La Leche League International
很多妈妈觉得自己感冒生病就不能喂奶，因为妈妈的身体和精力由于需要抵抗疾病而有所消耗，但这只是暂时的，康复之后妈妈的奶量会根据孩子的需求而相应增长。
生病的时候更需要给孩子哺乳，特别是感冒并不影响母乳喂养。妈妈如果感冒时在家里咳嗽打喷嚏，其实家里就已经有这些细菌了，如果不给孩子活的抗体细胞，孩子就没有办法抵抗这些病，他的身体就更有可能会感染妈妈的病。
妈妈可以继续母乳喂养，不用害怕也不用戴口罩。如果妈妈需要吃药，芬必得、布洛芬是安全的，不用断奶。一些抗生素类的药物或者精神方面的药，如果妈妈有问题最好咨询医生，也可以查询《药物与母乳喂养》，或者咨询母乳会的哺乳辅导，我们可以帮助查找相关的信息。
（本文根据对 Ivy Makelin 的采访内容整理）
网友：宝宝四个月了，来例假了，会不会影响到母乳？
周宗蓓：大部分的妈妈没有感到有什么影响，有的妈妈发现例假的那几天乳房不是那么胀了，可是那几天过去也就好了，这时候很重要的还是继续相信你的身体，继续频繁地按照宝宝的需求来喂，你的奶会自己调整起来的，所以不要灰心。 奶量随时可以有变化，也可以随时提高的，不是说一天偏低就永远低了。
主持人：奶量的情况应该不是一种稳定的状况，而是有曲线变化的，有下降也有上升。
周宗蓓：而且不一定是妈妈可以自己控制的，更多的是靠妈妈的身体自己调节。就像你的口水或者你的眼泪，有没有人说过我的口水量太少或者我的眼泪量太少？没有。我们的身体自动就会调节这些液体，包括母乳也是一样的，根据孩子的需求妈妈的身体会调。如果我们用别的东西满足宝宝的需求，不管是奶粉还是钙水还是其它的东西还是加了辅食或者糖水，任何别的东西开始代替孩子吃母乳的需求就会影响妈妈的乳量，妈妈的乳房意识到了孩子这段时间没有吃我的奶，所以下一次就少生产一些。
Sometimes a mother decides to resume breastfeeding, whether due to an emergency when there is a shortage of other food, after a separation, etc. Often a mother can rebuild a milk supply very successfully, with patience and determination (and a cooperative baby). La Leche League‘‘s BREASTFEEDING ANSWER BOOK (p. 52) recommends the following strategies for relactation and induced lactation, to stimulate milk production:
有时候妈妈们会因某一意外情形比如缺乏其他食物或与宝宝分离后重聚，想恢复母乳喂养。只要有足够的耐心和决心，再加上宝宝的配合，妈妈们通常都能成功的恢复产奶。国际母乳会的母乳喂养问答手册第52页推荐了以下几种刺激泌乳的方法（适用于重新泌乳和诱导泌乳）：
Putting baby to breast to suck at each feeding and for comfort between feedings as often as possible. 每次哺乳时让宝宝吸吮两边乳房，哺乳间隙尽可能频繁的让宝宝进行安抚吸吮。
Using a nursing supplementer (if available and if conditions are sanitary enough to make its use safe) to provide expressed milk at the breast while baby sucks at the breast.在宝宝吸吮乳房时,用哺乳辅助器（如果有并且卫生条件有保障时）提供给孩子事先挤出的乳汁。
Taking herbs/medication that increase milk supply. 用草药或其他药物增奶。请遵医嘱。
If you do use herbs or medications to increase your supply, be sure to put the baby to the breast frequently, to remove as much milk as possible. This will help avoid breast infections or plugged ducts.
如果服用草药或药物增奶，要确保让宝宝频繁吸吮乳房，尽可能多地排空乳房。这有助于预防乳房发炎或乳腺堵塞。
你在考虑是否应该服用医生给你开的药。如果你已经掌握了哺乳和药物的相关信息，你会很容易地作出决定。母乳喂养对你和你的宝宝来说都是重要的。审慎地研究要服用的药，甚至非处方药。（草药疗法也应该要研究）国际母乳会的《母乳喂养的女性艺术》一书第312页写道：“在为一个哺乳妈妈开药方时，有些医生出于安全，例行公事——坚决要求（患者）断奶。实际上，很少药物被证明对哺乳婴儿是有害的。”突然断奶对母乳妈妈和婴儿都会造成伤害并且导致额外的健康问题和双方的情感危机。你的医疗保健提供者需要知道你正在哺乳并且你想继续哺乳。
You are wondering if you should take the medication that your doctor has prescribed. It‘‘s easier to make that decision when you have information on breastfeeding and medications. Breastfeeding is important to you and your baby. It is prudent to investigate taking any medications, even ones available without a prescription. (Herbal remedies should also be researched.) LLLI WOMANLY ART OF BREASTFEEDING, says on page 312, “When prescribing a medication for a nursing mother, some physicians routinely insist on weaning as a precaution. In reality, few drugs have been proven to be harmful to the nursing infant.” Sudden weaning is traumatic for mother and baby and can lead to additional health and emotional risks for both. Your health care provider needs to know that you are breastfeeding and that you want to continue doing so.
当为哺乳妈妈开药方时要考虑到很多因素。比如，宝宝的年龄需要考虑。一个较大的母乳宝宝，他吃母乳已经不那么频繁了，所吃的母奶量也会小一些，因此通过妈妈的奶吃到的含在母乳里的药也会相应的少一些。以下有一些问题可供你在和你的医疗保健提供者进行会话时使用。（这些问题来源于LEAVEN文章“药物和母乳喂养”）
There are many variables to consider when a breastfeeding mother is prescribed a medication. For example, the baby‘‘s age needs to be taken into consideration. An older baby who is breastfeeding less frequently would consume smaller amounts of breastmilk and thus have less exposure to medication through mother‘‘s milk. Here are some questions to begin a dialogue with your health care provider. (They are from the LEAVEN article “Medications and Breastfeeding”.)
– Has the drug been given to infants? A drug commonly prescribed for infants is usually a good choice for a breastfeeding mother.
– Has the drug been given to other breastfeeding mothers? A drug that has a history of use by breastfeeding mothers is a better choice than a new, possibly untested drug.
– What is the duration of the drug therapy? The duration of the drug therapy can affect its compatibility with breastfeeding. A drug considered compatible with breastfeeding when taken for a few days might not be compatible when taken over a long period of time.
– Is the drug short-acting? A short-acting form of the drug may be a better choice for a breastfeeding mother than a longer-acting form that stays in the mother‘‘s system for a longer period.
– How is the medication being given? A drug given by injection or by mouth is less concentrated than one given intravenously. However, a drug may be given intravenously because it is inactivated or not absorbed by the digestive system, so the baby‘‘s digestive system would also inactivate or not absorb the drug.
– How well can the baby excrete the drug? Some drugs accumulate in a baby‘‘s system and can potentially build to toxic levels. A drug that is quickly eliminated by the baby is more compatible with breastfeeding.
– Does the drug interfere with lactation? Some drugs should be avoided by breastfeeding mothers because they affect breastfeeding itself (the let-down or milk supply).
参考资料：
药物与母乳，Thomas Hale, Ph.D著，每年都校订和更新，这种常见的参考资料是完整的，易于阅读，易于携带。包含药物报告、疫苗、病毒和草药的配制。这些报告包括美国儿科学会推荐的药品，此外，还包含有成人的和儿科的相关药品的副作用的说明。
Resources for Additional Information
Medications and Mothers‘‘ Milk, by Thomas Hale, Ph.D. Revised and updated every year, this popular reference is complete, easy to read, easily portable, and affordable. Contains reviews of medications, vaccines, viruses, and herbal preparations. The reviews include AAP recommendations as well as adult and pediatric concerns and side effects.
下图是美国卫生部公开建立的针对医护人员的药物与母乳喂养的英文数据库的链接。妈妈们可以将药物的英文名输入搜索，搜索结果包含孕产妇和婴幼儿的用药量，药物对母乳喂养的婴儿及对妈妈泌乳的影响，以及可替代的更安全的药物。建议妈妈们可以将相关信息提供给医生进行参考。
Can breastfeeding mothers get mammograms?
Yes, breastfeeding mothers can have mammograms.
母乳妈妈可以做乳房X射线检查吗？
是的，正在母乳喂养的妈妈可以做乳房X射线检查。
Mothers asking this question may have two concerns:
提出这个问题的妈妈们通常有以下两方面的疑虑：
1. Will the radiation affect my milk and harm my baby?
2. Is it possible to read the mammogram of a lactating breast?
1.X射线会影响母乳质量进而影响宝宝健康吗？
2.对正在授乳的乳房做X射线检查结果能准确吗？
X-rays do not affect mother‘‘s milk, so you can safely resume breastfeeding immediately after the mammogram. In fact, according to the LLLI WOMANLY ART OF BREASTFEEDING, page 134, “Mammograms, x-rays and ultrasound tests will not interfere with breastfeeding.”
X射线对妈妈的奶水没有影响，所以在做完乳房X射线之后可以立即喂养宝宝。实际上，在国际母乳会出版的《母乳喂养的女性艺术》第134页上有说明: 乳房X射线检查、X射线检查、超声波检查都不会影响母乳喂养。
The second question has a longer answer. It is possible to read a mammogram of a lactating breast. Breasts that produce milk are called lactating breasts. Due to milk production, there is more dense tissue present in the lactating breast than in a non-lactating one. This normal density may make it harder to read the results. The amount of tissue in your breast depends on the frequency that your baby is breastfeeding. If breastfeeding occurs infrequently, there will be less milk and tissue so the mammogram would be easier to read. To help reduce the amount of milk prior to a mammogram, you could bring your baby and breastfeed immediately prior to the procedure. Finding a radiologist experienced in reading mammograms of lactating breasts would produce more reliable results.
第二个问题需要详细解释。对正在授乳的乳房做X射线检查是有可能的。正在产奶的乳房称为授乳乳房。从泌乳的原理来看，授乳乳房比不授乳的乳房有更密集的腺体组织。这种密集的腺体组织会影响检查结果。腺体组织的数量取决于你授乳的频率。如果频率不高，存奶和腺体组织就会相对少一些，检查时就能看得更清楚。为了在检查之前减少乳房里的存奶，你可以带上宝宝，喂奶之后马上做检查。如果能找到一个对授乳乳房做检查比较有经验的放射科专家，那么他提供的结果可能会更准确。
I may have hypothyroidism; can I still breastfeed my baby?
Hypothyroidism is the name given to the condition of having an underactive thyroid. Because the thyroid controls the body‘‘s metabolic process, it is a serious condition. Any mother with thyroid disease should be under the care of a doctor who is supportive of her desire to breastfeed.
我可能有甲状腺功能减退，我还能母乳喂养我的孩子吗?
甲状腺功能减退指的是甲状腺的衰弱。甲状腺控制着身体的代谢这一重要过程。患有甲状腺功能减退的妈妈应在支持她母乳喂养意愿的医生指导下进行母乳喂养。
Thyroid supplements – used to treat this condition – are not contraindicated while breastfeeding. They simply bring the mother’s thyroid up to normal levels, making the mother feel better and increasing her milk supply.
甲状腺补充剂，用于治疗这种情况，在哺乳时也可以服用。药物帮助妈妈的甲状腺功能达到正常水平，使其感觉变好并且增加乳汁供应。
Symptoms of hypothyroidism may include fatigue, poor appetite, depression, intolerance to cold, thinning hair and dry skin. These symptoms, which are similar to those of anemia, may be wrongly attributed to normal postpartum fatigue, postpartum depression or even breastfeeding.
甲状腺功能减退的症状包括：疲劳、食欲不振、精神萎靡、怕冷、头发稀少以及皮肤干燥。
这些症状，和贫血的症状相似，往往与产后虚弱、产后抑郁症甚至哺乳带来的影响混淆。
Diagnosis of an underactive thyroid can usually be based on the mother‘‘s symptoms as well as a simple blood test. On occasion, radioactive testing is used to diagnose thyroid problems. If radioactive testing is recommended, the mother can ask her physician if the test could be postponed or another, non-radioactive test, be substituted.
甲状腺功能减退的诊断，主要根据妈妈的症状以及验血结果。有时，放射检查也用来检查甲状腺问题。如果被建议放射检查，妈妈可以要求医生延期或者做非放射性检查替代。
If the radioactive test is used, temporary weaning is recommended. “The length of time the mother needs to suspend breastfeeding will depend on the type and dosage of radioactive materials used for the test” (BAB). Radioactivity of breastmilk declines over time, and frequent milk expression will help the mother eliminate the radioactivity from her body more quickly. This milk must be discarded and not fed to the baby. (Frequent milk expression will not hasten the elimination of other drugs from breastmilk.) For pumping information see LLLI‘‘s FAQs about pumping.
如果做了放射检查，需要短期断奶。断奶的时间长短，取决于放射物质的种类以及剂量。母乳的放射性会随时间减弱，频繁挤奶会帮助妈妈将体内的放射性物质加速排出。但是这些乳汁必须丢弃，不能喂养宝宝（频繁挤奶不会加速母乳中其他药物的代谢）。有关挤奶的信息请参照国际母乳会网站的常见问题解答。
Contact a La Leche League Leader for the most up-do-date information about the time period needed to sufficiently clear radioactivity from breastmilk.
请联系国际母乳会的哺乳辅导以获得有关母乳中放射物质完全清除所需时间的最新信息。
Thomas W. Hale, Ph.D.
from Breastfeeding Abstracts, November 2004, Vol. 24, No. 1, pp. 3 & 4.
Virtually all breastfeeding mothers will at some time require the use of a medication. In the early postpartum period, the use of medications may become a contentious issue, with physicians sometimes hesitant to allow mothers to breastfeed while using needed medications, and mothers resistant to discontinuing breastfeeding. Fortunately the average transfer of most medications into human milk is exceedingly low, and therefore mothers are sometimes justified in resisting suggestions to discontinue unless the reasoning of the physician is sound and based on good science.1 But how do health professionals evaluate the situation and make sound judgments concerning safety of the medication in each particular mother/infant? The data below should provide some useful guidelines.
几乎所有哺乳期的妈妈都会在某些情况下有用药的需求。在产后的早期阶段，药物的使用可能成为一个争议的问题。当哺乳期妈妈必须用药而不想停止哺乳时，医生也会犹豫是否同意妈妈继续哺乳。幸运的是，大多数药物通过代谢转化进入母乳的含量都非常的少，因此，在适当的时候，母亲是有理由拒绝中止哺乳的建议，除非医生的建议是合理的，是有可靠的科学依据的。1但是，对于每一个特定的母亲或婴儿，其用药安全，医务人员究竟怎样来评估，并做出合理判断的呢？下面的数据应该可以提供一些有用的指导。
Milk Production and Drugs
母乳产出和药物
The clinical dose of medication transferred to the infant is largely a function of how much milk the infant ingests and the amount of medication present in the milk. Most mothers with young infants produce approximately 150 cc of milk per kilogram of infant weight per day. This amounts to about 700cc daily. The actual amount varies enormously by mother, and even from one week to the next. As the infant ages and with the institution of solid feedings, the actual rate of milk production normally declines to less than a few hundred cc per day at one year or later. Thus milk transfer is a highly variable function.
进入婴儿体内的临床药量取决于婴儿消化母乳的多少和进入母乳中的药量。大部分婴儿的母乳妈妈，按宝宝每公斤体重大约每天产奶150 CC。也就是每天700 CC左右。每个妈妈实际的产奶量差异很大，甚至同一个妈妈每周的产奶量都不尽相同。随着宝宝年龄的增长以及固体辅食的摄入，乳汁的实际产量会越来越少，通常在一年或一年后会下降到每天几百毫升的水平。因此，乳汁中的药物量是一个充满变量的函数。
However, because the clinical dose of medication transferred to the infant is largely a function of how much milk the infant ingests, after 6 months and in those infants who start on solids, the older the infant, the relatively less medication they receive. In a 14-month-old breastfeeding baby, the volume of milk provided is often so low that the dose of maternal medication transferred to the infant is minimal to nil. So stage of lactation is an important factor in determining the risk of using various drugs in breastfeeding women. After about 6 months, the later the stage of lactation, the lower the dose of medication transferred to the infant. Also, the older infant the better it can metabolize and eliminate various drugs.
然而，因为转入婴儿的临床药量主要取决于婴儿消化的奶量，所以，6个月后和开始添加辅食的婴儿，吸收的药量就相对少一些。一个14个月大的母乳宝宝，通常所需的母乳量已经很低了,所以用药后的母乳转入婴儿体内的药量接近为零。所以，哺乳的阶段是一个重要因素,它决定了哺乳母亲使用各种药物的风险。大约6个月后，越靠后的泌乳阶段，转入婴儿体内的药量就越低。而且，孩子越大，代谢和排除各种药物的能力就越强。
In the first 72 hours of milk production (colostral phase), there are numerous gaps between the lactocytes in the breast, and drugs and proteins may transfer into human milk relatively easily. However, the absolute amount of colostrum is generally so low (30-60 cc/day) that the relative dose of medication the infant receives is actually quite low during this period. It is only after milk production is high (600 cc/day) that one must begin to worry about the dose of medication transferred.
在乳汁产生的头72小时（初乳期），乳腺细胞之间有很多空隙，药物和蛋白转入母乳中相对要容易一些。然而，初乳的绝对吸收量一般很少（30-60 CC／每天），因此在这个阶段，对于药物，婴儿的相对吸收量实际很低。只有当母乳的产量很高（600 CC／每天）时，我们才开始需要担心药物的转入量。
Relative Risk Factors to Infants
婴儿相关的危险因素
The risk to infants is solely determined by the amount of the drug transferred via the milk. While this is often difficult to determine with accuracy, we know that most infants ingest around 150 cc of milk per kilogram per day. With this estimate and the concentration of medication in human milk we can estimate rather closely the clinical dose transferred each day. While perhaps fewer than half of all medications have been studied in breastfeeding mothers, published studies are available for many popular drugs in breastfeeding mothers.2, 3 Unfortunately, none of this data is published in prescribing information or the PDR so a mother may have to search for this information. On average, less than 1-4% of the maternal dose transfers to the infant. Very few drugs exceed this level, and those few include the CNS-active drugs, the antidepressants, and a few other very lipid-soluble drugs. In general, we do not become overly concerned about a medication until its transfer to the infant approaches 10% or more of the maternal dose.4 Termed relative infant dose (RID), this figure is measured by dividing the infant’s dose via milk (mg/kg/day) by the mother’s dose (mg/kg/day). There are fortunately very few drugs that exceed this safety level of 10%. Metronidazole (Flagyl, which is really quite safe), atenolol, potassium iodide, lithium and a few others may exceed this 10% level. In general, if the RID of a medication is less than 10%, it is probably pretty safe to use.
药物对婴儿的危险性只决定于转入母乳的药量。然而，转入量的精确值一般很难确定，我们知道大多数婴儿每天每公斤体重消化150 CC的母乳。鉴于此估计值和母乳中的药物浓度，我们可以相当精确地估计每天的临床转入药量。因为可能仅有少于一半的药物在哺乳母亲身上被实验过，因此很多常用药物的研究公告也可用于哺乳妈妈。2,3遗憾的是，数据并没有在处方信息上或PDR上公布，因此妈妈可能要寻找这类信息。平均来说，少于1-4% 的母体药量会转给新生儿。只有极少种药物能超过这个水平，包括神经中枢药物、抗抑郁药和一些其他的脂溶性药。一般说来，我们不过分关注一种药，除非它的转入量接近或超过10% 的母体摄入量。4 有一个术语叫相对婴儿剂量（RID），这个数据的算法是每天每公斤婴儿的摄入量（毫克）除以每天每公斤母体的摄入量（毫克）。幸运的是,很少的药物超过10% 这个安全值。甲硝唑（灭滴灵，其实是相当安全的），阿替洛尔，碘化钾，锂和一些其他药物可能超过10%。一般来说，如果RID少于10%，就是相当安全的药物了。
Know your medication
了解你的用药
It is important that the advisor understand just how toxic a medication is to the mother and infant, as this can directly affect the risk of breastfeeding. It should be obvious that mothers requiring hazardous medications such as anticancer drugs, methotrexate, certain antimanic drugs such as lithium, and others, should at least temporarily discontinue breastfeeding. Obviously, the more toxic a medication, the greater the degree of risk to the infant. Therefore, avoid taking a highly toxic medication while breastfeeding if at all possible, and avoid breastfeeding if a medication must be taken that is considered extremely toxic.
指导用药的人员，了解药物对母亲和婴儿有怎样的毒性是很重要的。，因为这会直接影响母乳喂养的风险。如果母亲在用危险的药物，例如抗癌药，氨甲喋呤，某些抗燥狂的药，例如锂或其他，则很明显地，母亲应该暂停母乳喂养。显而易见，毒性越大的药物，对于婴儿的危险度就越大。所以，母乳喂养过程中，应该尽一切可能避免使用高毒性的药物。如果必须使用毒性特别大的药物，就要避免哺乳。
Drugs that have the potential to suppress the production of milk are also relatively contraindicated. Medications such as bromocriptine and cabergoline are potent inhibitors of milk production. Perhaps less active, but still important lactation suppressants include estrogens in birth control products5 and possibly pseudoephedrine in cold remedies.6 These should be avoided if possible.
一些被认为可能抑制泌乳的药物也是相对禁止的。比如溴麦角环肽和卡麦角林是母乳的强效阻滞剂，也许只是减少活性，但是依然是重要的泌乳抑制剂，包括用于避孕的雌激素产物5和治疗感冒的伪麻黄碱也可能存在风险。6应尽可能避免这些药物。
Summary总结
Fortunately, the transfer of most medications into human milk is quite low. We have thousands of studies presently available which suggest that most medications can be safely used in breastfeeding mothers. Some caution is obviously needed with certain medications such as lithium, anticancer agents, and radioactive products, but the vast majority of medications transfer into milk in subclinical levels and pose little problem to a healthy breastfed infant.
幸运的是，大部分药物转入母乳中的剂量都非常低。我们有数以千计的研究结果表明，大多数药物可以安全使用于哺乳期的母亲。但一些特定药物很明显地是必须谨慎使用的，比如锂，抗癌因子和放射产物。但是绝大多数药物转入母乳是在亚临床水平，对健康的母乳宝宝不会有影响。
A mother and her physician must always weigh the risk to the infant of the medication in milk against the enormous benefits offered by breastfeeding. Mothers should resist discontinuing breastfeeding until they have consulted with a physician who is versed in the safety of medications in breastfeeding mothers. Almost without exception, drug information inserts warn against the use of the medication in breastfeeding mothers. Pharmaceutical firms do not want the liability, so they universally warn patients to not breastfeed. But these recommendations are often not supported by research. By working together, the mother and her physician can almost always find a safe and suitable drug to treat her condition while maintaining this most important breastfeeding relationship.
在母乳喂养所提供的巨大好处下，母亲和她的医生总是需要权衡母乳中药量对婴儿可能造成的风险。母亲应该坚持哺乳，直到他们咨询了精通母乳喂养用药安全的医生。几乎无一例外，药物的说明总是在警告哺乳母亲的用药，因为制药公司不想承担责任，普遍警示病人不要母乳喂养。但是这些建议往往没有研究所证实。通过共同努力，母亲和医生总能发现一些安全的，合适的药物来治疗母亲的病症，并维持最重要的母乳喂养。
(Anna Bai翻译，何佳、郝娜 校稿，Shiuh-jane、Daisy审稿）
References
1.Hale, T. W. and K. F. Ilett. Drug therapy and breastfeeding. From theory to clinical practice. London: Parthenon Press, 2002
2.Hale, T. W. Medications and mothers‘‘ milk. 11 th ed. Amarillo. TX: Pharmasoft, 2004.
3.Briggs, G. G., R. K. Freeman and S. J. Yaffe. Drugs in pregnancy and lactation: A reference guide to fetal and neonatal risk. 4 th ed. Philadelphia, PA: Lippincott, Williams and Wilkins, 1994.
4.Bennett, P. N. Use of the monographs on drugs. In: Drugs and Human Lactation. Amsterdam: Elsevier, 1996.
5.Lonnerdal, B., E. Forsum,and L. Hambraeus. Effect of oral contraceptives on composition and volume of breast milk. Am J Clin Nutr. 1980; 33:816-24.
6.Aljazaf, K., T. W. Hale, K. F. Ilett et al. Pseudoephedrine: Effects on milk production in women and estimation of infant exposure via breastmilk. Br J Clin Pharmacol. 2003; 56:18-24.
下图是美国卫生部公开建立的针对医护人员的药物与母乳喂养的英文数据库的链接。妈妈们可以将药物的英文名输入搜索，搜索结果包含孕产妇和婴幼儿的用药量，药物对母乳喂养的婴儿及对妈妈泌乳的影响，以及可替代的更安全的药物。建议妈妈们可以将相关信息提供给医生进行参考。
http://toxnet.nlm.nih.gov/
Nancy Williams
Santa Maria CA USA
From: NEW BEGINNINGS, Vol. 21 No. 3, May-June 2004, pp. 84-88
Season Yang译，Shiuh-jane、Daisy审稿
The birth of a baby is generally regarded as a time of great happiness. Mothers and fathers see the child they hold in their arms as the long-awaited fulfillment of their dreams.
婴儿的诞生通常被视为一段非常幸福的时光。看着臂弯里的孩子，父母们感觉到他们长久以来期待的梦想已经实现。
However, new parenthood may bring emotions that are the opposite of bliss and contentment. Some experts estimate that 50 to 80 percent of women are affected by some degree of depression following childbirth (Komaroff 1999). They may feel sad, tired, and anxious. Some of this may be due to hormonal changes following childbirth. The realities of caring for a helpless infant, which include lack of sleep and a loss of control over one‘‘s own life, also play a role. For most women, these “baby blues” last only a short time, and they emerge from their postpartum haze fully able to cope with the demands of mothering.
但是，初为人父母者所体验到的情绪可能与狂喜和满足相反。一些专家估计约百分之五十到八十的女人产后会被不同程度的沮丧情绪影响。(Komaroff 1999)她们可能会感到悲伤、疲劳，或者焦虑。有些情绪可能是由于产后荷尔蒙的改变引起的。照顾一个不能自理的婴儿，妈妈会缺少睡眠，失去对自我生活的掌控感，这些也会引起抑郁情绪。对大多数女人来说，这些“产后沮丧”只会持续一段短时间，一般出现于产后的慌乱期，而且完全可以融入于母职的工作中。
Some women, however, find themselves enveloped in an inexplicable and unrelenting sadness. They may be experiencing postpartum depression. Symptoms include feelings of helplessness, mood swings, anxiety, inability to sleep, and a lack of interest in life (see Box #1). These feelings do not go away. They persist for weeks, and the mother seems unable to help herself get better.
但是，有些女人发现她们笼罩在一种无法言说的无尽的悲伤中。她们可能患上了产后抑郁症。产后抑郁症的症状包括无助感、情绪不稳定、焦虑、失眠、对生活没有兴趣（见下文）。这些感觉持续不走，停留数星期，妈妈似乎无法自我改善。
Postpartum depression is but one of several mood disorders that may manifest itself following the birth of a baby. “Mood disorder” is a term psychiatrists and psychologists use to describe problems with feelings of depression, anxiety, and fear. It can also describe inappropriate “high” feelings defined as “mania.” As science has learned more about the brain and how it functions, mental health professionals and the general public have come to recognize that depression and other psychological disorders are not, as was once thought, the result of character weakness or a lack of will power. Depression and other mood disorders are caused by physical factors in the brain interacting with a person‘‘s life experiences.
产后抑郁症是一种但不是唯一一种在生产后显现的情绪障碍。情绪障碍是一个精神病学家和心理学家用来描述沮丧、焦虑和恐惧等感觉的术语。它也可以用来描述不适当的“情绪高涨”的感觉——称之为“躁狂”。由于科学研究已经更多地了解了大脑及其运作，心理健康专家和广大民众已经认识到抑郁和其它心理障碍，不是像以前人们所认为的那样是有性格缺陷或缺乏意志力所引起的。抑郁和其它情绪障碍是大脑中生理因素与人的生活经验交互影响造成的。
Depression is a fairly common illness. One in five adults will experience a major depression in his or her lifetime. The physical and emotional stresses of pregnancy, childbirth, and new motherhood can trigger depression and other mental health problems in vulnerable individuals. Postpartum depression occurs in about 10 percent of new mothers in the first year after giving birth (ACOG 1999). Other mood disorders, such as bipolar disorder (in which periods of deep depression alternate with manic periods of hyperactivity and elation), often make their first appearance during young adulthood. Thus, depression and other mood disorders affect a significant number of women during the time they are caring for and breastfeeding their babies.
抑郁是一种很常见的疾病。五分之一的成年人在他/她的一生中都会经历一次重大的抑郁。对易感的人来说，怀孕、生产和成为新手妈妈带来的生理和情感上的压力都可能引起抑郁和其它心理健康问题。在生产后的第一年，10%的新手妈妈会出现产后抑郁（ACOG 1999）。其它情绪障碍，如躁郁症（在此期间深度抑郁和极度活跃、快乐两种情绪交替出现），通常在成年早期首次出现。因此，沮丧和其它情绪障碍会影响许多妇女，在他们照顾和哺乳他们的孩子时。
Effects of mood disorders range from mild disruptions in life to severe disability and incapacitation. While the mother may often be acutely aware of something being wrong, family members are sometimes the first to notice. Some women feel persistently sad, anxious, and unhappy with motherhood. At the other end of the spectrum, women with severe symptoms may have hallucinations or delusions and a distorted view of reality.
情绪障碍的影响范围从对生活轻微的破坏到个体严重丧失能力。当妈妈可能经常敏感地察觉到什么事情不对时，家庭成员有时候是最先发现的。有些女人持续地悲伤、焦虑，对母亲的身份感到不开心。之后，症状严重的女人会有幻觉或妄想以及对现实的扭曲感。
Research has shown that a mother who is struggling with depression will have trouble being a good mother to her baby. The baby‘‘s development depends on having a responsive caregiver. Babies‘‘ brains develop their many networks of nerves and information in response to the myriad daily interactions between the mother and baby. Babies learn social behavior, language, and a great deal more from eye-to-eye contact with mother, from her animated facial expressions, vocal responses, and the like. A mother who has no energy to get out of bed or to engage her baby in “conversation” is unable to meet these needs. At the same time, the depressed mother is robbed herself of the day-to-day happiness of mothering her baby and other children.
研究显示，与抑郁情绪做斗争的妈妈无法胜任好妈妈的角色。婴儿的发育依赖于一个能与之积极互动的照料者。通过母亲与婴儿之间的大量日常互动，婴儿的大脑神经和信息网络得以发展。婴儿通过与妈妈的眼神交会、妈妈生动的面部表情、口头的回应等等来学习社会行为、语言表达等一切技能。一个没有精力起床或没有精力与她的宝宝进行“交谈”的妈妈是不能满足这些需求的。同时，一个抑郁的妈妈已经失去了自己照顾婴儿与其他孩子所带来的日复一日的生活中的幸福感。
This is why it is important to treat postpartum depression and other mood disorders promptly. The welfare of both the mother and the baby are at stake.
这就是为什么及时治疗产后抑郁和其它情绪障碍很重要的原因。妈妈和宝宝的福祉都处于危险之中。
Treatment of postpartum depression and other mood disorders will vary according to the needs of the individual. In many cases “talk” therapy is very effective. A psychotherapist can help a mother replace false messages she gives herself (“I am the worst mother in the world”) with a more realistic appraisal of herself and her situation. This type of therapy is called cognitive behavioral therapy; its goal is to help people recognize their false beliefs about the world and themselves and learn to think in new ways. Professional counseling can also help an individual build better support systems for herself and find ways to get her own needs met.
根据个体的需要，治疗产后抑郁和其它情绪障碍的方法也多种多样。在许多情况下“谈话”治疗很有效。一个心理治疗师能帮助一个母亲用对她自己及她的处境更实际的评价替换掉她给予自己的错误信息（如“我是世界上最差劲的妈妈”）。这种疗法称为认知行为疗法。它的目标是帮助人们了解关于自己对世界和自身的错误信念，进而学习以新的方式思考。专业咨询也可以帮助个体为自我建立起更好的支持系统，并且找到方法来满足自我的需求。
Sometimes depression is also treated with medication, which can provide excellent relief of symptoms within a relatively short period of time. It can be unwise, however, to only use medications to treat postpartum depression. Medications may help an individual feel better within a few weeks, but therapy can help that person make the life changes that can result in long-term wellness.
有时候抑郁症也会用药物治疗，药物能在相对短的时间里很好地减轻症状。但是，只使用药物治疗产后忧郁是不明智的。药物或许能帮助一个人在数周内感觉好些，但是治疗能帮助人改变生活从而获得长期的健康。
Caring for mothers with postpartum mood disorders presents unique challenges to health care providers, including mental health providers. Health care providers who treat mental illness include psychiatrists and other physicians who may prescribe antidepressant medication, and psychologists, counselors, or therapists who provide “talk” therapy. When they treat mothers of young infants, they have two, rather than the usual one patient to concern themselves with. Mother and baby are interdependent, especially if they are breastfeeding. They are a “dyad,” meaning two units that are regarded as one. Treatment of the mother‘‘s illness must support both the mother and baby.
照顾产后情绪障碍的妈妈是对医护人员的独特的挑战，其中包含精神健康照顾者。治疗精神疾病的医护人员，有精神病学家和内科医生，他们可能会开抗抑郁药物；而心理学家、咨询师和治疗师，他们可能会提供“谈话”治疗。当他们治疗有新生儿的妈妈们时，他们需要考虑到有两个病人而不是通常说的一个病人。妈妈和孩子是相互依赖的，尤其是在哺乳期的时候。他们是个“二联体”，也就是说二者是一体的。对妈妈的治疗必须同时照顾到妈妈和孩子。
Many health care providers do not have training or experience in devising a treatment plan that includes the needs of both members of a breastfeeding dyad. Consequently, it is very common for mothers to be told at the outset that they must wean in order to pursue treatment of their depressive illness. Physicians may tell the mother she must stop breastfeeding because of concerns about the baby‘‘s exposure to medication through the mother‘‘s milk. Therapists may also advise weaning, believing that if other family members could give the baby a bottle, the mother would be able to rest and relax. Many health care providers share the bottle-feeding mentality that is still the norm in Western cultures. A mother who insists on her “lifestyle” choice of breastfeeding in the face of challenges will often be viewed as making a foolish and possibly detrimental decision. Family members who are often frightened and worried by the mother‘‘s illness, may not be able to assist the mother in challenging treatment advice that includes sudden weaning.
很多医护人员没有制定哺乳双方的治疗计划的培训经历和经验。因此，在治疗一开始妈妈们就被告知必须断奶，以便治疗她们的抑郁症，这种情况是非常普遍的。内科医生可能会告诉妈妈她必须停止母乳喂养，因为担心孩子会通过母亲的乳汁而受到药物的影响。治疗师也可能会建议断奶，因为他们相信如果家庭成员能用奶瓶喂养孩子，妈妈就能休息和放松。很多医护人员持有奶瓶喂养的心态，这是西方文化中的普遍观点。一个坚持母乳喂养作为她的“生活方式”的妈妈面临很多挑战，她常常会被认为是做了一个愚蠢的、有害的决定。那些为妈妈的病而恐慌、忧虑的家庭成员可能也无法帮助妈妈反对治疗建议，其中可能包括突然断奶。
One mother, after recovering from a manic episode during which her doctor insisted that she wean immediately because of the medication she was taking, said later:
一个从躁狂发作中恢复过来的妈妈（她的医生坚持要她立刻断奶，因为她正在吃的药会影响到孩子）后来说：
People don‘‘t realize how desperate you and your husband feel to get help and be well. We didn‘‘t know who to listen to, as often three or four health care providers gave conflicting advice. The psychiatrist didn‘‘t see the baby as his problem and the pediatrician felt helpless to advise me. I feel a lot of sadness about weaning my baby, especially now as we are facing surgery to place tubes in the baby‘‘s ears because of frequent ear infections.
人们不能理解你和你丈夫希望获得帮助、恢复健康的愿望是如何迫切。经常三或者四个医护人员给出相互冲突的意见，我们不知道听谁的。精神病医生不会把孩子视为需要考虑的对象，儿科医生对我们又无能为力。给我的孩子断奶让我感到很伤心，尤其是现在，由于经常耳朵感染，我们正面临给孩子植入中耳通气管的手术。
A close look at weaning, however, reveals potential risks for both baby and mother that may outweigh any of the expected benefits. Some of these risks are especially pertinent in situations where a mother has a depressive illness or other mood disorder.
但是，仔细研究断奶会发现，断奶对孩子和妈妈的潜在风险可能要高于所期待获得的任何好处。在一个妈妈有抑郁症或其它情绪障碍的情况下，有些风险与断奶密切相关。
Maternal Concerns
Painful breasts. Most women experience engorgement, including the risk of breast infection and abscess, in the face of sudden weaning. A mother who stops breastfeeding will need to take steps to relieve her engorgement. This many involve acquiring an adequate pump or learning to hand-express milk, as well as using ice-packs and watching for symptoms of breast inflammation and infection. Some drugs used to treat mental illness may have a galactogogue effect, i.e., they cause the breasts to produce more milk. This can intensify the pain of engorgement and slow the process of getting the breasts to stop producing milk.
母亲的风险
乳房疼痛。大多数女人在面临突然断奶时遭遇过乳房肿胀，包括乳房感染和脓肿的风险。一个将停止母乳喂养的妈妈需要采取几个步骤来减轻她的乳房肿胀。这些步骤当中包含获得一个适当的吸奶器或者学会手动挤奶，同时视乳房发炎和感染情况使用冰袋。有些用来治疗精神疾病的药物具有催奶效果，也就是说，他们会使乳房生产更多的奶。这会加剧涨奶的疼痛并减缓乳房停止产奶的进程。
Hormonal shifts. Sudden weaning brings sharp changes to maternal levels of estrogen, progesterone, and prolactin. The result may be mood swings and exacerbation of the mother‘‘s depression. A breastfeeding mother‘‘s mood is positively affected by the oxytocin released into her blood whenever she nurses the baby; sudden weaning deprives a depressed mother of this mood-boosting hormone.
荷尔蒙的改变。突然断奶给母性的雌激素、黄体酮和催乳素带来巨大的改变。这样的变化可能导致情绪波动，也可能使母亲的抑郁症加剧。每当母亲哺乳宝宝时，她的心情就会正向地受到释放于血液中的催产素所影响；突然断奶剥夺了一个沮丧的妈妈的这种情绪促进荷尔蒙。
Additional burden of baby care in the long-term. Family and friends rally to the aid of the mother in crisis, and they are ready and willing to bottle-feed the baby so that the mother can get some rest. But this support is often short-lived as the demands of life require the helpers‘‘ attention elsewhere. When the helpers are gone, the mother finds herself with the additional burden of cleaning and preparing bottles and other feeding paraphernalia, where previously, breastfeeding meant that she could luxuriate in the opportunity to sit down and simply cuddle her baby to her breast.
长期照看孩子的额外压力。家人和朋友团结起来帮助处于危机中的妈妈，他们准备并且乐于用奶瓶喂养孩子，这样妈妈就能稍微休息一下。但是这种帮助是短暂的，因为生活需要帮助者们把注意力放到其它地方。当没有帮助者的时候，这个妈妈发现她有了额外的压力：清洗、准备奶瓶和其它相关用具，而在以前母乳喂养的时候她只需要舒服地坐下来，轻松地把孩子抱到她胸前。
Expense. The costs of weaning include not only the additional cost of buying formula, but also the expense of more frequent illnesses in baby. Bottles and other feeding paraphernalia may need to be purchased. This financial burden will fall on a young couple who likely can ill-afford it.
额外的开支。断奶的代价不仅仅是购买婴儿配方奶的额外费用，还有孩子更频繁地生病的花费。奶瓶和其它喂养相关用具需要购买。这些经济负担会降临到年轻的夫妇身上，他们可能负担不起这些。
Return of fertility. The possibility of another pregnancy is an important concern for a family already struggling to cope. Weaning the baby will cause the mother‘‘s fertility to return, so she must consider contraception. This can be an added cost. In families who choose not to use contraception, lactation amenorrhea provides an important child-spacing mechanism.
生育能力恢复。对一个已经疲于应对的家庭来说又一次怀孕的可能性是一个重要的要关注的问题。给孩子断奶会导致妈妈的生育能力恢复，因此她必须考虑避孕。这也会增加花费。在选择不避孕的家庭里，哺乳期闭经提供了一种重要的控制生育间隔的途径。
Disruption in bonding. It‘‘s not unusual for mothers who are depressed to find themselves unable to make the effort to play with their children, cuddle their babies, and so forth. When breastfeeding, the baby is assured of some loving contact with mother several times a day. The “mothering hormones” associated with breastfeeding foster the mother‘‘s attachment to the baby. If bottle-propping becomes an option for feeding the baby, the mother may not spend as much quality time with her infant.
亲子连接的破坏。抑郁的妈妈们发现她们不能尽力与她们的孩子玩耍、拥抱她们的孩子等等。哺乳的时候，能确保孩子与她们的妈妈每天有数次充满爱意的接触。与母乳喂养相关的“母性荷尔蒙”促进妈妈与她的孩子的连接。如果奶瓶喂养成为养育孩子的一个选项，妈妈可能就不会花那么多的一样高质量时间给她的婴儿。
Feelings of helplessness. Generally speaking, mothers with mood disorders are feeling out of control, powerless, and hopeless. Breastfeeding may be one thing that helps a mother to feel good about herself and her mothering. Telling her to stop breastfeeding delivers one more message of inadequacy. If others take over the baby‘‘s care, her inadequacy and powerlessness are confirmed. It‘‘s not unusual for mothers to experience tremendous grief, as well as hostility toward care providers even decades after an enforced weaning.
无助感。一般而言，有情绪障碍的妈妈们感觉失控、无力、没有希望。母乳喂养可能是能帮助这些妈妈们对她自己以及履行母职感觉好一些的一件事。让她停止母乳喂养给了她又一个能力不足的信息。如果其他人接手照顾宝宝，她的不足和无力便被确定了。甚至在被强行断奶数十年后，妈妈们还会有巨大的悲痛和对医护人员的敌意。
Infant Concerns
The younger the baby, the greater the risk for allergies and other nutritional problems. Substituting formula for human milk has significant health risks for infants, including increased risk of allergies, Type I diabetes, obesity, Crohn‘‘s disease, and much more.
婴儿的风险
婴儿越小，过敏和其它营养问题的风险越大。对婴儿来说，替代母乳的配方奶有很大的健康风险，包括过敏风险增大，得I型糖尿病、肥胖、克罗恩氏病等的风险会增大。
More frequent and serious illness. Breastfeeding protects babies against infectious disease. Babies who are formula-fed have more frequent colds, ear infections, diarrhea, and gastrointestinal upsets. Not only is weaning risky for the baby‘‘s health, it also creates parenting challenges. Sick babies need and demand more attention around the clock.
更频繁、更严重地生病。母乳喂养保护婴儿避免感染流行病。配方奶喂养的婴儿更频繁地感冒，耳部感染，腹泻以及胃肠不适。断奶不仅会给婴儿的健康带来风险，也会给婴儿的养育带来挑战。生病的婴儿一整天都需要并且要求更多的关心。
Attachment trauma. A baby who is denied access to the breast for food and comfort may be grief-stricken. Separating mother and baby for prolonged periods of time may have lasting effects. The research is clear on the desperate need of mother and baby to be together for babies to experience normal growth and development. When they are unable to interact, there is evidence that lifelong depression may begin forming in the infant. One study of rat pups who were weaned and separated from their mothers for one 24-hour period during the neonatal period demonstrated both elevations in stress hormones and disruption of the hypothalamic-pituitary-adrenal system, which helps to regulate mood (Schmidt 2002). The distress a baby experiences with sudden weaning is real and should not be ignored or minimized by health care providers or substitute caregivers.
依恋创伤。一个不许靠近乳房来取食和获取安慰的婴儿可能会极度悲伤。妈妈和婴儿的长时间的分离可能会带来持续的影响。研究清晰地表明，妈妈和婴儿极需彼此在一起，以便让婴儿能正常生长和发育。证据说明当他们不能互动的时候，终身的沮丧可能在婴儿时期就开始形成了。一个对新生老鼠的研究表明，在新生儿时期断奶并且与鼠妈妈隔离24小时后，帮助调节情绪的应激激素升高，下丘脑-垂体-肾上腺的系统被破坏。(Schmidt 2002)婴儿经历的由于突然断奶带来的悲痛是真实的，医护人员或是替代看护人不应忽略或看轻这一点。
The breastfeeding dyad that is struggling because of the mother‘‘s mood disorder may be particularly vulnerable to the effects of sudden weaning. If hormonal shifts and negative messages cause the mother‘‘s mood to spiral downward, she becomes less able to effectively mother her baby. If baby becomes more sickly because of stomach upsets or allergies, he presents a bigger challenge to her mothering skills. A baby who is more difficult to comfort can make a mother feel even more inadequate and helpless. And, since many experts believe that there is a genetic component to mental illness, it stands to reason that the disrupted attachment inherent in sudden weaning may predispose the baby to mood disorders in the future.
由于妈妈的情绪障碍而挣扎的母乳喂养二联体可能尤其容易受到突然断奶的伤害。如果荷尔蒙的改变和负面信息导致妈妈的情绪螺旋式下降，她会变得不那么能有效地照顾她的孩子。如果婴儿由于消化不良或是过敏导致更虚弱，就对妈妈的养育能力提出了更大的挑战。一个更难满足的婴儿会使妈妈觉得自己更不足和无助。同时，由于很多专家相信精神疾病有遗传因素的影响，突然断奶带来的依恋的破坏将使孩子未来产生情绪障碍的可能性增加，得出这样的推论看起来就合乎情理。
What Is the Answer?
In many situations, it is possible for a mother to continue to breastfeed while being treated for postpartum depression or other types of mood disorder. She will need the support of family and friends, as well as health care providers, as she continues to care for her baby and to attend to her own recovery. It is important for everyone assisting her to recognize and respect her needs and those of the baby.
应该如何处理产后抑郁？
很多情况下，当妈妈由于产后抑郁或是其它类型的情绪障碍接受治疗时继续母乳喂养是可能的。为了继续照顾她的孩子和自我恢复，她需要医护人员和家人、朋友的支持。让每个支持她的人认识到并且尊重她和孩子的需求，这一点非常重要。
The support and practical assistance of loved ones is crucial to a positive outcome. Many mothers who are depressed experience feelings of inadequacy and marginalization. Additionally, those caring for her may manipulate or coerce her into agreeing to a treatment plan that does not acknowledge what is important to her—breastfeeding and mothering her baby. This sometimes occurs as a result of the fear that loved ones feel when they see the mother having such a hard time. The fact is that, despite her illness, she is often quite capable of making decisions.
亲朋的支持和实际的帮助对于产生积极的结果至关重要。很多抑郁的妈妈都有无力感和边缘化的感受。另外，那些照顾她的人可能会控制或者强迫她同意治疗计划，那些治疗计划没有考虑母乳喂养和亲自照顾她的婴儿对她来说是重要的。这也许是那些关心妈妈的人自身的恐惧感带来的结果，因为看到妈妈如此艰难会令人担心。事实是，虽然她有病，但是通常她完全有能力做决定。
That being said, mothers would do well to discuss the importance of breastfeeding with family members before a crisis (of any kind!) occurs. Mothers should share their feelings about their relationship with the baby, breastfeeding goals and desires, and hopes for the future with their partners and other loved ones. When family and friends understand the importance of breastfeeding through the mother‘‘s eyes, perhaps they will not suggest weaning as a first recourse. Having this knowledge will also prepare these individuals to advocate for the breastfeeding mother and baby in the event of a crisis. Educating her family about breastfeeding could include sharing her LLL Leader‘‘s phone number and the names of some LLL friends.
也就是说，妈妈们完全能在任何形式的危机来临前与家庭成员讨论母乳喂养的重要性。妈妈们可以分享她们对于亲子关系的感受，实行母乳喂养的目标与愿望，以及未来对她的伴侣与关心的人的希望。当家人和朋友理解了妈妈眼中母乳喂养的重要性，或许他们就不会把断奶的建议当作第一选择。有了这点认识也会使这些人准备好在发生危机时支持母乳妈妈和孩子。分享国际母乳会哺乳辅导的电话和国际母乳会朋友的名字可以帮助她的家人了解母乳喂养。
Finding a mental health care provider who understands the concept of the breastfeeding dyad is also crucial to the mother‘‘s treatment. The mother will oftentimes be seeing both a psychiatrist and a psychotherapist, as they have different roles in the treatment. She will need support from both if at all possible.
找到一个理解母乳喂养共生体观点的精神健康照顾者对于妈妈的治疗也很重要。妈妈会经常看精神病医生和心理治疗师，因为他们在治疗中扮演着不同角色。如果可能的话她需要两者的帮助。
The psychiatrist should be willing to explore treatment options that allow the mother to continue breastfeeding. This may involve seeking out information about the effects of various medications on breastfeeding and the infant. It is important to know that many of the drugs being used to treat these problems are compatible with breastfeeding. In other cases, a safer substitute drug that is also effective may be used to treat the mother‘‘s disorder. Information on specific drugs may be obtained from various sources, including La Leche League‘‘s Professional Liaison Department and written materials such as Dr. Thomas Hale‘‘s Medications and Mothers‘‘ Milk. This information can then be shared with health care providers as appropriate.
精神病医生应该要愿意探索能让妈妈继续母乳喂养的治疗方案。包括寻找各种药物对母乳喂养和婴儿的影响的信息。了解很多用来治疗这些问题的药物与母乳喂养是不矛盾的是很重要的。另一方面，一种安全、有效的替代药物可能会用来治疗这个妈妈的情绪障碍。详细的药物信息可以通过多种渠道获得，包括国际母乳会专业联络部门和书面材料如Dr. Thomas Hale‘‘s的书籍《药物与母乳喂养》。这些信息在适当时可以与医护人员分享。
When physicians make decisions about drugs, there are factors to consider besides the drug‘‘s presence in the mother‘‘s milk. Whether or not a drug is harmful will depend on the amount of the medication that gets into the milk as well as the age of the baby and how much the baby is nursing. The risks of the baby receiving a small amount of the mother‘‘s medication in her milk must be weighed against the risks of formula-feeding. While using some drugs, it may be advisable to monitor the baby‘‘s blood levels and to watch for an adverse reaction. The mother‘‘s physician can consult the baby‘‘s physician on issues related to monitoring possible drug reactions in the baby.
当医生决定开药时，除了药物会在妈妈乳汁里外还有几个因素要考虑。药物是否有害取决于进入到乳汁中的药物的含量和婴儿的年龄以及婴儿摄入的奶量。婴儿从妈妈乳汁中汲取少量药物的风险要与婴儿配方奶带来的风险做比较。当使用某些药物时，监测孩子的血中药物浓度、观察不良反应是明智的做法。在监测婴儿可能发生的药物反应上，妈妈的医生可以向婴儿的医生咨询。
A good therapist should be willing to listen and learn about the family‘‘s specific needs, including the value the mother places on her breastfeeding relationship. This caregiver would be willing to talk with other health care providers (with the permission of the mother). Rather than advise the mother to wean, the therapist would listen to the mother‘‘s feelings about her breastfeeding relationship with her baby, and whenever possible, not only support it but advocate for it with other health care providers.
一个好的治疗师应该是乐于倾听和了解家庭特殊需要的，包括妈妈在母乳喂养关系上所赋予的价值。这位照料者可能乐于与其它医护人员交谈（经妈妈的同意）。与其劝妈妈断奶，治疗师不如倾听妈妈关于她对母乳喂养关系的感受，只要可能，不仅仅支持，而且向其它医护人员倡导。
One of the immediate issues in situations where a mother has a depressive illness is whether she is able to care for her baby and for other children in the family. If the mother is deemed able to care for the baby on her own, then certainly breastfeeding would make her task easier! If she needs assistance, her helpers can take over household responsibilities, or care for older children, leaving the mother to concentrate what energy she has on the baby. A woman with a severe mood disorder, whose symptoms or distorted perception of reality prevent her from safely caring for her baby or even herself, may need friends and family to take turns being with her and the baby. This would allow for continuing attachment between the mother and baby while at the same time ensuring safety for both. This mother could continue to breastfeed even if her helpers must physically assist her with getting the baby to the breast.
在一个妈妈有抑郁症的时候立即面临的问题之一就是她是否还能照顾她的婴儿和家里的其它孩子。如果这个妈妈被认为自己能照顾她的婴儿，那么母乳喂养肯定能让她轻松一些。如果她需要帮助，她的帮助者们能帮她做家务，或者帮她照顾大一点的孩子，以便她能集中精力照顾她的新生儿。有严重情绪障碍的女人（她们的症状或者对现实的扭曲妨碍到了婴儿甚至是她自己的安全）可能需要朋友和家人轮流在身边陪伴她和她的婴儿。这允许妈妈和宝宝之间的连接持续，同时也确保他们的安全。这位妈妈可以继续母乳喂养，即使她的帮助者必须帮助她把孩子抱到她的胸前。
In the event of an unavoidable hospitalization, the family could see about bringing the baby to the mother regularly, as well as arranging for a breast pump and assistance with using it. It‘‘s likely that, in many institutions, the idea of supporting continued breastfeeding would be new and therefore possibly viewed with suspicion or even scorn. Again, it becomes crucial for loved ones to advocate for the mother if she has trouble standing up for herself.
如果必须住院，家里人要考虑定期把婴儿带给妈妈，同时准备吸奶器以及帮助她使用吸奶器。多数情况下，很可能是这样的：支持继续母乳喂养的想法是新鲜的，因此很可能会被怀疑甚至是被讥讽。如果妈妈无法面对这些麻烦，关爱她的人的支持再次变得非常重要。
Fortunately, effective treatment is available for postpartum depression and other mood disorders. These illnesses do not carry the stigma that they have in the past, and treatment need not compromise any further a mother‘‘s attachment to her breastfed baby. When the mother, her partner, friends, and other family members work together with health care providers, solutions can be found that will enable the mother to continue to breastfeed as she recovers from her mood disorder. Both she and her baby will benefit.
幸运的是，产后抑郁及其他情绪障碍已经有了有效的疗法。这些疾病不会带着过去的污名，而治疗也不需要中断任何妈妈和宝宝的连接。当妈妈和她的配偶、朋友以及其它家庭成员和医护人员一起努力，可以找到使妈妈能够在复原过程中继续母乳喂养又能治疗她的情绪障碍的办法，妈妈和她的婴儿都将获益。
References（参考文献）
American College of Obstetricians and Gynecologists (ACOG). Answers to Common Questions about Postpartum Depression. Washington DC: ACOG, 2002.
Hale, T.R. Medications and Mothers‘‘ Milk, Eleventh Edition. Amarillo, Texas: Pharmasoft Publishing, 2004.
Kendall-Tackett, K.A. The Hidden Feelings of Motherhood. Oakland, California: New Harbinger Publications, 2001.
Komaroff, A.L., ed. Harvard Medical School Family Health Guide. New York: Simon and Schuster, 1999.
Mohrbacher, N. and Stock, J. THE BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois: La Leche League International, 2003.
Schmidt, M. et al. Maternal regulation of the hypothalamic-pituitary-adrenal axis in the 20 day-old rat: consequences of laboratory weaning. Journal of Neuroendocrinology 2002; 14(6):450-57.
Taj, R. and Sikander, K.S. Effects of maternal depression on breast-feeding. Journal of Pak Med Assoc 2003; 53(1):8-11.
| A mother with postpartum depression may suffer from any or all of the following symptoms, although the most severe symptoms occur only rarely.
一个产后抑郁的妈妈会有以下一些症状，尽管最严重的症状很少出现。 feelings of sadness and helplessness悲伤和无助感 anxiety焦虑 headaches头痛 mood swings情绪波动 insomnia失眠 general lack of interest in life对生活缺乏兴趣 loss of appetite食欲不振 fear of hurting the baby or worry over inability to care for the baby怕伤害宝宝或担心没有能力照顾宝宝 ankle swelling or weight increase踝关节肿大或体重增加 vomiting呕吐 panic恐慌 distorted perception of reality对现实的扭曲感受 hallucinations or delusions幻觉错觉 suicidal or homicidal thoughts自杀或杀人想法
If these symptoms intensify rather than fade, and last longer than about two weeks, the mother may be suffering from postpartum depression. It is important that a mother attempt to overcome her postpartum depression, because it not only affects the mother and her relationship with her baby. Untreated postpartum depression can also affect a baby‘‘s physical and social development. Source: Mohrbacher, N. & Stock, J. THE BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois: La Leche League International, 2003; 570-75. 如果这些症状加强而不是逐渐消失，并且持续两周以上，这个妈妈可能患上了产后抑郁症。妈妈试图克服产后抑郁是很重要的，因为它不仅影响妈妈及她与宝宝的关系，没有治疗的产后抑郁也会影响婴儿的生理发育和社会能力的发展。 来源于：Mohrbacher, N. & Stock, J. THE BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois: La Leche League International, 2003; 570-75. |
| Tips for Family Members家庭成员小贴士：
Get help for the mother early on. The mother‘‘s partner or other family members should attend psychiatric appointments with her to show support, ask questions, help the mother retain and understand information, and to provide relevant information about the mother‘‘s relationships and history. Talk of suicide should be taken seriously. Call the mother‘‘s doctor or her psychiatrist or therapist. Utilize broad-based support and resources to collect needed information, including La Leche League‘‘s Professional Liaison Department, lactation consultants, and sources of information on medications and breastfeeding. Evaluate demands on the mother, eliminating unnecessary tasks so that she can focus on the baby. Hire household help. Become educated on the specific disorder. ·尽早开始帮助妈妈。 ·妈妈的配偶和其它家庭成员应该跟她一起参与精神治疗以示支持，问问题，帮助妈妈记住、理解治疗信息，提供与妈妈的社会关系及生活历史的相关信息。 ·谈论自杀要认真对待。打电话给这个妈妈的治疗师或是精神科医生。运用广泛的支持和资源来收集需要的信息，包括国际母乳会专业的联络部门，哺乳顾问，以及药物与哺乳的信息来源。 ·评价妈妈的需要，减除不必要的工作以便她能关注于她的婴儿。 ·雇佣家政服务。 ·学习相关的情绪障碍知识。 |
| For more information about mood disorders, see the following sources:
想要了解更多关于情绪障碍的消息，参考以下来源： The National Women‘‘s Health Information Center 1-800-994-WOMAN (Spanish and English, Mon-Fri, 9 am-6 pm EST) 1-888-220-5446(hearing impaired) 8550 Arlington Blvd., Suite 300 Fairfax VA 22031 USA www.4woman.gov/faq/postpartum.htm Depression after Delivery 91 E. Somerset St. Raritan NJ 08869 USA 800-944-4773 www.depressionafterdelivery.com Postpartum Support International www.postpartum.net Postpartum Stress Center www.postpartumstress.com Kathleen Kendall-Tackett, PhD Psychologist, researcher, and author |
下图是美国卫生部公开建立的针对医护人员的药物与母乳喂养的英文数据库的链接。妈妈们可以将药物的英文名输入搜索，搜索结果包含孕产妇和婴幼儿的用药量，药物对母乳喂养的婴儿及对妈妈泌乳的影响，以及可替代的更安全的药物。建议妈妈们可以将相关信息提供给医生进行参考。
小巫 译 任钰雯校对
珍惜亲子关系 回归自然哺育
母乳喂养是一件自然而然且能够圆满完成的事情，否则人类就不会繁衍生存至今。即使在喂奶过程中遇到问题，现有的信息和支持也能帮助妈妈们来克服困难，从而继续母乳喂养。
乳腺导管堵塞或者乳腺炎就是喂奶的妈妈们可能遇到的问题之一。开始往往很轻微，仅仅是乳房的某一点酸痛或者有一处硬块。它也许没什么大不了的，会自行消失；但也许疼痛会加剧，不再局限于某一点，而是扩散到整个乳房，哺乳变得痛楚不堪，妈妈也会发烧生病。
许多时候，妈妈在家自己就能治疗乳腺堵塞或乳腺炎。无论妈妈自行处理还是咨询医生并接受治疗，在绝大多数情况下，继续哺乳对于母亲和婴儿来说都是最佳方案。
乳腺导管堵塞还是乳腺炎？
乳腺导管堵塞和乳腺炎之间的区别通常是指程度上的轻重。乳腺导管堵塞指的是乳房中出现疼痛点或者硬块，但是母亲没有发烧。发生的原因是某处乳腺导管没有完全疏通，从而肿胀发炎。堵塞部分后方压力增大，引起周围的软组织发炎。这种“结块”现象往往一次只在一侧乳房发生。
如果疼痛和硬块伴随着发烧（低于38.4摄氏度）以及类似流感的症状（疲倦、酸痛等），这就是乳腺炎。其他症状如恶心和呕吐也有可能发生。正在哺乳的母亲，当其他家人患感冒或流感时，有时就会患上乳腺炎。乳腺炎也往往一次只在一侧乳房发生。
无论乳房疼痛的起因是乳腺导管堵塞还是乳腺炎，治疗方法都一样：热敷，多用发炎的一侧乳房喂奶和休息。
热敷会加强疼痛部位的血液循环，进而加快炎症消退。有些妈妈用热敷垫，或者用一个小的放了热水的瓶子。轻柔的按摩也有助于治疗，先从疼痛点的后方开始，用清水浸湿并清除乳头上干涸的乳汁。简易的方法之一是侧躺在浴缸里温热的洗澡水中，或者站在温热的淋浴中，浸泡并且轻柔地按摩乳房。两只手掌一上一下托住乳房，轻柔而坚定地进行环状运动，从硬块后方开始，逐渐过渡到乳头。热处理和按摩之后立即哺喂宝宝或者吸奶，有助于缓解堵塞。
频繁地喂奶有助于避免乳房过度涨满，也保持乳汁流畅。只要乳房摸上去饱胀或温热，就要鼓励宝宝至少每两个小时吃一次，包括夜间。请先用发炎的一侧哺乳。
休息是治疗手段的第三要素。乳腺导管堵塞或者乳腺炎通常标志着母亲过于操劳，过度疲惫。如果有可能，推掉一切工作和活动，和宝宝一齐上床休息，直到感觉好一些。如果现实不允许，那么至少取消额外的活动，每天给自己多安排一到两个小时的休息时间。
还有其他一些办法可以帮助加快痊愈：
首先，松开紧身的衣服，尤其是胸罩。
其次，检查一下宝宝的哺乳姿势和衔乳方式，确认宝宝在衔住乳头时，他是面向乳房，不必扭着头吃奶；并且他的嘴张的很大（好像打哈欠），将乳房的很大一部分含在嘴里。在他衔住乳头时，将他抱紧，使他的下巴在吃奶过程中接触到乳房。正确的哺乳姿势和衔乳方式保证宝宝每一次哺乳更加有效地吸空所有的乳腺导管中的奶。
第三，试着调换不同的哺乳姿势。如果你通常坐着喂奶，不妨试试一两次躺着喂或者橄榄球式抱法。此外，采用宝宝的鼻子或下巴对着乳房上的疼痛点也会帮助宝宝更有效地吸掉淤积在那里的奶。
有些妈妈觉得这种喂奶姿势有助于疏通堵塞的乳管：把宝宝放在床中央或地上铺的褥子中央，妈妈趴着，让乳房垂下来，垂到宝宝嘴里喂奶。这样的姿势可以很容易的调整宝宝的鼻子和下巴位置从而对准你的乳房上的疼痛点。此外，地心引力也能帮助你的乳汁流出。
什么时候该看医生
采用以上方法，大多数妈妈在24小时之后就会感觉有所好转。但是如果持续发烧或者体温超过了38.4摄氏度，症状加重，就应该咨询医生，也许大夫会给你抗生素或者其他药物。
某些类型的乳腺炎需要马上看医生，比如，双侧乳房发炎、乳头看上去有感染、奶中有脓或血、疼痛部位周围有红纹、或者症状突然加重。这些都表明有细菌感染，需要医生马上检查。
即使需要使用抗生素和其他药物，继续哺乳对你和宝宝仍是最好的选择。大多数抗生素无碍于哺乳。宝宝生病时需要抗生素，此时从妈妈奶中得到的抗生素远远低于他自己用药的剂量。如果你的医生不确定所用抗生素是否会影响哺乳，咨询一下你孩子的儿科医生。如果对药没有把握，要求医生给你开可以哺乳的抗生素。如果使用抗生素，一定要坚持用完整个疗程。
可能的起因
了解引起乳腺导管堵塞或乳腺炎的原因有助于防止它再次发生。最常见的起因是：错过或者缩短了喂奶时间、长时间对乳房的压力、以及不正确的哺乳姿势和衔乳方式。
推迟或者减少宝宝哺乳时间，就会导致乳房过于涨满，从而提高发生乳腺炎的几率。比如，如果母亲限制喂奶时间，宝宝就没有机会把乳房吸软，母亲也会涨的不舒服。给宝宝吃奶瓶—无论是喂水、果汁、奶粉还是挤出来的母乳—都会加长两顿哺乳之间的时间。过多使用安抚奶嘴使得宝宝少吸吮乳头，也会导致问题。节假日的繁忙安排，意味着喂奶时间的推迟。另外，如果母亲开始离开家去上班或者上学，会导致原本应有的喂奶被推迟或取消。在这种情况下，母亲需要在离开宝宝的时间内挤奶（或者增加挤奶次数）。
有些时候是宝宝自己改变了吃奶习惯，要么晚上睡一整夜，要么一天中某些时候吃的频繁、另外一些时候就吃的少。正在长牙或者耳道发炎或者患了感冒的婴儿，会由于身体的不舒服而缩短吃奶时间。有些婴儿自行延长了两顿喂奶的间隔，但仍然体重增长良好、发育健康。母亲的乳汁供应会逐渐按照婴儿的需求来调整，但是在调整过来之前，妈妈可能需要在感到乳房涨满的时候挤一挤奶。
长时间对乳房的压力是乳腺导管堵塞和乳腺炎的另一起因。在乳房任何一处的持久性压力都会阻碍乳汁的流通，导致发炎。可能的原因包括：过紧或支撑力不够的胸罩、紧身游泳衣、婴儿抱带、沉重的挎包、或任何对乳房有压力的背带包、厚重的乳房护垫或护罩使得胸罩过于紧身、趴着睡觉给乳房带来压力、婴儿在妈妈胸上躺着休息、喂奶时压住了乳房，等等。
另外一个常见的起因是不正确的哺乳姿势和衔乳方式。如果宝宝没有正确地衔乳—如果他只是叼住了乳头的末端而没有含住整个乳晕—他就不会有效地吸奶，导致乳房过于涨满或乳腺导管吸空不均匀。不正确的哺乳姿势和衔乳方式还会引起乳头疼痛，导致喂奶时间推迟。
其他不常见的起因包括：个别婴儿吸吮无力（同时体重增长缓慢）、母亲疲惫、焦虑或者贫血、乳汁分泌过盛、乳头损伤、喂奶过程中使用乳头护罩、以及乳房缺陷，既往乳房手术等等。
反复感染
几周之内重复发生的乳腺炎往往是上一次发炎没有彻底治愈的结果。如果服用抗生素，一定要服用完整个疗程。
仔细考虑所有的可能起因，你或许可以确认重复感染的原因。最好和国际母乳会的哺乳辅导探讨自己的情况，她可能会给你更多的建议。
有些患慢性乳腺炎的妈妈，医生让她们长期服用预防性抗生素，得以痊愈。方法是在服用完治疗现存感染的抗生素以后，两三个月之内每天服用一片低剂量抗生素，以预防反复感染。
改变饮食习惯也有可能有所帮助。每天加一勺卵磷脂可以帮助一些妈妈预防乳腺导管堵塞反复发生。有些妈妈发现，如果取消或者至少降低对饱和脂肪酸的摄取，乳腺堵塞就会减少。
乳房脓肿
感染严重到乳房脓肿的地步，就需要切开引流排脓。有时脓肿会自身会破裂从而排出脓液。乳腺炎极少会发展成乳房脓肿，尤其是如果迅速及时地采用了上述治疗手段。如果确实发展成脓肿，医生也许会决定切开排脓。一般情况下，这属于门诊手术。如果你被要求留院几个小时，你也并不必和宝宝分离过久。在不让宝宝接触到刀口的情况下，可以继续让宝宝在发炎的一侧乳房吃奶。如果刀口贴近乳头，你可以让宝宝继续在没有发炎的一侧吃奶，将发炎一侧的乳汁挤出来，直到脓排净，这样可以防止乳房过于涨满。几天后，你就可以让宝宝重新回到发炎的一侧。
母乳喂养可以而且应该继续
过去的例行手续是一旦发生乳腺炎，就立刻推荐断奶。但是经验证明，如果乳房不变得过于涨满，乳腺炎痊愈的更快，也减少了发展成乳房脓肿的危险。即使是暂时的断奶，对于一个生病的母亲来说都是一种磨难。对宝宝来说，母乳中的抗体会保护他不受相关细菌的感染，所以在乳房感染甚至脓肿的时候，继续哺乳对宝宝是非常安全的。
综上所述，在几乎所有的情况下，一位患了乳管堵塞或者乳腺炎的妈妈，对自己和宝宝所能够做的最好的事情，是继续哺乳。
Sarah McCann, Carrickfergus, Northern Ireland
Adapted from her blog “Breastfeeding Resources, Northern Ireland,” posted August 2, 2011.
萨拉.麦卡恩，卡里克弗格斯，北爱尔兰
源自萨拉2011年8月2日发布的博客“北爱尔兰母乳喂养资源”
翻译：黄迎
审阅：Missy，Victoria
Sudden weaning in order to take a medication comes with risks and difficulties for mother and baby. Sarah looks at the implications of an early end to breastfeeding and explains that many medications are compatible with breastfeeding.
接受药物治疗导致突然离乳，会给母婴双方带来风险和困难。萨拉从探察提早离乳带来的影响，解释了许多药物与母乳喂养是兼容的。
When a mother is pressured to stop breastfeeding in order to take a medication, those doing the pressuring often don’t understand the implications of weaning for mother and baby. A health professional may not have much or any breastfeeding experience and may feel that breastfeeding into toddlerhood is strange. They may see nursing as the baby’s food and not be aware of the relationship. They may think that breastfeeding is a nice thing to do if all is well, but that it is stressful if a mother is ill (Calvert, 2014). They may wonder, “Why breastfeed for more than a few months anyway?”
当一位母亲因药物治疗而被迫停止母乳喂养时，那些施压的人并不了解离乳给母婴双方带来的影响。医务人员也许没有或者仅有很少的母乳喂养经验，可能会觉得哺乳学步儿是很奇怪的事情。他们把哺乳仅看成是婴儿食物而没有意识到其中的母婴联结关系。他们可能认为在母婴健康的情况下，母乳喂养是一件好事，但如果母亲生病了，母乳喂养将给妈妈带来压力（Calvert, 2014）。他们可能怀疑，“母乳喂养几个月就好了，为什么要喂那么久的奶呢？”
Why breastfeed for more than a few months anyway?
Katherine Dettwyler, Associate Professor of Anthropology at the University of Delaware, USA (2003), suggests that the natural weaning age of humans is probably between three and seven years of age. Both La Leche League and the World Health Organization support breastfeeding beyond the early months and into toddlerhood. As the length of time that a baby is breastfed increases, there is a reduced risk of infection, optimal teeth and jaw development, and development of a normal immune system, which is not mature until about six years of age (Dettwyler, 2003). Breastfeeding also provides pain relief (during teething, for instance), acts as a nutritional cushion during illness, and helps to avoid hospitalization. Breastfeeding is an easy way to comfort a baby or toddler and helps them to fall asleep. A mother’s confidence from these basic activities may have been vital to her parenting experience up until that point.
为什么母乳喂养不止是几个月的事呢？
美国特拉华大学人类学副教授Katherine Dettwyler（2003）认为人类自然离乳的时间大概在3-7岁。国际母乳会和世界卫生组织均支持在宝宝的生命最初几个月和学步期都进行母乳喂养。随着婴儿接受母乳喂养时间的延长，会降低感染的风险，促进牙齿和下颌的最佳发育，以及免疫系统的正常发育，而免疫系统完全发育成熟需要等到6岁左右（Dettwyler, 2003）。母乳喂养也能缓解疼痛（例如出牙时），在生病时提供营养来源，并有助于避免住院。母乳喂养是安抚婴儿和学步儿并帮助其入睡的舒适方法。母亲从母乳喂养这些基本行为中获得的自信对于她今后的育儿经历是很重要的。
Risks of sudden weaning to the mother.
突然离乳给母亲带来的风险
Sudden weaning can affect an individual nursing dyad in many different ways and may also have implications for the mother’s partner and wider family.
突然离乳会在许多不同方面影响母乳喂养中的母婴双方，甚至可能影响到母亲的伴侣和家庭中更多的人。
Sudden weaning may:
突然离乳可能会：
Induce pain and engorgement. A mother may continue to make a large volume of milk whatever baby’s age.
引起乳房疼痛和肿胀。无论婴儿月龄多大，母亲都可能持续分泌大量的乳汁。
Lead to plugged ducts, mastitis, or an abscess.
导致乳腺管堵塞，乳腺炎或者乳腺脓肿。
Increase mother’s stress levels, leading to increased symptoms of depression (Kendall-Tackett, 2007).
增加母亲的压力，导致抑郁症状加重（Kendall-Tackett, 2007）。
Lead to feelings of loss, grief or incompetency (Sharma and Corpse, 2008), even mimicking child loss (Gallup, 2010) and thus bringing on depression (Sharma and Corpse, 2008).
导致母亲感到失落、悲伤或无能（Sharma and Corpse, 2008），甚至像失去孩子一样（Gallup, 2010），从而引起抑郁（Sharma and Corpse, 2008）。
Cause mother to lose an easy way to feed and comfort her baby, especially during teething or illness.
让母亲失去一种简单的喂养和安抚孩子的方法，尤其是长牙或生病的时候。
Require dealing with baby or toddler’s continued desire to breastfeed, distressing both parties.
需要面对婴儿或学步儿仍然想要母乳喂养的需求，使得母亲和孩子双方都感到痛苦。
Cause a loss in the calming effects of prolactin and oxytocin, important hormones produced during breastfeeding that help mothers and babies relax and bond.
失去催产素和泌乳素带来的安抚作用，这两种在哺乳中产生的激素可以帮助母婴双方放松并产生连接。
Increase mother’s fertility, particularly if she has no access to other forms of contraception or chooses not to use birth control (Sears, 2015).
增加母亲怀孕的可能性，尤其是她没有使用其他避孕方式或者不选择节育时(Sears, 2015)。
Increase the risk that mother or another family member will have to put time and effort into caring for a sick baby or toddler.
增加母亲或其他家庭成员不得不花费时间和精力照顾生病的婴儿或者学步儿的风险。
Lead a mother to avoid treatment of a potentially dangerous and life-threatening situation for her and her baby to avoid sudden weaning (Amir, Ryan and Jordan, 2012).
导致母亲为了避免突然离乳对母婴双方造成的影响，而逃避对身体存在潜在危险或威胁生命的状况所进行的治疗（Amir, Ryan and Jordan, 2012）。
Risks of sudden weaning to the baby.
突然离乳给婴儿带来的风险
There are many implications for babies, including:
这对婴儿有许多影响，包括：
An increased risk of infection.
增加感染的风险。
Losing comfort and closeness with their mother, reducing bonding.Becoming suddenly totally dependent on outside sources of food, such as baby formula and solid foods. This can be difficult for some babies, especially if they won’t take a bottle or cup, or are only accepting a small amount of solid food, which is also stressful for the mother.
失去母亲的安抚和亲密，减少母婴亲密联结。突然变成需要完全依赖源自外部的食物，如配方奶和固体食物。这对于一些婴儿来说是很困难的，尤其是如果他们不接受瓶喂或杯喂，或者仅能接受少量固体食物。这也会给母亲带来压力。
Losing the protective effects of breastfeeding on future mental health, a particularly important issue if a mother is depressed. Research shows that the baby of a breastfeeding mother being treated for depression has better future mental health outcomes than the formula-fed baby whose mother is being treated for depression (Jones, McFall, and Diego, 2004).
失去母乳喂养对婴儿未来心理健康的保护作用，这种保护作用对母亲患有抑郁的婴儿尤为重要。研究表明，在母亲接受抑郁症治疗的情况下，母乳喂养的婴儿相对于配方奶喂养的婴儿，在未来有更好的心理健康（Jones, McFall, and Diego, 2004）。
Risks to the baby of medications in the mother’s milk.
母乳中含有药物给婴儿带来的医疗风险
Mothers may hear that early weaning is necessary due to increased risk to the child from medications in the mother’s milk. The reality is that:
母亲可能听说由于母乳中含有药物需要提早离乳。而事实是：
Risks to the baby are greater during pregnancy than during breastfeeding (Kendall-Tackett and Hale, 2010).
药物对宝宝的风险，在孕期大于哺乳期（Kendall-Tackett and Hale, 2010）。
If a toddler is feeding only a few times per day, his exposure to the medication will be much lower than that of a newborn.
如果学步儿在一天内只吃几次奶，他/她暴露在药物下的机会要比新生儿低很多。
Many medications are considered compatible with breastfeeding and are believed to cause no harm to the infant. Many medications don’t cross over into mother’s milk and most only cross in very small amounts, equivalent to a very small percentage of the mother’s dose (Hale, 2015).
许多药物治疗兼容于母乳喂养，并没有对婴儿造成伤害。许多药物不进入母乳，大多数药物仅有极少量进入乳汁，相当于母亲使用剂量的很少的百分比（Hale, 2015）。
See Breastfeeding and Medications for a summary of books, reputable websites, and helplines for checking the compatibility of medications during breastfeeding.
从书本、可信赖的网站和求助热线中了解母乳喂养与药物，以确定哺乳期是否可以使用相应的药物。
Gentle weaning
温柔离乳
If it is necessary for a mother to wean before she was planning to, here are some questions a Leader can use to encourage a mother to discuss options with her physician and pharmacist:
如果情况一位母亲确实需要比原计划提早离乳，哺乳辅导可以鼓励母亲与她的医生和药剂师就以下问题探讨可供选择的治疗方案：
Could an alternative, more compatible medication be prescribed?
是否可以使用与母乳喂养更兼容的替代性药物？
Can the medication be delayed until she planned to wean? Could it be delayed long enough to allow gradual, more natural weaning?
治疗是否可以推迟到母亲计划离乳的时候？能否推迟足够长的时间，使得离乳可以较为平缓和自然地进行？
Would the infant’s exposure to the medication for a relatively short time be safe, allowing for a more gradual weaning?
为了较为平缓地离乳，婴儿短期暴露在药物治疗下是否安全？
Might the mother temporarily wean and get baby back to the breast later?
母亲是否可以暂时离乳，过一段时间再帮助宝宝回到乳房？
When weaning is necessary
如果离乳是必须的
Sadly, there will be mothers who are faced with such serious illness that weaning is necessary. Cancer drugs, for instance, are so toxic that it is unlikely a mother could continue breastfeeding while receiving treatment (Jones 2013). As knowledge of the importance of breastfeeding and the safety of most medications spreads and grows, more women will continue to breastfeed who would in the past have weaned. However, not all doctors or mothers will want to take the risk of exposing their patients and babies to the risks of a specific medication, or the mother may be too ill to breastfeed.
令人难过的是，一些患有严重的疾病的母亲确实需要离乳。例如，抗癌药物的毒性使得母亲在接受治疗时不能继续进行母乳喂养（Jones 2013)）。随着母乳喂养的重要性和大多数药物的哺乳安全性等相关知识的传播，更多在过去选择离乳的妇女将会继续母乳喂养。尽管如此，并不是所有的医生和母亲愿意承担他们的病人和婴儿的暴露在药物治疗中的风险，或者母亲可能病情严重而无法哺乳。
Recently a mother phoned to say she had been diagnosed with thrombocytosis (a life-threatening condition of the blood) and was due to start a chemotherapy drug and another, less serious medication for life. We discussed temporary weaning, dry-up medications, and herbs. She decided to go for purely mechanical methods of weaning by pumping when her breasts felt uncomfortable and using cold cabbage leaves and ice packs.
最近，一位母亲来电说她被诊断为血小板增多症（一种威胁生命的血液病），准备要开始化疗和其他较不严重的药物治疗。我们一起探讨暂时离乳，离乳药物和草药。她决定在乳房涨奶时，仅挤出让自己感觉舒适的奶量这种方法离乳，并通过使用凉的卷心菜叶和冰袋冷敷，来缓解乳房不适。
Another mother was told to wean her ten-month-old daughter to start a stronger medication for depression. Once her daughter was suddenly weaned, the mother suffered pain in her breasts, developed mastitis, and her mood took several weeks to stabilize. Leaders cannot make decisions for the mother, yet they may be the only other people who understand how upset she is at having to wean. As La Leche League Leaders, we can give a mother information, support, and compassion.
另一位母亲因需要药效更强的药物治疗抑郁症而被要求给她10个月大的女儿离乳。当她的女儿突然断奶，母亲乳房疼痛并发展成乳腺炎，她的情绪也经过了几个礼拜才平稳。哺乳辅导不能替母亲做决定，但她们可能是唯一能理解离乳给母亲所带来的不安的人。作为国际母乳会哺乳辅导，我们可以给母亲提供信息、支持和热情。
If a mother does decide to wean suddenly, ice packs, cold cabbage leaves, sage tea, and a supportive bra can all be helpful. Pumping to remove some milk may also prevent and relieve engorgement (The Womanly Art of Breastfeeding, 2010; Humphries, 2003). Speaking to a board-certified lactation consultant may also help. Only the mother knows the full details of her situation. The Leader’s nonjudgmental attitude and helpful information may help her return to La Leche League for help if she has another baby and breastfeeds again.
如果母亲决定突然离乳，冰袋、凉卷心菜叶、鼠尾草茶和有承托力的胸罩都可能对她们有帮助。挤出一些乳汁可以预防和缓解肿胀（The Womanly Art of Breastfeeding, 2010; Humphries, 2003）。与经过认证的泌乳顾问讨论也可能会有帮助。只有母亲本人最了解自己的详尽情况。哺乳辅导不带评判的态度和适时的信息，可能会使母亲如果有下一胎并哺喂母乳时，再次来到国际母乳会寻求帮助。
Sarah McCann has been a Leader in Ireland since 1995. She is married to Mike, and they have three children, Ashleen (24), Timothy (21), and Eloise (18). Sadly, Mike and Sarah’s fourth child, Nathan, born in 2006, lived only a few hours. Sarah leads with LLL of Carrickfergus in Northern Ireland and has been in private practice as a lactation consultant for the last eight years.
作者简介：萨拉.麦卡恩自1995年起开始成为爱尔兰的一位哺乳辅导。她与迈克结婚并育有3个孩子，Ashleen （24岁），提摩西（21岁）和埃洛伊丝（18岁）。令人难过的是，迈克和萨拉第4个孩子内森，在2006年出生，仅存活了几个小时。萨拉在国际母乳会-北爱尔兰卡里克弗格斯担任哺乳辅导，并于过去8年里成为私人执业的哺乳顾问。
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原文链接：http://leadertoday-llli.org/sudden-weaning-for-medical-reasons/