母乳喂养不仅仅是一种生活方式的选择，它还是对母婴双方都很重要的一个健康选择，所以相关的卫生健康部门都支持母乳喂养。

  2001年，世界卫生组织建议： 6个月内纯母乳喂养是最佳的婴儿喂养方式。婴儿添加辅食后，他们建议母亲们将母乳喂养持续到两岁或更长时间。1997年，美国儿科学会发表声明指出，母乳应是所有新生儿的首选食品。美国儿科学会也建议婴儿在出生后的头六个月里应纯母乳喂养，不需添加任何辅食；另外母乳喂养应至少持续12个月或根据母婴双方的共同意愿来决定。这里提供一些国际母乳会和卫生保健机构认为母乳喂养十分重要的理由。
保护婴儿远离疾病

母乳喂养的孩子患感冒、中耳炎、上呼吸道感染，甚至慢性疾病（如哮喘）的次数和严重程度都明显降低。母乳喂养的婴儿较少患腹泻、其他肠胃疾病、肺炎、脓毒病、肠胃炎、脑膜炎以及某些儿童癌症。由于患上述疾病的次数和严重程度的降低，母乳喂养婴儿看医生的次数就较少。

Davis, M.K. Breastfeeding and chronic disease in childhood and adolescence. Pediatr Clin N A 2001; 48(1):125-41.

Haby, M.M. et al. Asthma in preschool children: prevalence and risk factors. Thorax 2001;56:589-95.

Oddy, W.H. et al. Maternal asthma, infant feeding, and the risk of asthma in childhood. J Allergy Clin Immunol 2002;110:65-7.

Scariati, P.D. et al. A longitudinal analysis of infant morbidity and the extent of breastfeeding in the United States. Pediatrics 1997;99(6):e5.

从出生到成年早期都表现出较高的智商

研究表明，婴儿时期母乳喂养的孩子和以配方奶喂养的孩子相比，智商的差异多达5至10点。注释中提及的Mortensen研究报告比较了一系列关于智力的研究，该比较综合了其它可能的影响因素，如父母的受教育程度，母亲是否抽烟以及婴儿的出生体重。近期人们才认识到的，天然存在于母乳中的不饱和脂肪酸二十二碳六烯酸(DHA)和花生四烯酸（AA）以及它们在婴儿大脑的发育过程中所起到的作用也许是造成上述智力差异的一个因素。

Mortensen, E.L. et al. The association between duration of breastfeeding and adult intelligence. JAMA 2002;28(15):2365-71.

Xiang, M. et al. Long-chain polyunsaturated fatty acids in human milk and brain growth during early infancy. Acta Paediatr 2000; 89(2):142-47.
剂量反应：母乳喂养越多，提供保护越多

当婴儿是纯母乳喂养时，母乳喂养为婴儿免患疾病提供了最大的保护。这种保护随婴儿接受辅食量的增加而逐渐减少（辅食包括配方奶、牛奶或其它食物）。母乳喂养的时间越长，婴儿也将得到越多保护。科学研究称这种作用为“剂量反应”。母乳喂养对下述状况呈现出剂量反应：儿童白血病和淋巴瘤，中耳炎，呼吸道感染，腹泻，B型流感嗜血杆菌（HIB），肥胖和超重，达到成长发育的重要指标。

Bener, A. et al. Longer breastfeeding and protection against childhood leukemia and lymphomas. Eur J Cancer 2001;337(2):234-38.

Raisler, J. et al. Breastfeeding and infant illness: A dose-response relationship? Am J Publ Hlth 1999;89(1):25-30.

促进婴儿免疫系统发育

母乳中含有免疫球蛋白、白血球和抗炎症因子，帮助婴儿的免疫系统在出生后发育成熟。婴儿出生后头几天中产生的母乳富含免疫因子。分泌性免疫球蛋白A（IgA），母乳中存在的一种活性分子,可以减少母乳宝宝患急性肠胃疾病的风险。母乳中的免疫球蛋白A（IgA）也可以刺激婴儿的免疫系统制造更多的分泌免疫球蛋白A（IgA）。母乳对婴儿免疫系统的促进作用会持续保护儿童，甚至到断奶以后。

Feist, N. et al. Anti-endotoxin antibodies in human milk: Correlation with infection of the newborn. Acta Paediatr 2000; 89(9):1087-92.

Mackie, R.I. et al.Developmental microbial ecology of the neonatal gastrointestinal tract. Am J Clin Nutr !999; 69(Suppl): 1035S-45S.

Ronayne de Ferrer, P.A. et al. Lactoferrin levels in term and preterm milk. J Am Coll Nutr 2000;19(3):370-73.
母乳可杀死癌细胞及其它病菌

在实验室条件下发现：母乳中的物质可杀死肺、咽喉、肾、直肠和膀胱中的癌细胞，以及淋巴瘤细胞，白血病细胞和肺炎球菌。其他研究人员在实验室条件下也观察到了相似的结果：母乳杀死或中和了衣原体孢子、HIV（人类免疫缺陷病毒）和某些种类的细菌。母乳作用的研究成果为研究人员开发新的疾病治疗方法提供了帮助。

Jensen, R.G. et al. The anticarcinogenic conjugated fatty acid, 9c, 11t-18.2, in human milk: confirmation of its presence. J Hum Lact 1998; 14(1):23-27.

Lampe, M.F. et al. Killing of chlamydia trachomatis by novel antimicrobial lipids adapted from compounds in human breast milk. Antimicro Agen Chemo 1998;42(5);1239-44.

Lee-Huang, S. et al. Lysozyme and Rnases as anti-HIV components in B-core preparations of human chorionic gonadotropin. Proc Natl Acad Sci USA 1999; 96:2678-81.
母乳喂养惠及家庭和社会

母乳喂养为家庭和社会减少经济压力。除了母乳是免费的这一好处外，母乳喂养还可以减少家庭在卫生保健方面的开支。美国的一项研究表明，根据母乳喂养时间的长短，每个家庭可节省200-800美元不等（约人民币1600－6400元）。

当低收入母亲选择母乳喂养时，用来帮助困顿人群的社会资源就可得到更长时间的使用。当婴儿接受母乳喂养时，母婴双方一生都会更健康。母乳喂养改善公共健康，减轻医院、保险公司和政府补助项目的经济压力。

Ball, T.M. Bennet, D..M. The economic impact of breastfeeding. Pediatric Clinics of North America 2001; 48(1):253-62.

Fok, D. et al. The economics of breastfeeding in Singapore. Breastfeed Rev 1998;6(2):5-9.

Montgomery, D.L. et al. Economic benefit of breast-feeding infants enrolled in WIC. J Am Diet Assoc 1997; 97(4):379-85.

母乳喂养有利环保

母乳喂养不必消耗金属、纸张、塑料，也不存在制造包装和运输配方奶和喂养器械所存在的能源需求。由于母乳可以被婴儿更充分地吸收，因此母乳喂养婴儿减少了污染和废物处理问题。另外，研究显示，纯母乳喂养提供了天然的避孕。虽然我们生活在一个被污染的世界里，科学家们仍一致认为母乳是婴儿最理想的营养来源，它甚至可以保护婴儿免受某些污染的影响。

Lovelady, C.A. et al. Weight change during lactation does not alter the concentration of chlorinated organic contaminants in breast milk of women with low exposure. J Hum Lact 1999:15(4):307-15.
如欲了解更多信息，请参照：

THE WOMANLY ART OF BREASTFEEDING. Schaumburg, IL:LLLI, 1997.

THE BREASTFEEDING ANSWER BOOK. Schaumburg, IL:LLLI, 2003.
为了获得母乳喂养的支持，或订购我们的出版物，或找到你附近的国际母乳会哺乳辅导，请登录我们的网站：www.muruhui.org

Marsha Walker, 国际认证泌乳顾问注册护士

●正常胎儿的胃肠道是无菌的

●分娩方式影响肠道微生物的形成
阴道分娩（顺产）的新生儿植入了母亲体内的细菌
剖宫产出生的新生儿最早接触的细菌可能来自外部环境、其他婴儿或护理人员，他们是细菌的载体
剖宫产出生的新生儿的主要肠道菌群可能受到长达六个月的干扰 (Gronlund et al, 1999)

● 不良微生物或非母体植入的高风险人群包括：剖宫产的婴儿、早产儿、需要重症监护的足月婴儿，或与母亲分离的婴儿
需要重症监护的婴儿获得肠道微生物较慢，建立双歧杆菌菌群也较慢
肠道细菌植入迟缓，种类有限，可能引发恶性后果
用母乳调节、影响新生儿的肠道，可作为防治肠道疾病的良方 (Dai & Walker, 1999)

● 使用抗菌剂的新生儿体内可能发生严重生态失调
在新生儿监护病房降低新生儿生态失调的措施之一是给他们喂新鲜的母乳 (Zetterstrom et al, 1994)

● 母乳宝宝和奶粉宝宝的肠道菌群不同
母乳宝宝肠道pH值较低，约为5.1-5.4（酸性环境），在最初的六周内以双歧杆菌为主，还有大肠杆菌，拟杆菌，梭菌和链球菌等降低病原的（致病）微生物
依据饮食类型建立的菌群出现在第四天，母乳宝宝肠道含有47%的双歧杆菌，奶粉宝宝仅为15%。此外，奶粉宝宝肠球菌含量较多。(Rubaltelli et al, 1998)
奶粉宝宝肠道pH值较高，约为5.9-7.3， 同时含有较多腐坏细菌
母乳和人工混合喂养的婴儿，在头四周肠道平均pH值为5.7-6.0，第六周降至5.45
如果在婴儿出生后最初七天内添加奶粉，将推迟形成体内的强酸性环境，该环境的潜能可能永远无法彻底发挥
添加了奶粉的母乳宝宝形成的肠道菌群及其行为类似奶粉宝宝

● 新生儿出生后，胃肠道经历了迅速的发育和成熟过程
  出生时宝宝的肠道功能不成熟，免疫发育不完善
胃肠道粘膜连接紧密，可能需要发育数周以上才能成熟，才能完全隔离蛋白质及致病菌
母乳宝宝肠道渗透率降低得比奶粉宝宝快 (Catassi, et al, 1995)
开放且不成熟的粘膜可能导致坏死性小肠结肠炎、腹泻及过敏
初乳及乳汁中分泌型免疫球蛋白A可以覆盖肠道，在新生儿肠道功能不完善时提供被动型免疫
母体分泌的免疫球蛋白A具有抗原特异性，抗体针对宝宝直接接触环境中的病原体
母亲吞咽、吸入或以其他方式接触致病菌时，在体内合成抗体
这些抗体会忽略正常肠道中的有益细菌，专门对抗疾病，却不会引起发炎

● 在母乳宝宝肠道屏蔽形成前不应当喂配方奶
  开始喂食添加品后,母乳宝宝的肠道菌群类似奶粉宝宝,不再以双歧杆菌为主,出现了专性厌氧菌 (Mackie, Sghir, Gaskins, 1999)
即使给母乳宝宝添加很少量的奶粉(每24小时1次),其肠道菌群也会向奶粉宝宝转变 (Bullen, Tearle,
Stewart, 1977)
添加固体食物会导致母乳宝宝的肠道系统发生剧烈变化,肠杆菌和肠球菌迅速增长,逐渐被拟杆菌、梭状芽胞杆菌和厌氧链球菌定植。 (Stark & Lee, 1982)
添加配方奶后，母乳宝宝的肠道菌群在24小时之内变得几乎与成人肠道菌群没有区别 (Gerstley, Howell, Nagel, 1932)
即使恢复纯母乳喂养，也需要2-4周的时间，肠道才能恢复成有利于革兰氏阳性菌群的环境 (Brown & Bosworth, 1922; Gerstley, Howell, Nagel, 1932)
● 来自易感家族的宝宝，出生头三天内，可能只需一瓶配方奶（错加、非必需的添加、或者是计划中添加），就足以使其对牛奶蛋白过敏。(Host, Husby, Osterballe, 1988; Host, 1991) 在新生儿育婴室应当避免即使是小剂量的过敏源，防止牛奶引起的过敏反应。(Cantani & Micera, 2005)
如果新生儿父母有一人有遗传性过敏，则其患病风险在37%；如果父母双方都是遗传性过敏，根据他们相同或不同的病因，62-85%的新生儿可能患病。不管家人情况如何，这些宝宝脐带血中免疫球蛋白E的含量增高。(Chandra, 2000)
牛奶蛋白和人乳蛋白存在交叉反应 (Bernard et al, 2000)，只要1纳克的牛乳清蛋白B就可以感染一个易感婴儿。(Businco et al, 1999)
具有过敏风险的母乳宝宝可以用低变应原的奶粉补充；6个月以内不应当添加固体食物，1岁以内不应当添加奶制品，妈妈应当在自己的饮食中完全避免花生、坚果、牛奶、鸡蛋和鱼。(Zieger, 1999; AAP, 2000)
冷冻的母乳是母乳宝宝的最好加餐，特别是高风险的易感人群；如果没有储存的母乳，推荐用深度（非部分）水解蛋白的奶粉 (Oddy et al, 2003)
对哮喘和过敏的研究结果可能因为宝宝早期喝过配方奶而受到干扰，小剂量的配方奶对宝宝的免疫系统可能造成伤害；即使母亲之后主要是纯母乳喂养，这一点也应当在研究分析时加以考虑。
● 对于易感家族的宝宝，过早接触牛奶可能增加患胰岛素依赖型糖尿病的风险 (Mayer et al, 1988; Karjalainen, et al, 1992)
  母乳中人胰岛素的含量比牛奶中牛胰岛素含量高；婴儿配方奶中胰岛素含量很低，甚至没有；胰岛素促进肠道成熟。
在动物试验中，口服人胰岛素刺激肠道免疫系统产生活跃细胞机制，以抑制自身免疫性糖尿病的发展
缺乏人胰岛素的配方奶可能破坏胰岛素的耐受性，并导致I型糖尿病的发展 (Vaarala et al, 1998)
在生命的最初几个月避免摄入牛奶蛋白，可能会减少以后发生胰岛素依赖型糖尿病，或延缓其在易感个体发病 (AAP, 1994)
纯母乳喂养至少4个月的婴儿患导致β细胞自身免疫的血清转换风险较低
母乳喂养时间较短或者过早添加牛奶为主的配方奶粉容易导致易患I型糖尿病的儿童出现β细胞自身免疫性疾病 (Kimpimaki et al, 2001)
对牛奶蛋白免疫记忆的发生和发展是导致胰岛素依赖型糖尿病的第一步 (Kostraba, et al, 1993)
肠道细胞形成紧密的封闭层之前接触牛奶就可能引发过敏
在感染引起胃肠道变化、抗原穿越被破坏的粘膜、启动免疫反应时，接触牛奶可能引发过敏
如果肠道中的牛奶蛋白破坏粘膜，引起肠道发炎，破坏了细胞连接成分，可能引起过敏。其他牛奶蛋白的干扰也可能引起过敏 (Savilahti, et al, 1993)
非母乳喂养或短期母乳喂养的儿童，会更多患β细胞自身免疫性疾病。过早接触牛奶的宝宝，直到5岁，患I型糖尿病的风险都会增加。(Holmberg et al, 2007)

美国儿科学会营养委员会、欧洲儿科变态反应和临床免疫学会及欧洲儿科胃肠病、肝病和营养学会，一致建议将纯母乳喂养作为预防食物过敏的手段。(Zeiger, 2003; Muraro, et al, 2004)

References
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American Academy of Pediatrics, Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics 2000; 106:346-349
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Smart Steps to Safer Bedsharing 安全同床共眠的好做法

Meet all seven and you can sleep sweet 符合七要诀，你可以睡得更安稳

翻译审校：Daisy, Hetty

1. NO SMOKING 禁烟

In the home or outside 屋内与屋外

2. SOBER PARENTS 父母双方皆清醒

No Alcohol 没有酒精

No Drowsy Meds 没有使人困倦的药物

3. NURSING MOTHER 母乳妈妈

Day & Night 白天与夜晚

4. HEALTHY BABY 健康的宝宝

Full Term 足月

5. BABY ON BACK 宝宝仰睡

6. NO SWEAT 没有流汗

No Swaddle 没有被包裹着

7. SAFE SURFACE 安全的平面

No super-soft mattress, no extra pillow, no toys, no heavy covers 没有极软床垫，没有额外的枕头，没有玩具与厚重的被褥

Clear of strings and cords 没有松脱的线绳

Pack the cracks: use rolled towels or baby blankets 使用卷起的毛巾或婴儿毛毯填补空隙

Cover the baby, not the head 被子盖宝宝的身体，不要盖到头

 

A Rhyme for Sleep Time 睡前的韵诗

Sing to “Row, Row, Row Your Boat” 唱着：“划呀，划呀，划小船”

No smoke sober mom  没有抽烟，清醒的妈咪

Baby at your breast. 宝宝在你的乳房

Healthy baby on his back. 健康的宝宝仰睡着

Keep him lightly dressed. 保持轻便的穿著

 

Not too soft a bed. 床不要太软

Watch the cords and gaps. 注意绳索和隙缝

Keep the covers off his head 别让被子盖到头

For your nights and naps.为着你的夜晚与打盹的安全

Where Does Donor Milk Banking Fit in Public Health Policy?

Lois W. Arnold, MPH, IBCLC

from BREASTFEEDING ABSTRACTS, February 2002, Volume 21, Number 3, pp. 19-20.

作者：罗伊斯· W· 阿诺德，公共卫生硕士，国际认证专业哺乳顾问

摘自《母乳喂养摘要》，2002年2月第21期，19~20页

Daisy, Christina 译 Shiuh-jane 审校

 

In 1980 the World Health Organization and UNICEF issued the following joint statement:

Where it is not possible for the biological mother to breastfeed, the first alternative, if available, should be the use of human breast milk from other sources. Human milk banks should be made available in appropriate situations¹ [Italics added by author].

1980年世界卫生组织和联合国儿童基金会联合发表声明：

在母亲不能亲自哺乳的情况下，如有可能，第一选择是使用其它来源的母乳。在适当情况下应该建立母乳库。^１

 

Even after the publication of reports that HIV could be transmitted through human milk, WHO and UNICEF continued to make positive statements about donor milk banking:

即使有公开报告显示，HIV可能会通过母乳传染，但世界卫生组织和联合国儿童基金会还是继续做出了倡议母乳库的积极声明：

 

When a baby is to be artificially fed, the choice of feeding method and product should not be influenced by commercial pressures. If donor milk is to be used, it must first be pasteurized, and where possible, donors should be screened for HIV.²

当婴儿要采取人工喂养时，喂养方式和产品的选择不应受商业压力的影响。如果要使用捐赠的母乳，必须经过巴氏消毒，条件允许的话，捐赠者应做HIV检测。²

 

Donor milk banking also plays a role in another WHO/UNICEF initiative, The Baby-Friendly Hospital Initiative. Donor milk banking can be applied to six of the Ten Steps to Successful Breastfeeding. Written breastfeeding policies in the hospital should list donor milk as an alternative feeding (Step 1) and all staff in the hospital should be trained to implement the policies relating to the use of donor milk (Step 2). All pregnant women should be informed of the benefits of human milk and how important it is for infants to have human milk as first feedings, using donor milk if no maternal milk is available (Step 3). All mothers should be shown how to express their milk (Step 5), and hospital staff should provide no food or drink other than human milk, with donor milk being used in preference to formula when supplementation is needed (Step 6). This means that the Baby-Friendly Hospital should have a supply of donor milk on hand, making it as easy to pull off the shelf as formula. Step 10 deals with community support of mothers. Part of community support should be knowing where donor milk banking resources are and helping mothers to access them, either to become donors or as the mother of a potential recipient.³

母乳库也是世界卫生组织和联合国儿童基金会的爱婴医院行动计划中的一项重要内容。在成功母乳喂养的十个步骤中，母乳库就适用了其中的六项。医院的成文的母乳喂养政策应将捐赠的母乳作为可选的喂养方式的一种（步骤１）。所有的医院工作人员都要经过培训来贯彻执行这项涉及到使用捐赠母乳的政策（步骤２）。所有的孕妇都应被告知母乳的益处，以及把婴儿吃母乳作为首选的喂养方式的重要性，如果没有母亲的母乳，要有捐赠的母乳可以用（步骤３）。应向所有的母亲演示如何挤奶（步骤５）。所有的医护人员不得提供除母乳以外的任何食物或饮品，如果必须要添加补充食物，要优先使用捐赠的母乳，其次才是配方奶（步骤６）。所有这些意味着爱婴医院应该有捐赠母乳的储存，就像拿出配方奶那样随手可得。步骤10是要有针对母乳妈妈的社区支持。社区支持的内容包括要了解何处有母乳捐赠的来源，并帮助母亲们获得这些资源，这样她们或是成为母乳的捐赠者或是成为接受者。³

 

There are also policy documents in place within the US which could support donor milk banking services. While donor milk banking is not specifically mentioned, it is an integral part of the policies relating to the importance of breastfeeding and human milk. For example, the Healthy People 2010 Goals for the Nation place an emphasis on prevention of morbidity through an increase in breastfeeding rates.⁴When used clinically, donor milk has comparable potential for preventing and reducing morbidity and mortality.

美国也有相关的政策支持母乳库的服务。虽然母乳库没有特别被提到，它却是母乳喂养和人乳重要性政策的不可分割的一部分。比如，2010国民健康计划着重提出通过提高母乳喂养率来预防疾病。⁴临床上使用时，捐赠的母乳有巨大的潜能来阻止和降低婴儿发病率和死亡率。

 

The last policy statement from the American Academy of Pediatrics to deal exclusively with donor milk was in 1980, pre-HIV.⁵ While this statement has not been updated, other more recent references to donor milk banking in AAP publications such as the Pediatric Nutrition Handbook, Guidelines for Perinatal Care, and the Red Book on Infectious Disease have become replacement policy statements.^{6, 7, 8} They specify that anyone using donor milk should follow the voluntary guidelines established by the Human Milk Banking Association of North America.

美国儿科学会（AAP）专门针对母乳库的一项政策声明最后发表于1980年，在HIV被确诊前。⁵尽管这项声明没有再更新过，但其它较新的美国儿科学会刊物中关于母乳库的文献，如《儿科营养手册》、《周产期护理指南》，以及《传染性疾病红皮书》已成为替代的政策声明。^{6, 7, 8}这些出版物都指出，任何使用捐赠母乳的人都应遵守北美母乳库联盟的自愿准则。

 

Perhaps the most powerful AAP policy statement which addresses donor milk usage indirectly is the 1997 breastfeeding statement.⁹

也许美国儿科学会的政策声明中最有力地间接阐明捐赠母乳使用的是1997年的母乳喂养声明。⁹

 

Human milk is uniquely superior for infant feeding and is species specific; all substitute feeding options differ markedly from it.

人乳是独特的，是婴儿喂养的最佳方式。它对人类物种来说是独有的。所有的替代喂养方式都与此有着显著的区别。

 

“Human milk is the preferred feeding for all infants, including premature and sick newborns, with rare exceptions. When direct breastfeeding is not possible, expressed human milk, fortified when necessary for the premature infant, should be provided.

“人乳是所有婴儿的优先喂养选择，包括早产儿和生病的新生儿，很少有例外。如果直接的母乳喂养不可能，挤出的母乳（早产儿必要时母乳需经强化），应该提供给早产儿。

 

Donor milk is one way to obtain expressed milk and remains species specific despite some immunological losses during processing.”

捐赠的母乳是获得挤出的母乳的一种途径，而且能保持物种独特性，尽管在这个过程中会有一些免疫物质的损失。”

 

The most recent policy statement into which donor milk is easily incorporated is the Strategic Plan from the US Breastfeeding Committee.¹⁰ The first goal in the Strategic Plan is to “assure access to comprehensive, current, and culturally appropriate lactation care and services for all women, children, and families.” Donor milk banks are a lactation service, providing human milk when a mother has been unable to supply her own. Most milk banks in the US also provide lactation support in the form of counseling to donors and others in communities far and wide. Strategies for implementing the first goal of the Strategic Plan include education of health care providers as well as reimbursement by third parties of lactation services. This means that milk banks themselves must take a lead role in the collection of data and the education of health care providers and insurers, as MacPherson and Talbot stated in 1939:

最近将捐赠母乳毫无疑问地编入政策声明的是美国母乳喂养委员会所制定的战略计划。¹⁰战略计划的首要目的是“确保所有妇女、儿童和家庭都能得到全面的、最新的、文化上适宜的哺乳护理和服务。”母乳库是一种哺乳服务，当一位母亲无法自我提供母乳时，它可以提供。美国大部分的母乳库也以为社区的捐赠者及他人提供广泛的咨询服务的形式来提供哺乳支持。执行这个战略计划首要目标的策略包括对医疗保健人员进行教育以及从第三方（如保险公司）得到获取母乳的补偿费用。这就意味着母乳库自身必须承担数据收集、教育医疗保健人员和保险公司的角色，正如1939年麦克弗森和塔尔博特所说的：

 

“The milk bank also has the opportunity to educate physicians and medical students and nurses, by means of lectures and personal interviews. This should be one of its duties whenever the opportunity arises because of the tendency today to overemphasize the ease of feeding with cow’s milk mixtures.”¹¹

“母乳库也有机会通过演讲和个人访谈来教育医生、医学院学生和护士。只要有机会，这应该是它的职责之一，因为今日的流行趋势是过于强调配方奶喂养的简便性。” ¹¹

 

With so many places for donor milk to fit in the public health policy picture, why are we making so little progress in the US with donor milk banking? Why does Brazil, for example, have a milk banking system that is rapidly growing while in the US milk banking is rapidly losing ground? Politics, lack of funding, and lack of direction from agencies within the federal government combine to make milk banking very difficult in the US. More money needs to be put into breastfeeding and milk banking from all sectors of healthcare funding. Milk banks in the US also need to be federally regulated so that they can gain the trust and confidence of the healthcare community. Federal agencies such as the Centers for Disease Control (CDC), the Department of Agriculture (USDA), and the Food and Drug Administration (FDA) need to decide on jurisdictional issues and develop a cohesive plan of action relating to donor milk banking. Milk banks also need to collect better data and publish studies on clinical uses of donor milk in order to demonstrate need for the service and cost-effectiveness. Only then will we turn the tide and start growing milk banking again in the US.

有这么多的地方需要捐赠母乳来配合制定公共卫生政策，为什么美国母乳库建设的步伐还这么小？比方说，为什么在巴西，母乳库体系快速成长而美国的却在快速萎缩？需要有各方的更多的公共卫生资金投入到母乳喂养和母乳库的建设上。政治、资金的匮乏以及联邦政府专门机构指导的不足一起使美国的母乳库处境越来越难。联邦政府机构，如疾病控制中心（CDC）、农业部（USDA）和食品及药物管理局（FDA）等，应确定母乳库涉及的司法问题，并制定各部门协调一致的行动计划。母乳库也要收集更多的数据，对捐赠母乳的临床应用发表研究，以证明服务的需要和成本效益。只有那时我们才能扭转形势，让美国的母乳库重新成长。

 

Lois D. W. Arnold is the former Executive Director of the Human Milk Banking Association of North America and is the President of the National Commission on Donor Milk Banking. She is an administrative consultant to Baby-Friendly USA and is a co-author of the recently published Reclaiming Breastfeeding for the United States.

罗伊斯· W ·阿诺德女士是北美母乳库联盟的前任执行理事，也是国家母乳库委员会主席。她是美国爱婴医院的常务顾问，是最近出版的《让美国重新回到母乳喂养》一书的合著者。

 

REFERENCES

1. World Health Organization/United Nations Children‘‘s Fund. Meeting on infant and young child feeding. J Nurs Midw 1980; 25:31-38.
2. World Health Organization/United Nations Children‘‘s Fund. Consensus statement from the WHO/UNICEF consultation on HIV transmission and breastfeeding. April 30-May 1, 1992, Geneva.
3. World Health Organization/United Nations Children‘‘s Fund. Protecting, promoting, and supporting breastfeeding: The special role of maternity services. A Joint WHO/UNICEF Statement. Geneva: WHO, 1989.
4. Healthy People 2010 Goals. Available from the Centers for Disease Control and Prevention at www.cdc.gov or Health Resources and Services Administration at www.hrsa.gov
5. American Academy of Pediatrics Committee on Nutrition. Human milk banking. Pediatrics 1980; 65:854-57.
6. American Academy of Pediatrics Committee on Nutrition. Pediatric Nutrition Handbook, 4th ed. Elk Grove Village, IL: AAP, 1998, pp. 15-16.
7. American Academy of Pediatrics Committee on Fetus and the Newborn and American College of Obstetrics and Gynecology Committee on Obstetric Practice. Guidelines for Perinatal Care, 4th ed. Elk Grove Village, IL: AAP, 1997, pp. 288-90.
8. American Academy of Pediatrics Committee on Infectious Diseases. 1997 Red Book, 24th ed. Elk Grove Village, IL: AAP, 1997, pp. 76-77.
9. American Academy of Pediatrics Work Group on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 1997; 100(6):1035-39.
10. United States Breastfeeding Committee. Breastfeeding in the United States: A National Agenda. Rockville, MD: MCH Bureau, Health Resource and Services Administration, DHHS, 2001.
11. MacPherson, C. and F. Talbot. Standards for directories for mother’s milk. J Pediatr 1939; 15:461-68.

What is an International Board Certified Lactation Consultant (IBCLC)?

An IBCLC is a health care professional who specializes in the clinical management of breastfeeding. IBCLCs are certified by the International Board of Lactation Consultant Examiners. IBCLCs work in a variety of health care settings including hospitals, pediatric offices, public health clinics, and private practice.

This definition is adopted from the International Lactation Consultant Association website.

国际认证专业哺乳顾问(IBCLC)是精于母乳喂养临床指导的专业卫生保健人士。国际认证专业哺乳顾问由国际哺乳顾问认证委员会认证。国际认证专业哺乳顾问服务于一系列的保健机构，包括医院、儿科诊室、公共卫生保健中心以及私人诊所等。

What are some pathways to becoming an International Board Certified Lactation Consultant – IBCLC?

As an international leader in providing guidelines for breastfeeding and mother-to-mother support, La Leche League International has made a commitment to facilitating the development of the International Board of Lactation Consultant Examiners (IBLCE). The IBLCE has developed the internationally recognized certification standard, and awards credentials to individuals who demonstrate competence in providing breastfeeding assistance to mothers and children worldwide.

The most current information on pathways to becoming an International Board Certified Lactation Consultant (IBCLC) can be found at https://iblce.org .

如何成为国际认证专业哺乳顾问？

国际母乳会作为一家提供母乳喂养指导以及“母亲对母亲”的帮助支持的国际领先机构，承诺会促进国际哺乳顾问资格考试（IBLCE）的发展。IBLCE已经具备国际公认的认证标准，并可以对个体授予证书，证明其可对专业全球的母亲和儿童提供母乳喂养方面的指导。

有关IBLCE最新的信息，请查询 https://iblce.org.

翻译：鲁鹭    审稿：Daisy, Missy

It’s much easier to travel with a breastfed baby than a bottle-fed one. A breastfeeding mother doesn’t need to worry about packing bottles and formula or sterilizing all the feeding supplies. Your milk is always ready and always at the right temperature, and the comfort of nursing can help reduce the stress of being in unfamiliar places.

带母乳宝宝出门旅行要比带奶粉宝宝容易得多。母乳喂养的妈妈不用操心如何打包奶瓶和配方奶粉，或者如何给所有这些喂奶器具消毒。您的母乳每时每刻都是准备好了的，也总是温度适宜，此外，哺乳的舒适也能减轻身处陌生环境的压力。

If you fly, take an extra set of clothes for you and the baby in your carry-on bag in case your luggage is delayed (or the baby’s diaper leaks onto your lap). Wear a loose-fittingtop you can easily pull up for nursing. A light blanket can help give you privacy in tight quarters. Air travel can be dehydrating, so make sure you drink plenty of water and/or juice. Your baby may feel some temporary discomfort during the plane’s descent as the air pressure changes. Sucking (more specifically, swallowing) may relieve this discomfort, as it helps the ears to ‘pop’. Note that safety experts recommend that, to avoid injury, babies and children should stay restrained in their seats for the duration of the flight just as adult passengers are expected to do. They also contend that it’s just as important to properly restrain your child in a plane as it is in a car. (See References below.) Many mothers find that it is possible to breastfeed their baby in a car seat while remaining buckled in themselves. As an alternative, you may wish to offer a pacifier or sippy cup.

如果您坐飞机，在随身行李里给自己和宝宝额外备一套衣服，以防托运行李迟迟未送到（或者宝宝的尿布漏了，弄到您的腿上）。穿着一件宽松的上衣以便您能轻松地掀开哺乳。您可以找个角落，用一张轻便的毯子遮蔽以保护隐私。飞行途中您可能会失去一些水分，请妈妈确保自己摄入足量的水分或果汁。在飞机起降期间，您的宝宝可能会因为气压改变而感到暂时的不适。吮吸（更确切的说，是吞咽的动作）能舒缓这种不适，因为它帮助宝宝的耳朵“通气”。安全专家提醒，为避免在飞行期间受伤，婴儿和儿童都应待在座位上、保持安全带系好，正如他们也向所有成年乘客做出同样的要求一样。安全专家还提醒说，飞行期间孩子系好安全带，就如同坐汽车时孩子必须待在安全座椅里一样重要（详见下面的参考资料）。不少妈妈会发现，她们在汽车里绑着安全带时也能给宝宝哺乳。您也可能想给孩子其他的安抚物作为替代，如安抚奶嘴或吸管杯。

On a long car trip, be sure to allow extra time for breastfeeding stops. It’s unsafe (and illegal in most places) to travel with the baby in your arms. If your baby needs to be held, stop the car and take a break. If your baby sleeps well in the car, consider driving at night or during nap times.

在长途汽车旅行时，请确保给自己留出额外的时间来哺乳小憩。抱着宝宝坐车是不安全的（并且在大部分地区是违法的）。如果您的宝宝想要被抱着，那么停车，休息会儿。如果您的宝宝在车里能睡得很好，您可以将开车时间安排在晚上或者宝宝的小睡时段。

Even the most enjoyable traveling can be tiring with a baby. Try to leave plenty of time in your schedule for relaxing and unwinding. Pay careful attention to your own needs for nutritious food, plenty of liquids, and rest. Watch carefully to see that your baby is not overtired from too much handling or stimulation. He or she may want to nurse more than usual. It’s not unusual for a baby’s schedule to change when you’re away from home.

就算是最惬意的旅行，带着宝宝也可能会让您觉得疲惫。试着在行程时间表里给自己留出足够的休息和放松时间。悉心照顾自己，摄取有营养的食物和充足的水分，保证休息时间。关注宝宝，避免宝宝因为疲于应付过度的刺激而过于劳累。他或她可能比平时更爱吃奶。出门在外期间，宝宝的作息时间改变并不少见。

Depending on your baby’s age, bring along a few familiar toys as well as some new ones to entertain him/her. Some babies sleep better in strange places if you bring sheets and/or blankets from home (they’ll smell and feel right to the baby). If you will be visiting friends or relatives who aren’t supportive of breastfeeding, try some role-playing ahead of time to help you deal with criticism. (Look for more suggestions in the FAQ about “Dealing with Criticism about Breastfeeding.”)

根据您宝宝的年龄段，在带些新玩具的同时也带一些他熟悉的旧玩具，让他愉快地度过旅行时光。如果您带着宝宝一直用的被子和（或）毯子（它们闻起来、摸起来令宝宝感觉舒适），能令有些宝宝在陌生的地方睡得更好。如果您将要拜访的亲友对母乳喂养不是特别支持的，提前做些角色扮演练习，以便您能应对批评（更多关于应对批评的建议，请参考llli.org“常见问答”中“如何处理关于母乳喂养的批评”）。

References  参考资料

Childproof your flight — this brochure from the Federal Aviation Administration of the USA discusses the importance of approved child restraint systems during airplane travel. (PDF file)

Our FAQs present information from La Leche League International on topics of interest to parents of breastfed children. Not all of the information may be pertinent to your family’s lifestyle. This information is general in nature and not intended to be advice, medical or otherwise. If you have a serious breastfeeding problem or concern, you are strongly encouraged to talk directly to a La Leche League Leader. Please consult health care professionals on any medical issue, as La Leche League Leaders are not medical practitioners.

Resources

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

Page last edited 2016-01-10 00:21:10 UTC.

翻译：郝婉淇  审校：戎锦、Daisy

如果你曾经历过母乳喂养中的困难，如果你曾参加过国际母乳会的聚会，你就能体会到在那个房间里，这些母乳妈妈们带来的力量和重要性。

很多母乳妈妈在解决了含乳不佳、奶量问题，或者母乳喂养已经步入正轨，直至渐入佳境之后，就不再来参加国际母乳会的聚会了。

然而，在宝宝出生后头几周或头几个月之后继续参加国际母乳会的聚会，仍旧有益处。下面，就是即便妈妈的母乳喂养非常顺利的情况下，也仍会考虑参加聚会的原因：

1. 你可以在聚会中跟新妈妈分享你的经验，或许当初你面临和她一样的困难，可是这个困难被你解决了。让我们一起面对它。你在街角杂货店或者日托中心遇到的路人甲妈妈可能压根不理会你所给的，关于吸奶器喇叭口尺寸或者哪个牌子哺乳胸罩最好之类的建议；可是一位参加国际母乳会聚会的新妈妈很可能会感谢你分享的这些信息——而且，这些信息就是她在寻找的。占据在你大脑无价空间中的哺乳小诀窍和所有相关知识都分享到国际母乳会聚会里吧！
2. 对于遭遇障碍想要跨越过去的妈妈们来说，你就是一座灯塔。即使猛长期或者孩子长牙都有可能带来新的挑战，但是你可以证实你的宝宝可能一次睡眠可以超过一个小时了，或者含乳比以前更深了。你肯定还记得刚做妈妈的那些时刻，当你身处其中，好像觉得早期那些阶段永远都不会过去。看一眼宝宝六个月大的妈妈，和一位孩子六岁大的妈妈，你能看出来哪个是有更多休息时间的妈妈。你只要去参加聚会，哪怕就站在那儿，那些正在努力摸索如何平衡宝宝需求和自己需求的新手妈妈们就能够看到你，也就明白了，原来更好的日子在前面的希望。
3. 你会记得，在母乳喂养的道路上，你走了多久。在最初，你每天都睡眼惺忪呵欠连天，你觉得永远都无法掌握给小宝宝哺乳的窍门。“快别跟我说喂一年了，我连一个月，不，一天，不，一个小时都撑不下去了。”在聚会中，在那些新妈妈的面孔上，你或许就看到了当初的自己，也可能，用一种新的宽容，来看待当初那个“我”。

你看到了，在聚会中解决了自己母乳喂养问题之后继续来参加，不仅对新的妈妈们有帮助，同时对母乳喂养经验丰富的妈妈们来说，也会有意外的收获。

 

If you’ve ever experienced breastfeedingdifficulties and attended a La Leche League meeting, you know the importanceand power of room filled with other breastfeeding mothers.

Many nursing mothers stop attendingmeetings as soon as

• latching or supply issues are resolved.
• breastfeeding becomes more routine.
• breastfeeding feels like a dance with choreographythey have mastered.

However, there are benefits to attendingmeetings beyond the early weeks or months. Here are a few reasons to considerattending even after breastfeeding is going well.

1. You can offer your hard-earned wisdom tonew mothers who stand where you once stood. Let’s face it. The random motheryou meet in the grocery store or at the daycare center is probably notreceptive to your advice about the size of a breast pump flange or the bestnursing bra. A new mother at an LLL meeting will probably appreciate hearingwhat worked for you. She is someone who actually wants to know. It will be aplace to download nursing tips and trivia occupying your valuable brain space.
2. You can serve as a beacon to help herpast that obstacle. Even though growth spurts and teething may create new challenges,you can attest to the fact that your baby now sleeps more than an hour at atime or has an improved latch. As you remember those first moments ofmotherhood, the beginning stages can seem eternal when you are in the midst ofthem. It can really help to see how the mother of a six-month-old or asix-year-old looks when she has more rest. By simply showing up, new motherswho are still figuring out how to balance their own needs with the needs of aninfant will see you as a symbol of better days to come.
3. You can remember how far you have comeon your breastfeeding journey. In the bleary-eyed early days, you may havefelt like you would never get the hang of nursing your new little one.You may have wondered if you could make it another hour, much less a day, amonth, or a year. In the faces of brand new mothers, you will catch a glimpseof your own past and perhaps look at your past self with a new level ofcompassion.

Asyou can see, attending meetings when you’ve passed your own hour of need notonly benefits new mothers but also holds unexpected value for more experiencedmothers.

参加国际母乳会月度聚会能获得什么？

翻译：Victoria, Marien, Missy

国际母乳会是一个国际性非盈利机构，专注于为希望母乳喂养的女性提供支持和鼓励。

国际母乳会—中国通过月度聚会、电子邮件和电话，向所有感兴趣的女性提供免费的“母亲对母亲”的哺乳帮助和资讯。

因为哺乳是一种亲密关系，注定会有起起落落。国际母乳会给你提供一个安全的场所，让你在提问和欣喜的同时也可以抱怨。这是一个你会找到理解的地方。你可以迟到早退，也可以带哭闹的宝宝散步、换尿布，还可以和很快变得像老朋友一样的其他妈妈交换心得。如果你在怀孕期间至少参加了一次国际母乳会聚会，你就更好地为哺乳做了准备，因为亲眼看见别的妈妈哺乳会让你自己的哺乳更容易。只是见一见将来你打电话求助时会接电话的那位女性也会有帮助！看到其他宝宝每个月茁壮成长——正如预览你自己的宝宝在接下来的几周或几个月的行为，会很让你感觉有趣和安心。你可以看到每个孩子是多么的独一无二，见到不同的母乳妈妈和宝宝之间以不同的安抚方式相处。自然，婴儿和学步儿在国际母乳会总是会受到欢迎。

聚会通常包括关于选定主题的小组讨论，紧接着是关于哺乳和履行母职的相关问题提问时间。在既定程序的聚会结束后，妈妈们有机会和其他妈妈在温暖和受欢迎的环境中交谈。妈妈们也会被邀请借阅我们图书库的图书，主题覆盖积极养育的各个方面。

• 想寻找资讯？国际母乳会的聚会不但对母乳妈妈非常有帮助，同时还会提供给孕妈妈非常需要的准备，一点学习对于她们收获母乳喂养成功的结果会带来很大的不同。我们欢迎那些希望学习通过哺乳履行母职的人。
• 想建立新的社交网络？国际母乳会的聚会提供了一个寻找志同道合的朋友，跟社区内的其他人交流的极佳机会。来参加聚会的妈妈们来自各种背景、民族和文化，有各种各样的观点。事实上，聚会上的妈妈们拥有丰富多样的个人经验和想法，为你提供很多适合自己的选择，你可以带走那些适合你家庭情况的想法，将不适合的部分留在现场。
• 在母乳喂养中遇到特定的挑战需要帮忙？与会的妈妈分享心得和个人经验，对于你来说可能有帮助，她们是母亲对母亲帮助的极好资源。此外，哺乳辅导不仅受到母乳喂养管理方面的培训，本身也是有经验的母亲。你可以随时在聚会里提你的问题，或着面对面地单独跟哺乳辅导讨论，帮助你解决育儿中遇到的困扰。

关于哺乳辅导 

母乳会哺乳辅导是由国际母乳会委任的有母乳喂养经验的母亲，她们在母乳喂养的各个方面帮助妈妈和准妈妈。哺乳辅导可以提供信息和实用的建议，以帮助妈妈们解决可能发生的任何困难。母乳会哺乳辅导可通过电话或电子邮件来回应妈妈。国际母乳会的哺乳辅导在委任过程中所接受的培训使她非常胜任支持其他母乳喂养的妈妈。我们选择具有良好母职经验，动机和同理心的妈妈，完成母乳会要求的综合程序，这使得她们不仅更熟悉母乳喂养的常见情况，也同时提升她的咨询技巧。一旦获得委任，一位哺乳辅导会获得持续的母乳喂养资讯和支持，包括定期期刊，与其他经验丰富的哺乳辅导保持联系，参加工作坊和会议。所有的哺乳辅导都是志愿者。

想知道最新的聚会信息，请关注我们的微信公众号或访问http://129.226.149.214/hyxx.asp。我们每个月的月初会发布。

 

La Leche League is aninternational, nonprofit organization dedicated to providing support andencouragement to women who want to breastfeed.

La Leche League China offers free mother-to-mother breastfeeding help and information to allinterested women through monthly meetings, email and telephone calls.

Because breastfeeding is a relationship, it’s bound to have its ups and downs. La Leche League gives you safe place to complain, as well as to ask questions and celebrate. This is aplace you will find understanding. You can come late, leave early, walk a fussy baby, change a diaper, and compare notes with other mothers who quickly come to feel like old friends. If you can attend at least one LLL gathering while you are still pregnant, you will be much better prepared for breastfeeding because seeing other mothers breastfeed in person makes your own breastfeeding easier.Just seeing the face of the woman who will be on the other end of the phone ifyou call, can help! It’s both fun and reassuring to watch the other babiesthrive and grow month by month – a preview of your own baby’s behavior a few weeks or months from now. You’ll see how unique each baby is, and see the varied comfortable ways in which different breastfeeding mothers and babies relate to each other. Naturally, babies and toddlers are always welcome at LLL.

Meetings typically involve a group discussion about the selected topic followed by a time forquestions related to breastfeeding and mothering issues. After the structuredmeeting is concluded, mothers are given a chance to chat with other mothers ina warm and welcoming environment. Mothers are also invited to borrow from ourmulti-lingual lending library with titles that cover all aspects of positive parenting.

❖Looking forinformation? LLL meetings are veryhelpful for breastfeeding mothers, but can also provide much-needed preparationfor expectant moms as a bit of education can make a big difference in thesuccessful outcome of a rewarding breastfeeding experience. We welcome anyonewho wants to learn more about mothering through breastfeeding.

❖Want to make a newsocial network? Meetings are a great way tomeet like-minded friends and make connections with others in the community. Wehave mothers from all backgrounds, nations, cultures and perspectives come toLa Leche League. In fact, participants at our meetings are so varied in theirpersonal perspectives that you will hear a variety of ideas expressed – you cantake what suits you and your family and leave the rest behind.

❖Have a specific breastfeeding challenge you’d likehelp with? Our mothers are a great resource formother-to-mother support, sharing insights and personal experiences that may behelpful to you. In addition, our leaders are trained in breastfeedingmanagement and are experienced mothers themselves. You may feel free to askyour questions in the group setting, or approach a leader for a more privatediscussion regarding suggestions to help you overcome the bumps in the road youmay be experiencing with your baby.

 

LEADER INFORMATION

La Leche League Leadersare experienced mothers who are accredited by La Leche League International tohelp mothers and mothers-to-be with all aspects of breastfeeding. They canprovide information and practical suggestions to help a mother cope with anydifficulties that may occur. La Leche League Leaders are available to speakwith a mother on the telephone or to answer questions by email. The trainingwhich a Leader receives through the accreditation process makes her uniquelyqualified to support breastfeeding mothers. Selected initially for herexperience, motivation and empathy, a La Leche League Leader is required tocomplete a comprehensive program to familiarize herself with most aspects ofbreastfeeding and also to develop her counseling skills. Once accredited, aLeader is provided with a continuing supply of information and support,including regular journals, contact with other experienced Leaders, andenrichment workshops and conferences. All Leaders are volunteers.

For updated schedule of our monthly meetings, pleasefollow our official WeChat account，or visit  http://129.226.149.214/hyxx.asp. We will post theschedule during the start of each month.

翻译-曾瑛容
审稿-陈淑娟

当妳知道你怀的是双胞胎，会是多么震惊啊！一时之间，许多期望、决定或计划都要随着改变。可是，你若决定要哺喂母乳，并不需要改变。母乳对于双胞胎而言特别重要，因为双胞胎的宝宝出生时通常比较小，更需要母乳所提供的好处。哺育母乳能使妳和两个小生命有亲密且特殊的连结。许多妈妈都成功地哺喂双胞胎宝宝，同样地，你也可以享受以这特别的方式来亲自哺育你的双胞胎。

哺乳之初
宝宝出生后，尽早喂奶及经常喂奶会比较容易成功。即使，如果因为你或宝宝的健康问题必须彼此分开，并不意味着你必须放弃哺喂母乳。
如果因为其中一个宝宝或两个宝宝都无法直接吸吮乳头，妳需要将乳汁及时排出来，可以使用电动吸奶器，白天每隔2-3小时，夜里至少一次。
乳汁的供应量是根据宝宝吸吮(或挤乳)的多寡对乳房所产生的刺激而订。这就是为什么双胞胎的妈妈总是可以分泌充足的乳汁来给两个宝宝。

协调哺乳
一旦双胞胎健康的返家后，许多妈妈发现同时哺喂两个宝宝会更容易一些。使用枕头来支撑着宝宝，你的双手就可以空出来协助每一个宝宝以正确的姿势吸乳。
当宝宝吃得比较好时，有些妈妈是每24小时让宝宝轮换吸吮两边的乳头。例如：今天A宝宝喝左边，B宝宝喝右边；明天则换B宝宝喝左边，A宝宝喝右边。如果宝宝吃得不是很好，也可以每一次哺乳时轮换。
如果你能学会躺着喂奶，夜里喂奶会更容易些。

照顾哺乳妈妈
最重要的是：双胞胎的哺乳妈妈必须好好照顾自己，均衡饮食，渴了就喝。尽可能配合宝宝的作息，能休息尽量休息，接受他人在烹煮食物、洗涤衣物及照顾家中较大的孩子的协助。
好好享受当你可以亲自同时喂养两个小人儿的特别时光。

 

矛盾情结
怀孕时、待产时及产后，一些双胞胎的妈妈对于她们同时拥有「双重的恩典」有着复杂的情绪。很不幸地，由于需经常卧床、疲累或是因为周遭的人无法体恤自己的负面情绪，这些妈妈产生了被隔离的感觉。其实，面临如此巨大的压力情境，这种反应是很正常的，也不应该去忽略或轻视它，与其他双胞胎的妈妈聊聊通常会有一些帮助。

 

寻找支援
务必确定你的朋友及家人清楚知道他们可参与的务实协助方式，鼓励他们阅读以下的资料，让他们知道在你人生中最不可思议的时期，该如何帮助及鼓励妳！

救命呀！

一封致双胞胎哺乳妈妈的配偶、朋友及亲戚的公开信
双胞胎的妈妈如果要在第一年存活下来需要别人的帮忙。这听起来十分戏剧性，但这是真的。对于双胞胎妈妈非常重要的是：充足的睡眠、做最少的家事、找出负向情绪的宣泄管道及排解孤立感。这时来自亲朋好友及配偶的协助与支援，可以给一个新手双胞胎妈妈天壤之别的差别待遇。
很多时候，别人想帮忙却不知如何着手。朋友及家人想协助却可能愈帮愈忙。
这里是一些给任何愿意提供协助给双胞胎妈妈参考的列表。

 什么是你能做的事：
当你探望时帮她带些食物
帮宝宝换尿布
当她在喂奶时帮她做背部或足部按摩
帮她带水或果汁
当她睡觉时帮她看顾宝宝
如果其中一个宝宝夜里醒来喝奶，先帮他换尿布再抱给在床上的妈妈；当另一个宝宝醒了，则与妈妈交替宝宝。
当妈妈需要暂时休息15分钟时，帮她看顾宝宝。
如果她感到害怕、疲惫、或是压力太大的时候，倾听她。如果她需要哭出来，就抱着她让她哭。告诉她：你爱她
帮她洗涤衣物、折衣服，并把衣服摆放入抽屉
帮她到食品杂货店购物
帮她准备午餐或晚餐并端给她
帮她带最新的杂志或录影带
帮她找个双胞胎妈妈聊聊
帮她清理厨房、洗碗盘、吸地板及整理家务
告诉她：目前她为宝宝所做的一切，是多么棒的一件事！

有几件事，你需谨记在心！
当你拜访时，是要协助这个妈妈能够轻松一点，而不是被款待
她需要的是支持及鼓励；当她抱怨或看起来疲累时，不要给予建议
妈妈可能会很脆弱；不要问：「你确定你的宝宝们有吃饱吗？」或「为何他们不能一觉到天亮？」这种负向的问题只会打击妈妈的信心。
专心在「照顾妈妈」及帮忙家务杂事上，而不是想尝试取代她照顾宝宝
双胞胎的妈妈需要至少一整年的外来协助；不要3个月就不见了

郑宇 翻译

Finding out you are pregnant does not mean you must stop breastfeeding your toddler. Many mothers choose to continue breastfeeding throughout pregnancy, while others decide to wean. The following information may help you decide what is best for you and your family.

发现怀孕并不意味着必须停止给宝宝哺乳。很多妈妈选择在整个怀孕期内继续哺乳，然而也有些选择断奶。下面的信息或许能帮助你做出决定，怎样做对你自己和你的家庭是最好的。

Relatives, friends and health care professionals may express doubts about breastfeeding while pregnant. Their concerns might include that you would be risking the health of your unborn baby. It may be reassuring to know that in a normal pregnancy there is no evidence that continuing to breastfeed will deprive your unborn child of necessary nutrients. In addition, according to the La Leche League International BREASTFEEDING ANSWER BOOK, 3rd Edition 2003, page 407. “Although uterine contractions are experienced during breastfeeding, they are a normal part of pregnancy. .. Uterine contractions also occur during sexual activity, which most couples continue during pregnancy.” Also, according to the BAB, page 408, “Currently, no specific medical guidelines exist that define in which situations it may be risky to continue breastfeeding during pregnancy, and prenatal caregivers vary widely in their recommendations.” The materials listed in the “Additional Resources” section of this FAQ will help you address the fears others may express.

亲戚、朋友和保健专家可能会对孕期哺乳表示质疑。他们担心的可能是这会给你腹中的胎儿带来风险。并没有证据显示在正常怀孕过程中哺乳会损失掉未出生宝宝必需的营养，了解了这一点以后担心应该会少很多了。另外，根据国际母乳会出版的《母乳喂养问答手册》（BREASTFEEDING ANSWER BOOK，以下简称BAB），2003年第三版，407页，“尽管哺乳期间会感到宫缩，但宫缩本来就是怀孕过程中的正常现象，……，在性生活的过程中也会出现宫缩，而大部分夫妇在怀孕时也保持性生活。” 另外，BAB第408页，“目前，没有明确的医学指南定义在何种情况下孕期哺乳可能产生风险，孕期护理者对此也是众说纷纭，各执一词。”列在本问答后的“附加信息来源”中的材料会帮助你解除其它可能有的担忧。

Needing extra rest is normal in pregnancy. Breastfeeding during your pregnancy may help you get extra rest if you breastfeed your toddler while lying down. Completely childproofing one room with a mattress or pallet on the floor would allow you to continue to rest if your toddler goes off to play. Who knows, you both may drift off for a little nap!

孕期需要额外的休息。孕期哺乳时以躺下的姿势来给宝宝喂奶将帮助你获得额外的休息。布置一间符合孩子安全要求的房间，躺在地上的垫子或者板床上喂奶，如果你的宝宝吃完奶去玩了，你就可以继续休息。谁知道呢，你们俩可能都渐渐睡着了。

Some mothers develop tender nipples during pregnancy. Careful attention to your child‘‘s position can help. Breathing techniques from childbirth classes can help you cope with the increased sensitivity. The breathing techniques may also help if you become restless while your toddler breastfeeds. If your child is old enough, you can ask him or her to nurse more gently or for shorter periods of time. This will help with both your tender nipples and your feelings of restlessness.

有些妈妈在怀孕期间乳头可能会变得敏感。仔细地调整宝宝吃奶的位置会有帮助。从生产课程学到的呼吸技巧可以帮你改善乳头敏感度提高引起的不适。如果给宝宝喂奶让你感到疲惫，呼吸技巧也可以带来帮助。如果你的宝宝足够大能沟通，你可以告诉他或她吃奶的时候轻柔一点或者少吃一会儿。这样将有助于保护你敏感的乳头并且缓解你的疲劳感。

Women who breastfeed while pregnant often find their milk supply decreases around the fourth or fifth month. If your breastfeeding baby is less than a year old, watch his weight gain to be sure he is getting enough to eat. It‘‘s also not uncommon for the flavor of your milk to change. These changes may prompt some older toddlers to nurse less often or to wean entirely.

孕期哺乳的妇女经常会发现在怀孕四五个月的时候奶量会减少。如果吃奶的宝宝还不满一岁，要观察他的体重增长情况来确定他是否吃到了足够多的奶水。有个别的妈妈在怀孕期间乳汁的味道还会发生改变。这些改变有可能会促使比较大的孩子减少吃母乳的次数，或者完全离乳。

If you decide you want to wean your toddler, it‘‘s easiest to proceed gradually. The approach of “don‘‘t offer, don‘‘t refuse” is one that has worked for many mothers. See if you can anticipate when your child is likely to ask to nurse and offer a distraction or a healthful snack instead. Avoid sitting in your favorite nursing chair. Be sure you give lots of extra hugs and attention. Remember that weaning a toddler can be hard work: continuing to nurse is sometimes easier for the mother. See these FAQs for additional thoughts on weaning.

如果你决定要给你的学步儿断奶，循序渐进会更加容易。“不提供，不拒绝”的办法对很多妈妈都很有效。试试看你能不能观察出你的孩子什么时候会要求吃奶，然后及时地分散他的注意力或者用健康的小点心代替母乳。避免坐在你最常喂奶的地方。确保你给予孩子更多的拥抱和关注。记住，给孩子断奶可能很困难，以至于有时妈妈很轻易就又开始哺乳了。更多的关于离乳的看法可以参考这些问答。

After the new baby is born, it‘‘s not unusual for the weaned child to want to taste the milk or ask to nurse again. Some may not remember how to suckle, others will complain about the taste and there will be some who would be happy to resume a breastfeeding relationship. If you do not want to breastfeed the older sibling, you could offer a taste of your milk in a cup or spoon.

小宝宝出生后，通常已离乳的大孩子不会再要品尝母乳或是重新要求吃母乳。有些孩子可能已经忘了如何吸吮，有些会抱怨母乳的口味，也有一些孩子会很高兴重新通过母乳喂哺和妈妈恢复亲密。如果你不希望大孩子来吸吮乳头，可以用杯子或者勺子来喂挤出的母乳。

If you continue breastfeeding through your pregnancy, you may find yourself breastfeeding both an infant and an older sibling. Many mothers have found this arrangement, called “tandem nursing,” is a good way of meeting the needs of both children. Your local LLL Leader can give you more information on breastfeeding while pregnant and/or tandem nursing. The resources below will help you to explore your feelings about breastfeeding both your new baby and your “old” baby.

如果你整个孕期都在哺乳，你会发现自己要同时喂哺一个初生婴儿和他的哥哥或者姐姐。很多妈妈发现这种名为“手足哺乳”的安排是很好的满足两个孩子的方法。你所在当地的国际母乳会的负责人可以给你提供更多关于孕期哺乳和/或手足哺乳的信息。