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 www.granitescientific.com

 

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。

翻译：盛菲菲

审阅：Missy, Daisy

An overactive thyroid gland, also referred to as hyperthyroidism or Graves’ disease, is an important health concern. Thyroid disease is serious as the thyroid controls the body’s metabolic processes. According to the LLLI BREASTFEEDING ANSWER BOOK (BAB), any breastfeeding mother with thyroid disease should be under the care of a doctor who is supportive of her desire to breastfeed.

甲状腺过分活跃，也被称为甲亢或甲状腺功能亢进症，是一个重要的健康问题。甲状腺疾病需要引起重视，因为甲状腺控制身体的代谢过程。根据国际母乳会的《母乳喂养问答全书》（BAB），正在母乳喂养的妈妈，若得了甲状腺疾病，应寻找支持她母乳喂养意愿的医生得到医疗照护。

Diagnosis of an overactive 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.

甲状腺功能亢进可以基于哺乳妈妈的症状及同时做简单的血液测验结果来获得诊断。有时，放射性检测也用于诊断甲状腺疾病。如果需要用放射性检测，哺乳妈妈可以询问医生，是否可以推迟检测或者用别的非放射性测试来代替。 

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 FAQs about pumping.

如果哺乳妈妈已经做了放射性测试，推荐她暂时离乳。“妈妈暂停母乳喂养的时间需要根据放射性药物的使用种类和剂量不同而定”（BAB）。母乳中的放射性物质会随着时间减少，频繁的挤出乳汁也会帮助母亲更迅速地消除体内的放射性物质。这段时间的母乳必须丢弃，不能喂给宝宝。（频繁的挤奶不会加速母乳中的其他药物代谢。）关于吸奶，可以参考国际母乳会常见问题解答中的吸奶部分（英文网站：llli.org）。

Contact a La Leche League Leader for the most up-do-date information about the time period needed to sufficiently clear radioactivity from breastmilk.

如希望获得关于乳汁中放射性彻底消除时间的最新信息，可以联系母乳会哺乳辅导。

Some medications for overactive thyroid are not concentrated in human milk and result in minimal doses to the breastfed baby. If a mother is taking thyroid suppressants, she will need to tell her baby’s doctor so the baby can be monitored for thyroid levels. Weaning is usually not necessary. If a doctor insists on weaning, the mother is encouraged to seek a second opinion before weaning. When temporary weaning is recommended, it is important to be sure the risks and benefits have been fully evaluated. If you have questions about the medications you are taking, contact a La Leche League Leader.

有些治疗甲亢的药物不会聚集于母乳，对母乳宝宝的影响很小。如果母乳妈妈正在服用甲状腺功能抑制剂，那就要告诉儿科医生，以便对宝宝进行甲状腺水平监测。妈妈通常并不需要因此离乳。如果医生坚持暂停母乳喂养，我们鼓励妈妈在决定离乳前能试着再寻找第二种意见以进行比较。推荐暂时离乳时，妈妈必须确保已经充分评估过这样做的风险和益处。如果您对正在服用的药物有疑问，请联系母乳会哺乳辅导。

If radioactive compounds are used to treat an overactive thyroid, temporary weaning is necessary. The mother will need to pump and discard the milk during this time. Before a mother resumes breastfeeding, her milk must be checked for radioactivity. Your local LLL Leader will be able to share more information and offer support.

如果治疗甲亢的过程中，使用了放射性药物，那就必须暂时离乳。母乳妈妈在此期间需要吸出母乳并丢弃。在妈妈再次继续母乳喂养之前，她的母乳需要接受检测，以确定是否含有放射性。您当地的母乳会哺乳辅导可以与您分享更多的信息，并提供帮助。

Contacting an LLL Leader in your area or attending a meeting will help you cope with this. To find a Group near you, call 1-800-LALECHE or look at our LLL Web Page Index.

联系您所在地区的母乳会哺乳辅导，或者可以参加聚会，都可以帮助到您。您可以致电1-800-LALECHE或者从国际母乳会网站可以找到离您最近的小组。

Resources for Additional Information

LLLI FAQ on breastfeeding while taking medications

提供更多信息的资源:
国际母乳会关于服药期间母乳喂养的常见问题解答(LLLI FAQ)

The following items, plus many others, are available from the LLLI Online Store or through your local Leader:

以下书籍都可以从国际母乳会网站在线商店（store.llli.org）或者通过您当地的母乳会哺乳辅导获得。

THE WOMANLY ART OF BREASTFEEDING La Leche League International’s keynote title includes important references and resources for the breastfeeding mother. Its vast depth of factual information makes this book a necessary source for breastfeeding mothers, and its warm, friendly tone makes it a classic worth reading again. THE WOMANLY ART OF BREASTFEEDING is the definitive guide, bringing the importance of parenting through breastfeeding into the 21st century. Softcover, 465 pages.

《母乳喂养的女性艺术》是国际母乳会的旗帜书籍，囊括了给母乳妈妈的重要参考内容和资源。这本书里有大量深入的真实信息，是母乳喂养的妈妈们的必备信息来源，温暖，友好的文风使其成为值得反复阅读的经典。《母乳喂养的女性艺术》是一本指南性书籍，它指出，在当今21世纪藉由母乳喂养来育儿的重要性。英文简装版，465页。

La Leche League International’s BREASTFEEDING ANSWER BOOK by Nancy Mohrbacher and Julie Stock is the definitive resource for those who are dedicated to helping mothers breastfeed. This guidebook can be used by LLL Leaders, lactation consultants, doctors, and other health care professionals with confidence to help mothers establish and enjoy a satisfying breastfeeding relationship with their babies. Hardcover, spiral bound book, 680 pages.

《国际母乳会母乳喂养问答书》（BAB）是一本由Nancy Mohrbacher和Julie Stock撰写的权威书籍，它致力于帮助妈妈们进行母乳喂养。国际母乳会哺乳辅导、当地的哺乳顾问、医生以及其他的健康照护人员都可以使用这本指南，来帮助母亲建立并享受与自己的孩子快的哺乳关系。英文精装版，680页。

Breastfeeding and Human Lactation, Revised by Jan Riordan, EdD, RN, IBCLC and Kathleen G. Auerbach, PhD, IBCLC: This classic textbook, written by two La Leche League Leaders and internationally recognized lactation specialists, is a skillful blend of clinical experience, research documentation, and technical know-how. Hardcover, 874 pages.

《母乳喂养和人类泌乳》一书由由教育学博士、注册护士、国际认证哺乳顾问Jan Riordan和 Kathleen G. Auerbach博士、国际认证哺乳顾问修订。这本经典教材是由两位母乳会哺乳辅导和国际公认的哺乳专家撰写，将临床经验、研究文献和技术诀窍完美的融合在一起。英文精装版，874页。

Breastfeeding Conditions and Diseases, by Anne Merewood, MA IBCLC, and Barbara L. Phillip, MD, IBLCE: A comprehensive reference guide that addresses issues surrounding breastfeeding in medically complicated situations, this book explores a wide variety of information from the common cold to Sheehan’s syndrome. Breastfeeding Conditions and Diseases also includes suggestions on how to help breastfeeding mothers in difficult situations, fully referenced data, up-to-date research on human milk and breastfeeding, and background information on medical conditions. Softcover, 267 pages.

《母乳喂养状况和疾病》一书由Anne Merewood（硕士，国际认证哺乳顾问）和Barbara L. Phillip（医学博士，国际认证哺乳顾问委员会成员）撰写，这本书是一本全面的参考指南，它剖析了医学复杂情况下的母乳喂养的问题，从普通的感冒到席汉氏综合征，此书都给出了很多参考信息。这本书也包括哺乳妈妈在困难情况下哺乳的一些建议。此书充分引用数据，以及关于母乳喂养的最新研究，医疗条件下的背景资料。英文简装版，267页。

Page last edited 2016-01-09 23:45:07 UTC.

英文原文http://www.llli.org/faq/hyperthyroidism.html

翻译：Languid

审阅：Daisy, Missy

Ouch! Breastfeeding is not supposed to hurt. However, for any number of reasons, mothers may develop sore nipples.

喂奶是不应该让妈妈感觉到疼的。然而，妈妈们可能会因一种或多种原因经历乳头疼痛。

 

Nipple tenderness at the beginning of a feeding may be normal in the first two to four days of breastfeeding. Soreness that is more intense or continues for a longer time indicates that some adjustment needs to be made.

在开始喂奶的两到四天内，乳头敏感可能是正常的。如果疼痛更加严重或持续很长时间，这说明需要做些调整。

 

To begin healing sore nipples see our FAQ, How Do I Prevent Sore Nipples to determine the cause of your soreness. Being able to correct the situation causing the soreness will ultimately lead to nipple healing. The comfort measures below will allow you to continue breastfeeding your baby until the problem is resolved.

在处理乳头疼痛前可以先阅读一下国际母乳会英文网站中llli.org的常见问题“如何预防乳头疼痛”一文确定乳头疼痛的原因。如果能够改善引发疼痛的状况，那将最终实现乳头的康复。以下这些舒适的方法可以允许您在问题解决之前继续母乳喂养。

 

Note: If thrush or a yeast infection is the cause of your sore nipples, please see our Thrush FAQ for further information. In general, thrush thrives on milk and moisture so your nipples should be kept dry. Try rinsing them with water and letting them air dry after each feeding.

注：如果乳头疼痛是由鹅口疮或酵母菌感染所引起的，请进一步阅读国际母乳会英文网站中llli.org的常见问题（FAQ）中有关鹅口疮的信息。通常，鹅口疮会因乳汁和潮湿变得严重，因此你的乳头必须保持干燥。在每次喂奶之后试着用清水清洗乳头，并自然晾干。

 

Check positioning and encourage your baby to open wide when latching on. See our FAQ on Positioning.

选择合适的哺乳姿势，并鼓励宝宝在含乳时尽量张大嘴巴。请查看我们的常见问题栏中关于哺乳姿势的文章。

 

Offer your baby short, frequent feedings to encourage a less vigorous suck.

给你的宝宝提供短时间的、频繁的哺喂从而减少宝宝强力的吮吸。

 

Nurse on the least sore side first, if possible.

如果可行，先用不太疼的那侧乳房喂奶。

 

When removing your baby from your breast, break the suction gently by pulling on baby’s chin or corner of mouth.

在宝宝离开你的乳房时，请通过轻柔地拉宝宝的下巴或嘴角结束吮吸。

 

Warm, moist compresses applied to your nipples (if a yeast infection is not present) may be soothing.

在非酵母菌感染的情况下，湿性热敷或许可以减轻疼痛。

 

Freshly expressed breastmilk applied to your nipples will not only soothe your nipples but also reduce the chances of infection, as human milk has antibacterial properties. (Again, do not use if thrush is present.)

挤点新鲜的乳汁抹在乳头上不仅可以减轻乳头疼痛，而且可以减少感染的机会，因为母乳具有抗菌的作用。（同样地，有鹅口疮的情况下不要用这种方法。）

 

Moist wound healing has been shown to be very effective for healing sore nipples. Keeping your nipples covered with a medical grade (100% pure) modified lanolin ointment or hydrogel dressing will encourage any cracks to heal without scabbing or crusting.

保持乳头的湿润对乳头疼痛的愈合非常有帮助。用100%纯的医用级羊毛脂膏或水凝胶敷料抹在乳头上能促使裂口愈合且不会结痂。

 

Moist tea bags applied to the nipples are a folk remedy that recent research has shown to have an astringent effect that may promote drying and cracking, and is therefore not advised.

用湿润的茶叶袋敷乳头是一个偏方，但最新研究显示它具有收敛作用，可能导致乳头皮肤干燥和皲裂，所以不再提倡。

 

At one time, it was recommended that a hair dryer or sunlamp be used on sore nipples. Research has now shown that this promotes drying and further cracking and is not advised.

曾经，吹风机或太阳灯被认为可以用于治疗疼痛的乳头，但最新研究显示这将导致干燥和进一步的皲裂，所以也不再建议使用。

 

Resources for Additional Information

其他信息资源

 

The LEAVEN article “Nipple Pain: Causes, Treatment and Remedies” will provide you with additional information, as will the many resources on our nipple pain Web resource page.

母乳会杂志《影响力》有一篇文章“乳头疼痛：原因、处理和治疗”将为我们提供更多信息，网站上还有很多关于乳头疼痛的资源。

 

Contact a local La Leche League Leader for more information and support during this challenging time.

在这样艰难的时期，联系国际母乳会当地的哺乳辅导可以获得更多的信息与支持。

 

These pamphlets may be ordered from the LLLI Online Store or a Leader may have a copy you can purchase.

这些小册子可在国际母乳会英文网站的网店上订购，从哺乳辅导那里或许也可以买到。

 

Positioning Your Baby at the Breast is a step-by-step guide to positioning the baby correctly to ensure that baby sucks well and gets plenty of milk, and mother avoids nipple soreness and pain.

喂奶的姿势是一个逐步改进的过程，正确的哺乳姿势可以使宝宝很好地吮吸并获得充分的乳汁，而妈妈可以避免乳头疼痛。

 

Sore Nipples includes step-by-step illustrations of latch-on and emphasizes the importance of correct positioning; also features recommendations about treatment of sore and cracked nipples reflecting current research on moist wound healing.

乳头疼痛的处理包括正确含乳的逐步说明，同时强调正确哺乳姿势的重要性；另外，也要关注处理乳头疼痛和皲裂的湿性伤口愈合的最新研究成果。

 

Breastfeeding Resources:

母乳喂养资源：

 

THE WOMANLY ART OF BREASTFEEDING, NEW 8th Edition, published by La Leche League International, is the most complete resource available for the breastfeeding mother.

《母乳喂养的女性艺术》，第8版，由国际母乳会出版，为母乳喂养的妈妈们提供了最全面的资源。

 

LLLI Breastfeeding Tips and Products includes helpful answers to frequently asked breastfeeding questions plus a section that features books and products.

国际母乳会母乳喂养技巧与产品栏目可以给母乳喂养常见问题提供帮助，并且还有书籍和相关产品出售。

 

Page last edited 2011-06-21 21:32:46 UTC.

英文原文http://www.llli.org/faq/heal.html

母乳的分泌原理：宝宝吸吮刺激乳头上的神经传感器，这些传感器将信息传送至妈妈脑内的下垂体分泌泌乳素和催产素至妈妈的血液中，促使乳腺及其组织分泌和释放乳汁。

刚刚分娩完是靠妈妈身体分泌的荷尔蒙产生乳汁，头三天是初乳，初乳是最珍贵的奶，蛋白质高，营养丰富，抗体最浓，所以被誉为“黄金奶”。孩子出生一个小时内开始吸吮乳房是最好的，一天吸10—12次。

第三天你的荷尔蒙会引起突然奶胀，有的妈妈是第四天甚至第五天，在月子里你的奶是通过宝宝的吸吮来控制的，但月子之后（通常后四到六周），很多妈妈发现奶量少了，这时候会很紧张，但不用担心，因为你和宝宝之间在奶量需求供应上已经达到一个平衡了，他的需求就是你身体提供的，这时你的乳房应该软了，不胀了，或者比较少胀，只是当孩子睡的时间比较长或者妈妈出门比较久，错过本来该喂奶的时间才会感觉胀奶。

如果产后四到六周还经常胀奶说明妈妈的奶量供应大于宝宝需求。应尽量避免奶量过多，每次宝宝吃完不用挤奶器排空，否则容易产太多引起其他麻烦。你的奶量和宝宝的需求达到平衡才是最理想的状态，供需平衡后乳房不胀奶，妈妈很舒服，宝宝也能吃到所需的奶量。

（本文根据对 Ivy Makelin 的采访内容整理）

网友：宝宝今天才11天，纯奶粉能吃70毫升左右，自己感觉母乳有一些不够，但是还是想让宝宝喝母乳。每次都是先让他吸20分钟乳房再喂奶粉能喝40毫升左右，请问这样的混合喂养有什么不妥的地方？

周宗蓓：一天喂几次母乳？如果每一次先喂母乳再喂奶粉，那么母乳量达不达到10—12次呢？在24小时之内，如果能达到的话，其实有可能根本不需要增加奶粉。

任何纯母乳喂养的宝宝如果把一个奶瓶塞到他嘴巴里，不管放什么东西在里面，因为他出生有那么强烈的吸吮需求，所以他还是会喝掉很多，这个不证明他饿或者没吃饱或者奶不够，这个只是说明他有一种特别强烈的吸吮需求，不证明孩子饿了。如果妈妈已经喂了20分钟在一边或者两边，孩子已经吃得很够了。因为一个出生婴儿的喂只有像他的小拳头那么大，一个乒乓球那么大。如果孩子是用奶瓶喂的，不管喂什么，通常吃的比他的胃口多得多，所以他的胃涨起来像气球吹起来一样，这样判断他的胃口是不准确的，是虚的，其实胃口没有那么大。

妈妈不用判断孩子母乳喂养完吃多少奶就够了，这是一个不正确的判断标准，妈妈也不能用挤奶器挤出来看有多少奶。挤奶器是一个机器，跟自己的宝宝含你的乳头是不一样的，有很多心理因素会影响你的喷乳反射，母亲对于一个机器的喷乳反射跟自己宝宝的喷乳反射是不一样的。妈妈不用担心，我们的乳房天生没有这个刻度，乳房上面没有写多少量是合适的，我们根本不用担心。我们怎么判断出来孩子吃得够不够？一个是我们的次数有没有达到，有的妈妈说我的奶不够，一天24小时喂五六次，那这个次数远远不够。再少应该给一个新出生的婴儿喂8—12次，也可以超过这个次数，如果觉得孩子还吃得不够饱的话。最好定一个目标，至少10—12次，8次对于有的孩子太少了。

国际母乳会哺乳辅导　 陈淑娟

大部分的妈妈从孕育新生命开始就自然特别注意饮食的摄取。孕育一个健康的宝宝是所有母亲的第一愿望。哺乳期的妈妈持续对饮食的关注以确保母乳的营养， 并且母体的健康也直接影响着她照顾宝宝的能力。

母体营养的基本概念

在1944-1945， 在荷兰大饥荒的冬天，其妇女普遍处于营养不良的状况。那时候出生的宝宝并不因为妈妈的身体状况而影响他们日后的生长发育。(Smith,1947) 在巴西营养不良的妇女所分泌的奶水中反而较营养充裕的妈妈含较多的脂肪成分。(Spring et al., 1985) 孟加拉国处于营养不良边缘的妇女仍维持平均每天可产乳汁750ml 。(Brown etal., 1986) 综合这些广泛的研究证实当母体面临营养不良的状况对乳汁的分泌及成分影响有限。

天生的母性让我们在得知怀孕开始自然的改变饮食习惯，去摄取营养及多样性的食物；同样的在哺乳期也应鼓励这样的行为。 哺乳期明显额外需增加200-500 卡路里热量的需求。

增加液体的摄取也有帮助， 但并不需刻意强调。当母体感觉口渴，摄取足够的水分自然能分泌足够的奶水。 最简单的方式是建议妈妈每次坐下来喂奶时手边同时也准备一杯水随时可饮用。此外她可以观察尿液颜色。如果她摄取到足够的水分，早上醒来的第一次小便颜色应该是清澈到淡黄色之间。 若液体的摄取量不够将导致母体的乳汁制造量减少。(Stumbo et al., 1985)

我们也鼓励哺乳期的妈妈根据她的需要及文化背景摄取多样化自然的食物，尽量避免过度加工化的食物。通常完全哺喂母乳的妈妈若不过度进食并注意脂肪含量不要过高，并不容易增加体重，特别在前几个星期需制造大量乳汁及哺喂频繁时。

食物

大部分的妈妈可摄取她们希望摄取的食物， 对宝宝并不会有影响。尽管如此，许多哺乳妈妈仍被告知许多并不需要的哺乳饮食禁忌。一旦宝宝有特别的哭闹不安情形产生，妈妈可能就联想到是不是吃了不该吃的食物。

有些妈妈根据她们的文化背景在怀孕及哺乳期避免摄取一些会造成宝宝问题的食物。这些饮食禁忌各地区有所不同。例如：在中国和东南亚的国家避免坐月子期间或哺乳期进食冷饮。除了怕影响恶露排出外也担心对宝宝有不好的影响。一些非洲的美国妇女在哺乳期间会避免吃洋葱。苏丹妇女在怀孕及哺乳期避免多盐、酸及辣的食物以免引起心口灼热、腹泻、肠绞痛及恶心、呕吐。 在澳洲， 哺乳期的妈妈避免更多的食物，包括：包心菜、巧克力、辣食物、豆类、洋葱、花椰菜及许多的水果及蔬菜。理由可能是在过去的经验中这些食物与引起宝宝皮肤过敏、肠绞痛有相关性。但牛奶并不包含在其中，虽然现今牛奶已被证实是引起高过敏的食物。

常见的关于哺乳期营养的疑虑

许多妈妈问是不是该吃什么食物以便让宝宝吃到更营养丰富的奶水？好的营养意味着根据当地的文化背景尽可能多摄取多样化及营养均衡的食物。通常而言在“食物新鲜”及”有益健康”的原则下并没有对哺乳妈妈应该吃或不能吃的建议，但会因国情文化差异的不同而有所差异。以下是常见的一些问题：

Q：哺乳时的钙质流失会不会导致日后母体的骨质密度疏松？

A：不会， 根据研究在哺乳期母体的骨质密度较配方奶哺喂者低。但待离乳后，母乳妈妈们的骨质密度反而较高。

Q：母乳中的铁含量如何?

A：许多研究证实母乳宝宝吸收母乳中的铁相较配方奶喂食者有较高的利用率。完全哺乳六个月者通常不会有缺铁的疑虑。足月宝宝持续哺乳至九个月母乳中的铁可以满足他的需求。值得一提的是：过早添加副食品将使宝宝体中的铁含量减少。

Q：母体摄取咖啡因会影响母奶宝宝吗？

A：一般哺乳妈妈每天摄取平均总量750ml的咖啡并不会对宝宝造成问题。(Nehligand Debry 1994) 但必须考虑体质敏感的例外，也必须考虑除了咖啡、茶类、可乐或其他含咖啡因的饮料及含咖啡因的药物。宝宝体内积聚太多咖啡因将使宝宝的神经过度刺激，易哭闹不易安抚。

Q：对高敏感宝宝或家族过敏遗传的饮食该如何建议?

A：若宝宝有下列症状：如喂奶后哭闹不安、长时间的哭闹、睡眠中断不安稳、湿疹、喘鸣等则考虑是否食物引起的过敏反应。若妈妈因一样新食物而引起宝宝的过敏问题，应在24小时内去除。若是因妈妈长期进食引起的食物累积所激发的过敏反应，则在排除问题食物后，几天后宝宝的症状将逐渐改善， 但仍需2-3星期才能将食物完全排除于母体外。

许多怀孕或哺乳期的妈妈选择以牛奶来提供钙质的营养来源，但牛奶却是引起高过敏的食物来源。 研究发现母体里的牛乳抗体以一种蛋白质型态透过奶水引起宝宝的哭闹不安。另一项报告发现肠绞痛宝宝的母亲奶水中含较高的牛奶蛋白。在66 个有肠绞痛宝宝的妈妈，其中三十五个在排除乳制品后其宝宝的肠绞痛有明显的改善。但因牛乳蛋白需10-14天才能完全排出母体外，故提醒妈妈在停用乳制品后需观察一至两星期。可改摄取其他食物含高钙食物例如：卤白菜的一杯份量的钙质含量相当于1/2杯牛奶中的钙含量。半杯的芝麻所含的钙质是一杯牛奶的两倍，可用于饼干或麦片上。其他含钙丰富的食物来源，包括：蜜糖、豆腐、菠菜、花椰菜、大头菜、肝脏、沙丁鱼、鲑鱼和软骨皆含丰富的钙质来源。其中Blackstrap 蜜糖又浓又甜，营养成份很高，两汤匙就含有274 mg的钙质﹝相当于一杯牛奶的含钙量﹞，也是非乳制品食物中的最佳钙质源之一。其他易引起过敏的食物有蛋、麦片、玉米、猪肉、鱼、虾、蟹、花生、蕃茄、洋葱、包心菜、草莓、核仁、香料、柑橘类……等。

对于没有家族遗传过敏的妈妈并不需刻意为了避免孩子过敏而排除易过敏的食物。妈妈并不需要为了哺乳而放弃食物所带给我们的满足感。只需要在孩子出现症状时考虑排除该特定食物。

对于有过敏遗传的家庭，有研究显示若妈妈从怀孕开始就将会引起家人过敏的食物排除并持续到后来的哺乳期，将使宝宝日后过敏的机率大大降低。

母乳的颜色

有时候因妈妈所进食的食物或药物将使母乳或宝宝小便的颜色改变，通常并没有关系。

有报告指出香吉士汽水所含的红、黄色素，使奶水颜色呈现粉红-橘色间的色调。而另一位喝香吉士汽水妈妈则发现宝宝的小便呈现粉红-橘色间的色调。至于绿色奶水与宝宝的绿色小便，根据研究与饮料中的绿色食用色素相关或有可能是妈妈食用了海草类及一种海藻类锭剂(一种健康食品)。

许多妈妈提到宝宝解绿色水便，但并没有其他生病症状，这可能是一种”泌乳过剩症候群”，(oversuppy syndrom) 妈妈交替乳房过于频繁， 以致宝宝只喝到含乳糖丰富的前奶，而太多乳糖会刺激宝宝的消化道而快速排泄，产生绿色水泻便。若长期下来，宝宝因含脂肪丰富的后奶摄取较少，即使妈妈的奶水供应十分充裕仍会产生宝宝体重增加迟缓的现象。

对素食哺乳妈妈的建议

素食者分好几种。原则上若有摄取到动物性蛋白食物来源则素食者喂母乳与一般妈妈无异。例如：虽素食但可接受乳制品及蛋，或有的只接受乳制品。这些食物多少含有动物性蛋白。若饮食中完全没有动物性蛋白来源的话， 则可能需要补充品来避免B12的缺乏。B12缺乏症包括手麻、 食欲减低、嗜睡、肌肉萎缩、呕吐等。若不愿意接受B12补充品，可建议添加发酵豆制品或在食物中添加酵母。一个研究中提到素食哺乳的妈妈较一般未素食者体内含较少的钙与维D，但不会影响母乳中的钙含量。只要宝宝每天日晒几分钟就可以得到足够的维D。鼓励素食哺乳者多摄取其它含钙丰富的食物。

参考资料

1.Breastfeeding and Human Lactation

2. Breastfeeding 4th, A guide for the medical profession, Ruth A, Lawrence

3.Breastfeeding Answer book, La leche league International, Nancy Mohrbacher, IBCLC

and Julie Stock, BA, IBCLC