母乳喂养 科普手册系列

许多职场妈妈不但认为母乳喂养可行，而且认为喂母乳比喂配方奶容易得多。母乳喂养对妈妈和宝宝都是一种乐趣。对那些需要定期与宝宝分离的妈妈来说，母乳喂养关系尤为珍贵。

这种情感上的亲近可以建立妈妈和宝宝之间的特殊情感，从而补偿了他们在时间上的分离。

无论选择哪种喂养方法，妈妈离开宝宝重返工作岗位都很难。

重返工作岗位时请记住以下几点：

◆与你的伴侣讨论，他将负责购物、烹饪、换尿布和其他工作。你们每个人都有什么期望？

◆和宝宝在一起的时候开始计划跟亲喂次数差不多的手挤奶或用吸奶器挤奶。尝试让宝宝适应奶瓶，可以与当地的国际母乳会哺乳辅导联系，了解一些合适的方法。

◆从周中开始上班可以让第一周恢复工作的时间变得短暂。如果可以的话，下周三请假。在一周半的时间里，你连续工作不超过两天!计划在工作时至少挤奶两次(也许三次)。

◆无论你是计划在午餐和休息时间给宝宝喂奶，还是工作期间需要在一个干净的私密的房间手挤奶或使用吸奶器，请与你的老板讨论你的需求和日程安排。这将使你有机会为彼此制定一个可行的计划。

◆两件套服装让工作时手挤奶或使用吸奶器都更容易。穿西装外套或开衫可以避免漏奶的尴尬。防溢乳垫可能会有帮助，特别是在回到工作岗位的头几周。

◆每天晚上尽可能多做一些准备工作，并与另一半讨论第二天的计划。

母乳喂养的妈妈往往更少需要请假来照顾生病的宝宝，因为她们的宝宝比较不容易生病。

END

撰稿 | 沐凡

审阅 | Victoria、晓璠、沐凡

编辑 | 斯琦

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母乳喂养保护宝宝免患婴儿猝死综合征

婴儿猝死综合征(SIDS)或称“摇篮死亡”，是指婴儿原因不明的意外死亡。婴儿猝死综合征可能发生在婴儿出生后第一年的任何时候。风险最高的时间是在第1-6个月期间。而婴儿窒息或憋闷是发生在婴儿无法呼吸的时候，这不同于死亡原因不明的婴儿猝死综合征。

婴儿猝死综合征最大的风险因素如下：

• 家庭成员吸烟

• 让婴儿脸朝下趴着睡觉(俯卧睡)

• 让婴儿独自待着，无人看护

• 配方奶喂养(参阅《甜蜜睡眠》第345页)    

不管你如何喂养宝宝，或者你和宝宝在哪里睡觉，让宝宝仰卧睡觉同时不使用襁褓就是最安全的睡眠方式。    

吸烟：

如果你要吸烟（包括电子烟），你能为宝宝做的最好的事情就是母乳喂养，了解这一点很重要！母乳喂养有助于减少吸烟对宝宝可能产生的一些负面影响。如果你吸烟的话，那么即使你从不在宝宝身边吸烟或者是一直在室外吸烟，也建议你不要和宝宝同床睡眠，可以把宝宝放在同一个房间的摇篮或婴儿床里睡觉，但不要紧挨着你的床。只要宝宝和你睡在同一个房间，你就能在晚上轻松地给宝宝喂奶。更多信息请参阅吸烟、“电子烟”、尼古丁和母乳喂养

经常醒来可以预防婴儿猝死综合征：

如果婴儿有睡眠呼吸暂停，那么频繁夜醒有助于他们保持警醒。

研究人员怀疑，死于婴儿猝死综合征的婴儿是由于他们难以从深睡眠中醒来而造成的。不幸的是，父母用来试着让宝宝睡得更久的许多技巧实际上却增加了患婴儿猝死综合征的风险。

因此，避免以下几点很重要：

1.睡觉前给宝宝喝一大瓶配方奶。

2.把宝宝独自放在一个温暖的房间，远离任何会吵醒他的声响。

3.用襁褓紧紧地包裹住宝宝。

4.让宝宝趴着睡觉。

保证宝宝有充足的睡眠，同时满足他夜间经常醒来的需求，就有助于：

• 保证你的产奶量。

• 预防婴儿猝死综合征。    

• 让宝宝整个晚上都能保持平静和放松。

睡在宝宝身边可以预防婴儿猝死综合征：

母乳妈妈把宝宝放在触手可及的范围内一同睡觉，即使两个人都睡着了，也能保持步调高度一致。你在调整姿势时的动作、呼吸和声音都会防止宝宝陷入深度睡眠的状态。有些宝宝会很难从深睡眠中醒来。

母乳妈妈与宝宝同床睡眠，即睡在同一张床上，通常会面对着宝宝睡觉。她们的一只胳膊放在宝宝脑袋上方，身体蜷着围住宝宝。(詹姆斯ž麦肯纳博士称之为Breastsleeping“乳房睡眠”)。喂完奶后，妈妈可以把宝宝从乳房上放回成仰卧姿势。这是预防婴儿猝死综合征最安全的睡眠姿势。

同床睡眠：

加拿大卫生部不建议和宝宝同床睡眠。然而，很多母乳妈妈会整晚或者夜里某段时间带着孩子同床睡。加拿大卫生部认识到了这一点，并提供了如何安全地同床睡眠的信息。英国国家医疗服务体系也推荐在安全的情况下同床睡眠。安全同床睡眠的父母要遵循下面的《安全睡眠七要诀》。

许多研究表明，同床睡眠提高了母乳喂养率并增加了夜间醒来的次数。母乳喂养和经常夜间醒来都可以预防婴儿猝死综合征。研究还表明，即便他们的宝宝醒得更多，同床睡眠的父母睡得更多。

安全床面检查清单：

◆避免下面这些可能引起窒息的风险因素：

• 沙发和躺椅

• 使婴儿无法自由抬头的松软或下垂的物件

• 床垫和床头板、侧栏杆、墙壁之间有空隙，可能会卡住婴儿

• 同床睡的人睡得很不老实或睡得特别沉

• 床上还有其他孩子

• 床上有宠物

◆把你床上的以下物品清理掉：

• 不用的枕头

• 毛绒玩具

• 厚毯子和厚被子

• 任何悬挂或缠绕在周围的东西(如线、绳子、围巾、丝带、松紧带)

◆检查你的床是否有潜在的危险：

• 床面到地板的距离

• 地面的性质（如地砖比木地板或地毯潜在危险更大）

• 尖锐、易戳到或夹住孩子的地方

《安全睡眠七要诀》和《安全床面检查清单》来自《甜蜜睡眠: 母乳喂养家庭的午间和夜间睡眠策略》。

SIDS Prevention and Breastfeeding

Breastfeeding protects babies from SIDS 

Sudden Infant Death Syndrome (SIDS) or “crib death” is the unexpected and unexplained death of a baby. SIDS can occur any time in the first year. The time of highest risk is between one to six months. Suffocation/smothering occurs when a baby cannot breathe. This is not the same as SIDS. SIDS deaths are unexplained.

Biggest risk factors for SIDS

• smoking

• laying a baby facedown for sleep (prone)

• leaving a baby unattended

• formula-feeding (Sweet Sleep, p.345)

Regardless of how you feed your baby or where you and baby sleep, putting your baby to sleep unswaddled on his back is the safest option.

Smoking cigarettes 

It’s important to know that if you are going to smoke cigarettes or use e-cigarettes (‘vape’), the best thing you can do for your baby is breastfeed. Breastfeeding helps to minimize some of the negative effects that smoking can have on your baby. If you use nicotine, even if you never smoke around your baby or always smoke outdoors, it is recommended that you not share a bed with your baby. Instead, put your baby to sleep in a bassinet or crib in the same room, but not right next to your bed. With your baby in the same room as you, you can easily get to your baby during the night for feedings. See Smoking, ‘Vaping’, Nicotine and Breastfeeding for more information.

Waking frequently protects against SIDS

Frequent waking during the night helps babies to rouse themselves if they have sleep apneas (stopping breathing).

Researchers suspect that babies who die of SIDS do so because they have trouble rousing out of deep sleep. Sadly, many of the techniques that parents use to try to get their babies to sleep longer actually increase the risk of SIDS. Thus, it’s important to avoid:

• giving your baby a big bottle of formula before bed.

• putting your baby in a warm room alone away from any arousing noises you might make in the night.

• tightly swaddling your baby.

• putting your baby on their tummy to sleep.

Getting enough sleep while supporting your baby’s need to wake frequently at night helps to:

• protect your milk supply.

• prevent SIDS.

• keep your baby calm and relaxed through the night.

Sleeping near your baby protects against SIDS 

Breastfeeding mothers who sleep with their babies within arm’s reach are deeply in tune with their babies even when both are asleep. Your movements, breathing and noises, while adjusting your position, keeps your baby from falling into a deep sleep state. Some babies have difficulty waking from a deep sleep.

Breastfeeding mothers who bedshare, or sleep in the same bed as their babies, usually sleep facing their babies. They have one arm above their baby’s head and their body curled around their baby. (Dr. James McKenna calls this “breastsleeping.”) After feeding, mothers can roll their babies away from the breast onto their backs. This is the safest sleep position for SIDS prevention.

Bedsharing 

Health Canada recommends not bedsharing with your baby. However, many breastfeeding mothers bring their babies in bed with them for all or part of the night. Health Canada recognizes this and provides information about how to bedshare safely. The National Health Service in the UK recommends bedsharing as long as it is done safely. Parents who bedshare safely follow the Safe Sleep Seven.

Many studies have shown that bedsharing increases breastfeeding rates and increases nighttime waking. Both breastfeeding and frequent night-waking are protective against SIDS. Studies also show that parents who bedshare get more sleep, even though their babies wake more frequently.

The Safe Surface Checklist: 

• Avoid these possible smothering risks:

• Sofas and recliners.

• Softness or sagging that keeps a baby from lifting his head freely.

• Spaces between a mattress and headboard, side rails, and a wall where a baby could get stuck.

• A bed partner who thrashes or sleeps exceptionally soundly.

• Other children in the bed.

• Pets in the bed.

Clear your bed of:

• unused pillows.

• stuffed toys.

• heavy covers and comforters.

• anything nearby that dangles or tangles (such as cords, strings, scarves, ribbons, elastics)

Check your bed for possible hazards:

• Distance to floor.

• Landing surface.

• Sharp, poking, or pinching places.
  The Safe Sleep Seven and The Safe Surface Checklist are from Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family.

资料来源：https://www.lllc.ca/sids-prevention-and-breastfeeding

参考文献References:

Resources for Parents 

Basis: Baby Sleep Info Source, UK.

LLLI: Bedsharing and Breastfeeding

Mother Baby Behavioral Sleep Laboratory 

Bartick, M., Young, M., Louis-Jacques A., McKenna, J.J. and Ball, H.L. (2022). Bedsharing may partially explain the reduced risk of sleep-related death in breastfed infants. Frontiers in Pediatrics. 10:1081028. doi:10:3389/fped.2022.1081028

Blair, P.S., et al. Bedsharing and Breastfeeding: The Academy of Breastfeeding Medicine Protocol #6, Revision 2019.

Health Canada. (February 10, 2023). Safe Sleep for Your Baby.

National Health Service, United Kingdom (NHS). Reduce the risk of sudden infant death syndrome (SIDS). (November 15, 2021).

Pitman, T., West, D., Wiessinger, D. (2014). Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family.

Vennemann MM, Bajanowski T, Brinkmann B, Jorch G, Yücesan K, Sauerland C, Mitchell EA; GeSID Study Group. (2009, March). Does breastfeeding reduce the risk of sudden infant death syndrome? Pediatrics;123(3):e406-10.Doi: 10.1542/peds.2008-2145. PMID: 19254976.

END

作者：加拿大母乳会

翻译：传艳

一审：Lynn

二审：Marien、笑仪、张艳莹

编辑：斯琦

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父母们应该知道，如果你在吸烟或者使用电子烟，你能为宝宝做的最好的事情就是母乳喂养。母乳喂养有助于减少吸烟对宝宝造成的负面影响。

对产奶量的影响

直接吸烟和接触二手烟似乎都会影响母乳喂养相关的激素——即催产素和泌乳素。这可能会导致泌乳量减少，也可能会降低母乳中的脂肪含量。怀孕期间吸烟会影响婴儿在出生后前几周的吸吮能力。如果你的宝宝吸吮不佳，也会影响到你的产奶量。这并不意味着你不应该给孩子母乳喂养了，只是说你可能需要额外用心来达到充足的奶量。要做到这一点，你可以频繁地哺乳，并确保宝宝的有效含乳。欲了解更多信息，请参阅建立奶量。

早产儿

与很多其它有害物质一样，尼古丁也会少量进入乳汁。由于早产儿更加脆弱，对尼古丁等有害物质的耐受能力较差，因此与医护人员讨论你可能在用的任何有害物质就很重要了，即使只是偶尔使用尼古丁。

安全睡眠

即使父母不在家里吸烟，与吸烟的父母同床共眠也会增加宝宝患婴儿猝死综合征(SIDS)的风险。如果吸烟者是母乳妈妈，这一点尤为重要。暴露在烟雾中，甚至是衣服上的烟味，似乎都会使婴儿的自然唤醒机制变得迟钝。如果你吸烟，把宝宝放在卧室里你旁边的一个单独的床面上睡觉很重要。这对于有人吸烟的家庭来说是最安全的安排。

电子香烟、尼古丁口香糖、皮肤贴片、含片和吸入器

如果是母乳妈妈使用这些产品的话，似乎母乳中的尼古丁含量似乎比直接吸烟的低，这些产品里面也不像香烟那样含有焦油和一氧化碳等肺部刺激性物质。用这些产品可能会增加50%-60%的戒烟几率。

如何尽量减少吸烟对宝宝的影响

• 改用电子烟、尼古丁口香糖或其它尼古丁替代品。

• 每天少吸一点烟。可能的话，完全戒掉烟。
  

• 先给宝宝喂奶，喂完后马上吸烟。然后可能的话，等两到三个小时再喂奶。吸完一支烟后，需要花95分钟才能清除掉你体内一半的尼古丁量。如果宝宝在这两到三个小时的窗口期内醒来要吃奶，那当然就喂他吧。    
  

• 在室外或到单独的房间吸烟。
  

• 在碰触宝宝之前先换掉衣服（让你的伴侣这样做也很重要）。
  

即使你吸烟，母乳喂养对宝宝仍然很重要。如果你吸烟，你的宝宝患肠绞痛、呼吸道感染和婴儿猝死综合征(SIDS)的风险会增加。但是母乳喂养的宝宝患这些疾病的风险要比配方奶喂养的宝宝更低。即使他们的妈妈继续吸烟，也是如此。此外，母乳中含有的蛋白质、脂肪和糖类可以保护宝宝免受多种疾病的侵害。

如果你是一位吸烟的妈妈，母乳喂养对你自己和孩子都有益处，就像不吸烟的妈妈一样。

如果你有母乳喂养的任何问题，国际母乳会的哺乳辅导可以为你提供资讯和支持。

2023年更新

Nicotine – Smoking, ‘Vaping’, and Breastfeeding

It’s important for parents to know that if you are going to smoke or use e-cigarettes (‘vape’), the best thing you can do for your baby is breastfeed. Breastfeeding can help to minimize some of the negative effects that smoking could have on your baby.

Effect on milk supply

Both smoking and exposure to secondhand smoke appear to have an impact on the hormones related to breastfeeding, oxytocin and prolactin. This may cause a reduction in milk supply and may also reduce the fat level in the milk. Smoking during pregnancy can affect a baby’s ability to suck well in the first few weeks of life. If your baby is not sucking well, this may also impact your milk supply. This does not mean that you should not breastfeed your baby. It just means that you might want to take extra care to have a plentiful milk supply. You can do this by feeding often and making sure that your baby has an effective latch. For more information see Establishing Your Milk Supply.

Premature Babies

Nicotine, like many other substances, does pass into your milk in some amount. Because premature babies are more fragile and less capable of handling drugs such as nicotine, it is important that you speak with your healthcare provider about any substances you may use, even if it is just an occasional use of nicotine.    

Safe Sleep

Sharing a bed with a smoking parent, even if that parent does not smoke in the house, increases a baby’s risk of Sudden Infant Death Syndrome (SIDS). See SIDS Prevention and Breastfeeding. This is particularly important if the nursing mother smokes. The exposure to smoke, even on clothing, seems to dull a baby’s natural arousal mechanisms. If you smoke, it is important that you place your baby to sleep on a separate sleeping surface near you in your bedroom. This is the safest arrangement for a family where someone smokes. See Sleep and the Breastfeeding Family.

E-cigarettes, nicotine gums, skin patches, lozenges and inhalers .

It appears that the amount of nicotine in a mother’s milk is lower with these products than when smoking cigarettes. There are no lung irritants, such as tars and carbon monoxide, that are present in cigarettes. Use of these products may increase the chances of quitting smoking by 50% – 60%.

How to minimize the impact of smoking on your baby

·Switch to e-cigarettes, nicotine gum or another nicotine replacement product.

·Smoke fewer cigarettes per day. If possible, quit smoking.

·Nurse your baby first and smoke immediately after. Then, if possible, wait two to three hours before nursing again. After smoking a cigarette, it takes 95 minutes for half of the nicotine in your system to be eliminated. If your baby wakes to feed in that 2 to 3-hour window, breastfeed, of course.

·Smoke outside or in a separate room.

·Change your clothes before handling your baby. (This is important for your partner to do too.)

Breastfeeding is important for your baby even if you smoke cigarettes. When you smoke, your baby is at increased risk of colic, respiratory infections, and SIDS (Sudden Infant Death Syndrome). But babies who are breastfed are at lower risk for these diseases compared to those given formula. This is true even if their mothers continue to smoke. In addition, your milk has proteins, fats and sugars that give your baby protection against many illnesses.

If you are a smoking mother or parent, breastfeeding is just as beneficial for you and your baby, as it is for a parent who doesn’t smoke.

If you have questions about any breastfeeding issues, La Leche League Leaders are here to provide information and support.

Updated 2023

资料来源：www.lllc.ca/nicotine-breastfeeding

参考文献References:

Mohrbacher, Nancy. (2020). Breastfeeding Answers: A Guide for Helping Families, Second Edition. Nancy Mohrbacher Solutions, Inc.

Public Health Agency of Canada. (2022, April 29). Ten Valuable Steps for Successful Breastfeeding. canada.ca

END

作者：加拿大母乳会

翻译：传艳

一审：Lynn

二审：Marien、王雪

编辑：斯琦

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本篇文章来源于微信公众号: 国际母乳会LLL