[36]Luo Q,Hu Y,Zhang H.Effects of Point Massage of Liver and Stomach Channel Combined with Pith and Trotter Soup On Postpartum Lactation Start Time[J].J Obstet Gynaecol,2017,37(7):1-5.DOI:10.1080/01443615.2017.1309366.
[37]张慧,胡引,周菲菲,等.以肝胃经为主穴按摩对产后泌乳Ⅱ期的影响[J].中华护理杂志,2015,50(9):1043-1046.DOI:10.3761/j.issn.0254-1769.2015.09.003.
[38]金亚蓓.针灸治疗产后缺乳症62例[J].中国针灸,2005,25(2):138.DOI:10.3321/j.issn:0255-2930.2005.02.031.
[39]贾润萍,吕蔚萍.催乳药膳促进剖宫产术后乳汁分泌的疗效观察[J].现代中西医结合杂志,2011,20(23):2935-2936.DOI:10.3969/j.issn.1008-8849.2011.23.051.
[40]Zuppa A A,Sindico P,Orchi C,et al.Safety and Efficacy of Galactogogues:Substances that Induce,Maintain and Increase Breast Milk Production[J].J Pharm Pharm Sci,2010,13(2):162-174.DOI:10.18433/J3DS3R.
[41]Gabay M P.Galactogogues:Medications that Induce Lactation[J].J Hum Lact,2002,18(3):274-279.DOI:10.1177/089033440201800311.
[42]Jones W,Breward S.Use of Domperidone to Enhance Lactation:What Is the Evidence?[J].Community Pract,2011,84(6):35-37.
[43]Grzeskowiak L E,Lim S W,Thomas A E,et al.Audit of Domperidone Use as a Galactogogue at an Australian Tertiary Teaching Hospital[J].J Hum Lact,2013,29(1):32-37.DOI:10.1177/0890334412459804.
[44]Osadchy A,Moretti M E,Koren G.Effect of Domperidone On Insufficient Lactation in Puerperal Women:A Systematic Review and Meta-analysis of Randomized Controlled Trials[J].Obstet Gynecol Int,2012,2012:642893.DOI:10.1155/2012/642893.
[45]陈最萍.产后康复治疗仪促进乳汁分泌的效果观察[J].中华现代护理杂志,2009,15(29):3057-3058.DOI:10.3760/cma.j.issn.1674-2907.2009.29.043.
[46]惠素琴,宗继伟.通乳颗粒配合Hbc-2000综合治疗仪治疗气血亏虚型产后乳汁不足的疗效[J].国际护理学杂志,2016,35(9):1290-1292.DOI:10.3760/cma.j.issn.1673-4351.2016.09.048.[本文编辑陈伶俐]