国际母乳会

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  • 剖宫产与母乳喂养Cesarean Birth (C-Section) and Breastfeeding


    点击上方国际母乳会LLL 设为星标，获取哺乳信息


    剖宫产与母乳喂养


    如果你进行了剖宫产，无论是计划之中的还是计划外的，都可以母乳喂养自己的宝宝。


    重要的是要知道，分娩阵痛和剖宫产手术期间的干预措施会影响早期的母乳喂养。如果你知道这些影响可能是什么，就能早做准备。


    你可能在产后初期需要更多的支持来让母乳喂养有一个良好的开端。但没关系，你可以参阅为母乳喂养做准备了解更多信息。


    尽快频繁地母乳喂养


    许多母亲剖宫产后立即在手术室或恢复室进行母乳喂养。你越早抱着宝宝做肌肤接触并母乳喂养，就越会让你们双双获益。


    如果你和宝宝分开了，孩子的父亲、你的伴侣或其他家庭成员也可以抱着孩子，直到你自己能抱为止。


    分娩后即刻哺乳可以刺激你的身体产生大量的乳汁。这种产奶量的激增通常发生在产后几天内。然而，在剖宫产后它往往会延迟，原因可能包括:


    • 分娩过程中用的强效药物，如硬膜外麻醉

    • 手术给身体带来的生理压力

    • 第一口奶延迟

    • 产后初期哺乳次数较少

    • 婴儿嗜睡


    初乳营养丰富，在你的奶水下来前提供了宝宝所需的一切。


    产奶量通常在产后第3~4天之间急剧增加，但也可能早在第2天、迟至第6天增加。剖宫产后产奶量在第5或第6天才会增加。


    如果你担心的话，就在喂奶后挤出一些初乳，把它用杯子、勺子、眼药水滴管或注射器喂给宝宝（参阅杯喂）


    额外多挤初乳将激发你的身体更快地产奶，宝宝就有更多的奶水吃了。如果你在孕晚期的最后几周挤初乳并存放在冷冻室里，可以把解冻的初乳喂给宝宝(参阅在产前挤出初乳 )。


    分娩期间给你用的药物可能会让宝宝特别困倦。这些药物要花一周或更长时间才能从宝宝体内排出。所以，产后初期宝宝可能没法很清醒地吃奶。如果是这样，就用手挤奶，然后用杯子、勺子、眼药水滴管或注射器喂给他。


    尽量避免使用奶瓶。它们会让宝宝含乳更困难。当宝宝变得更清醒后，你可以把他放在胸前直接哺乳。欲了解更多信息，请参阅建立奶量。


    静脉注射的药物增加了你的体液量，这会导致产后初期乳房过度肿胀(充盈)，可能让宝宝更难含乳。你可能需要先挤出一些乳汁再给宝宝喂奶。欲了解更多信息，请参阅涨奶该怎么办？


    正常的体重下降


    大多数婴儿会在出生后的前几天体重下降。直到你的产奶量增加后，宝宝的体重才会增长。之后你就可以期待宝宝每天体重增加大约20~35克了。


    如果你在临近分娩前的两小时内输了液，宝宝体内也就有了这些额外的液体。随着宝宝尿出这些多余的液体，体重好像减轻了很多。这些多余的液体会在产后头24小时内被宝宝的身体排出。因此建议在婴儿出生24小时后再称体重。这时的体重可以作为宝宝的起始体重。


    婴儿体重下降的幅度通常可以达到出生体重的7%之多。对于一些婴儿来说，体重下降8%到10%可能没什么问题。不过建议由医疗保健人员观察过母亲和婴儿后评估母乳喂养的效果。


    如果宝宝体重下降过多，可能就需要暂时补充喂养。这是短期的，直到你的身体产生大量的乳汁，宝宝也吃得很好了，就不用再补充了。欲了解更多信息，请参阅如何知道婴儿是否吃到了足够的母乳。点击“阅读原文”可查看英文版《补充喂养的同时如何保护母乳喂养》


    找到一个舒适的姿势



    图|国际母乳会中国图片库


    对于剖宫产后的母亲来说，半躺式和后躺式哺乳通常更舒服。这些姿势也有助于激活宝宝天生的哺乳反射。

    其它可选择的姿势有橄榄球式、摇篮式和交叉摇篮式。如果宝宝含乳很好，侧卧喂的姿势哺乳会很舒服。用枕头或折好的毯子保护好手术伤口对你很有帮助。宝宝踢到伤口处会生疼。

    可以寻求帮助来找到一个对你和宝宝都舒服的姿势。欲了解更多信息，请参阅哺乳中最容易忽视的要点（上）：哺乳姿势和哺乳中最容易忽视的要点（下）：含乳姿势。


    身体需要时间来恢复


    计划之中的剖宫产往往比计划外的剖宫产恢复得更快。做计划外的剖宫产手术时，你的身体已经进入分娩状态，所以手术往往会很快。不管是计划好的还是计划外的，剖宫产都是个大手术。你可能需要用止痛药，这不会影响母乳喂养。


    做剖宫产手术的母亲往往需要比超出预想中更多的时间来愈合伤口和恢复身体。产后最初几周你可能发现很难四处走动、起床、坐下、走楼梯，有时甚至咳嗽或大笑都很难。试着尽量多休息。定点进食(特别是富含蛋白质的食物)，每次给宝宝哺乳时都要喝点水。


    为自己打造一个哺乳“加油站”


    在你经常哺乳的地方准备一些有用的东西会很有帮助。这些东西可以包括:一个喝水瓶、零食、尿布、清洁湿巾、毯子、你的手机、充电线、电视遥控器、阅读材料等。这会帮助你减少起身和躺（坐）下的次数。


    如果你住在两层楼的房子里，就会希望两层都各有一个哺乳“加油站”。当坐下来哺乳时，你所需的所有东西就都在手边了。这就省得你每次需要换尿布时还得爬楼梯！


    接受朋友和家人的帮助


    让其他人尽可能多做些照顾宝宝的其它事情和家务事。这样你可以把精力集中在身体恢复和母乳喂养上。请参阅伴侣和支持者如何提供帮助里的一些建议和想法。


    你洗澡或小憩的时候让信任的人照看宝宝，这能给你带来奇迹。婴儿喜欢被抱着，当他们不吃奶时，可以由其他人抱着。


    对自己和宝宝要和善耐心


    你需要花些时间才能从术后恢复，重新回到自己以往的状态。宝宝也需要时间从生产中恢复过来。你们两人都需要时间学习如何一起母乳喂养。花时间抱着宝宝做肌肤接触有助于让你和宝宝放松。


    复杂的情感


    如果你的剖宫产是计划外的，你可能会对自己的分娩经历感到内疚、愤怒或失望。有人可能会告诉你没关系的，因为你现在已经生下一个漂亮的宝宝了。这样的说法会让你觉得更糟。对自己的生产感到难过并不意味着你对孩子的到来不感恩，孩子的到来让你不快乐。你当然是既高兴又感动。


    但是，期待的生产方式落空，让你感到难过、愤怒、羞耻或者悲伤等等，各种情绪要分出类来还是很难的。和别人谈谈你的经历会很有帮助。一个曾经做过计划外剖宫产的朋友、一位国际母乳会的哺乳辅导、一位哺乳顾问或治疗师都可以。


    获取母乳喂养的帮助


    如果你有母乳喂养方面的问题，或者你准备剖宫产，可以联系国际母乳会中国的哺乳辅导或者一位IBCLC (国际认证哺乳顾问)寻求支持。大多数难题都能通过充足的资讯和良好的信息和支持来克服。





    Cesarean Birth (C-Section) and Breastfeeding



    If you have a cesarean birth (C-Section), either planned or unplanned, you can breastfeed your baby. It’s important to know that interventions during your labour and the c-section can impact nursing in the early days. If you know what those impacts may be, you can be prepared. You may require more support in the early days to get breastfeeding off to a good start. But that’s okay. For more information see Preparing to Breastfeed.


    Breastfeed as soon as possible and often
    Many mothers and parents breastfeed in the operating or recovery room right after a cesarean birth. The sooner you can hold your baby skin-to-skin and breastfeed, the better for both of you. If you are separated from your baby, the baby’s father, your partner or another family member can hold the baby skin-to-skin until you are available.

    Nursing soon after birth stimulates your body to produce a lot of milk. This increase in milk production usually occurs in a few days. However, it is often delayed following a cesarean birth. Causes of this delay may include:

    • strong medications received during labour, such as those given via an epidural.

    • the physical stress of surgery on your body.

    • a delay in the first feeding.

    • fewer feedings in the early days.

    • a sleepy baby.


    Colostrum is very nutrient dense and provides everything your baby needs until your milk comes in.

    Milk production usually increases dramatically between days three and four but this could happen as early as day two and as late as day six. After a cesarean birth this occurs closer to day five or six. If you are concerned, express some colostrum after a feeding. Offer it to your baby in a cup, spoon, eye dropper or syringe (see Cup Feeding). The extra removal of colostrum will encourage your body to make milk quicker. And your baby gets more to eat. If you expressed colostrum in the final weeks of pregnancy and stored it in the freezer, you can feed your thawed colostrum to your baby (see Prenatal Colostrum Expression).


    Medications given to you during labour may make your baby extra sleepy. It may take up to a week or more before they are eliminated from your baby’s body. Your baby may not be alert enough to nurse well in the early days. If this is the case, hand express your milk and feed it to him with a cup, spoon, eye dropper or syringe. Avoid bottles, if possible. They can make it harder for your baby to latch. When your baby becomes more alert, you can put him to your breast. For more information see Establishing Your Milk Supply.


    Medication given by IV increases the amount of fluid in your body. This can lead to increased breast engorgement (fullness) in the early days. It may make it harder for your baby to latch. You may need to express some milk before feeding your baby. For more information see Breast Engorgement.


    Normal Weight Loss
    Most babies lose weight in the first few days. Your baby will not begin gaining weight until after your milk production increases. After that, you can expect your baby to gain around 20 to 35 g/day. If you got IV fluids within the final two hours before the birth, your baby also got these extra fluids. As your baby pees out these extra fluids, it may seem like a large weight loss. This extra fluid is eliminated by your baby’s body in the first 24 hours. For this reason it is recommended that your baby’s weight be taken 24 hours after birth. This weight can be used as your baby’s starting weight. Babies often lose up to 7% of their birth weight. A weight loss of 8% to 10% may be fine for some babies. However, it is recommended that mother and baby be seen by a healthcare provider to evaluate the breastfeeding. If your baby is losing too much weight, you may need to temporarily supplement. This will be short-term until your body is producing lots of milk and your baby is drinking well. For more information see How to Know Your Baby is Getting Enough Milk .


    Find a Comfortable Position
    Laid-back and reclining positions are generally more comfortable for mothers following a cesarean birth. These positions are also helpful for activating your baby’s natural feeding reflexes. Other options are the football hold, cradle hold, and cross-cradle hold. If your baby is latching well, the side-lying position can be very comfortable. Protecting the surgical site with a pillow or folded blanket can be helpful. A kick at the incision site can be extremely painful. Ask for help to find a position that is comfortable for both you and your baby. For more information see Positioningand Latching    .


    Take Time To Heal
    Recovery from a planned cesarean birth tends to be faster than recovery from an unplanned one. With an unplanned c-section your body has gone into labour and the surgery is often very fast. Both planned and unplanned cesarean births are major surgery. You will likely need to take pain medication. This should not interfere with breastfeeding.


    Parents who have cesarean births often need more time to heal and recover than they expect. For the first few weeks you will likely find it difficult to move around, get up, sit down, use stairs and sometimes even cough or laugh. Try to get as much rest as possible. Eat regularly (particularly protein-rich foods) and drink water every time you nurse your baby.


    Set Up a Nursing Station
    It can be helpful to have useful items right where you are going to be nursing. These will likely include: a water bottle, snacks, diapers, diaper wipes, blankets, your phone, charging cords, TV remote, reading material, etc. This will help you reduce the number of times you need to get up and down. If you live in a two-story house, you will probably want to have a nursing station on both floors. Then when you sit down to nurse everything you need will be close at hand. This will save you from walking up all of those stairs every time you need to change a diaper!


    Accept Help from Friends and Family
    Allow others to do as many of the other baby and household tasks as possible. It allows you to focus your energy on healing and breastfeeding. See How Partners and Supporters Can Help for ideas    . Have someone you trust watch your baby while you take a shower or have a short rest. This can do wonders for you. Babies like to be held. When they are not feeding, they can be held by others.


    Be Kind and Patient with Yourself and Your Baby
    It will take time for you to recover from surgery and feel like your old self again. It will also take time for your baby to recover from birth. And it will take both of you time to learn how to breastfeed together. Spending time holding your baby skin-to-skin can help both you and your baby relax.


    Complicated Feelings
    If your cesarean birth was unplanned, you might have feelings of guilt, anger, or disappointment about your birth experience. You may have people tell you that it doesn’t matter because you now have your beautiful baby. Those kinds of comments can make you feel even worse. Feeling sad about your birth does not mean that you are not happy and grateful to have your baby. Of course, you are. But it can be difficult to sort through all of the feelings of sadness, anger, shame or grief for the loss of the birth you hoped for. It can be very helpful to talk to someone about your experience. This may be a friend who also had an unplanned cesarean birth, a La Leche League Leader, or a counsellor or therapist.


    Get Help with Breastfeeding
    If you are having problems breastfeeding, or chestfeeding, or you are anticipating having a cesarean birth, contact a La Leche League China Leader     or an IBCLC (International Board Certified Lactation Consultant) for support. Most issues can be overcome with good information and support.



    参考文献:
    Hobbs, A. J., Mannion, C. A., MacDonald, S. W., Brockway, M., & Tough, S. C. (2016).    The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum.BMC Pregnancy & Childbirth.16:90.

    La Leche League International. (2017, November). Breastfeeding After Cesarean Birth.

    www.lllc.ca/sites/default/files/Cesarean%20Birth%20%28C-section%29%20and%20Breastfeeding.pdf



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  • 涨知识！产后抑郁，竟然还分这么多种？

    点击上方 国际母乳会LLL 设为星标 ，获取哺乳信息

    图|国际母乳会中国图片库

    像许多母亲或新手父母一样，您可能有照顾自己的新生宝宝完全不知所措的经历。

    产后沮丧

    您可能发现自己感到悲伤或想哭。这通常从产后第3~5天您的乳汁供应量增加（即“下奶”）时开始。

     

    这种悲伤的感觉可能会在几个小时或几天内一波又一波地反复。我们称之为“产后沮丧”。它会随着母乳喂养的建立以及体内孕产相关的激素水平下降而得到改善。这种症状通常持续一到两周。大约50%至80%的母亲会经历这种“产后沮丧”。

     

    如果您母乳喂养有困难，或者您认为宝宝可能母乳没有吃够，就会感到很有压力。如果有这种感觉，您可向医疗保健专业人员和您所爱之人寻求所需的支持。在产后初期，对自己和宝宝要有耐心。在国际母乳会聚会中与其他新手妈妈交流，会让您知道自己并不孤单。

     

    相关信息：

    伴侣和支持者如何提供帮助HOW PARTNERS AND SUPPORTERS CAN HELP

    哺乳中最容易忽视的要点（上）：哺乳姿势

    哺乳中最容易忽视的要点（下）：含乳姿势

    如何知道婴儿是否吃到了足够的母乳 How to Know Your Baby is Getting Enough Milk

    建立奶量Establishing Your Milk Supply

    产后抑郁症（PPD）

    与产后沮丧不同，产后抑郁症（PPD）的症状不会在几周后消失。它们有可能在产后第一年的任何时侯出现。大约13%-20%的母亲以及2%-25%的父亲会经历产后抑郁症。如果不解决根本原因的话，症状可能会随着时间的推移而持续加重。
     
    经历产后抑郁症的母亲反映说：
    • 感觉她们在育儿方面做得不好
    • 为生了孩子而感到内疚
    • 为她们再也感受不到幸福而绝望
    • 在集中注意力和做决定的方面有困难
    • 饮食和睡眠模式被打乱（超出了家里有小宝宝的正常范围）
    • 被孤立，因为她们没有精力走出家门或与其他人互动
    极个别（不到1%）患有产后抑郁症的母亲会有伤害自己或婴儿的想法。这些情况下需要立即寻求心理健康方面的帮助。通常母亲们需要住院和药物治疗来稳定她们的症状并确保自身和婴儿的安全。
    产后抑郁症的一些早期预测指标有：
    • 以前诊断出患有抑郁症或其它精神疾病
    • 有虐待史
    • 高水平的全身性炎症，例如感染或严重创伤、烧伤或出血
    • 分娩或哺乳引起的疼痛
    • 母亲认为她的分娩经历很负面（这不同于实际上确实有负面的分娩结果）
    • 婴儿“高需求”或有“很难搞定”的气质
    • 缺乏社会支持
    身体和心理的压力都会增加炎症。最近的研究表明，炎症可能是抑郁症的危险因素。目前产后抑郁症的治疗方法包括减轻产妇压力和减轻炎症。母乳喂养和运动有助于减轻产妇的压力。有可能需要药物来减轻炎症。
    爱丁堡产后抑郁症量表（https://psychology-tools.com/epds/ ）是一种自我筛查工具，您可用来确定是否患有抑郁症。
    加拿大不列颠哥伦比亚省的围产服务网站（http://www.perinatalservicesbc.ca/health-professionals/professional-resources/public-health/edinburgh-postnatal-depression-scale-(epds) ）有英文和其它语言的可供打印的表格。中文表格可在这个链接下载http://www.perinatalservicesbc.ca/Documents/Resources/HealthPromotion/EPDS/EdinburghEPDSScale_ChineseSimplified.pdf
    如果您正在经历相对轻微的产后抑郁症，您有可能意识不到自己身上到底发生了什么。我们的社会期望新手父母高高兴兴地孕育孩子。如果您觉得说出自己的感受不安全，就很难和他人讨论这些感受。您可能害怕被批判，因为生了宝宝并没有对生活激动不已。

    产后焦虑症（PPA）

    一些新手父母在生完孩子后会持续担忧或害怕。他们可能难以入睡，感到疲劳（超出了家有新生儿的正常范围），且有其它的焦虑症状。这被称为产后焦虑症（PPA）。
     
    产后焦虑症的症状通常与产后抑郁症很相似，父母也可能同时患有这两种病症。大约6%-28%的女性在分娩后的头六个月里可能会出现产后焦虑症。女性患产后焦虑症的概率是男性的两倍。

    产后强迫症（PPOCD）

    3%-5%的新手父母可能经历一种叫产后强迫症（PPOCD）的产后焦虑症。患有产后强迫症的父母会感受到自己无法控制的持续、反复、可怕的想法。
     
    这些强迫性念头是对婴儿危险的感知。父母不大可能遵照这些想法行事。相反他们往往过度警惕（即过于小心）并强迫性地保护婴儿免受这些自认为的危险。许多新手父母没有说出这些感受，是因为害怕婴儿会被夺走，不让他们照顾。未经治疗的产后强迫症会导致难以与婴儿建立亲情联结并照顾好他们。强迫性的想法和强制倾向也会影响母亲的睡眠或照顾自己的能力。
     
    产后强迫症常见的强迫症状想法有：
    • 担心宝宝会意外或故意受伤
    • 担心宝宝会生大病
    • 担心宝宝会因环境中的食物或化学物质中毒
    • 害怕独自陪伴婴儿
    • 害怕做出对婴儿有负面影响的决定
    产后强迫症常见的强迫性行为有：
    · 收起家中的尖锐物品，如刀子、剪刀等
    · 在婴儿睡觉时反复检查
    · 经常清洁
    · 要求他人保证婴儿没有受到伤害或虐待
    · 由于害怕伤害到婴儿而避免某些行为，如给婴儿洗澡、喂食或怀抱
    这些症状通常在产后2-3周左右出现。它们通常会逐渐出现，并随着时间的推移而加重。
     

    产后创伤后应激障碍（PTSD）

    分娩期间经历的创伤可能导致产后创伤后应激障碍。

     

    值得注意的是，即使很多人认为生产 “很成功”，母亲（或父母）仍然会觉得是创伤。产后创伤后应激障碍会增加患产后抑郁症的风险。

     

    创伤性事件可能包括：

    • 分娩时非常担心自己或宝宝的健康

    • 极度疼痛。分娩期间有并发症。觉得医务人员不支持自己。感觉对自己的身体或分娩无法控制。

    • 在分娩期间感到不受尊重、被辱骂、被羞辱或被虐待。

    产后创伤后应激障碍的症状包括：

    • 重新经历分娩时的创伤事件

    • 梦魇和回想重现

    • 回避与分娩相关的人员、地方或情况（例如：回避医院）

    • 睡眠困难

    • 疏离感（例如：感觉与宝宝疏远）

    • 频繁不断地哭泣

    • 食欲改变

    • 感到绝望

    • 对曾经喜欢的事情失去兴趣

    获得帮助
     
    如果您有这些心理健康中的任何一种状况，您身边的人也会感到困惑。您的伴侣可能不确定如何帮助您。他们不理解您是不能“像其他新妈妈那样能摆脱困境且振作起来”的。家里的大孩子们可能会对你行为的变化感到迷惑。您可能得挣扎着对新生儿做出回应。母乳喂养有助于您维持与宝宝的关系。
    如果您患有慢性抑郁或焦虑，您的新生儿宝宝可能会受到负面影响。因此，接受治疗很重要。当症状严重时，通常是由您身边的人（伴侣、亲戚和朋友）来拼凑出线索来。可能是他们建议您寻求适当的诊断和支持。

    一位母亲记得她在儿子过一岁生日时，感觉松了很大口气——儿子终于活下来了，尽管她（自认为）育儿方式“很笨拙”。

    回过头来，她意识到从那天起，生活感觉更容易了，快乐又回归了。不论是她还是身边的人，都没有意识到她在第一年中经历着产后抑郁症，因为她看起来是正常的。

    治疗

    这些心理健康状况的治疗通常集中在三个主要策略上：

    • 药物
    • 获得充足、优质的睡眠
    • 获得家庭/社区的支持

    与医护人员合作找出适合您和家人的策略是非常重要的。理想情况下，此策略要包含以上这三个方面。睡眠不足是使症状加重的最大因素之一。如果您正在母乳喂养同时还与睡眠不足作斗争，请向您的支持网络寻求帮助。您在维持奶量以及母乳喂养宝宝的同时，要找到哪些方法能让您睡得更好。

    一位母亲，她四周大的宝宝每次睡觉仅能睡20分钟，一天下午她发现自己产生了幻觉。她意识到情况很不寻常，就叫朋友带她和孩子去看了医生。这位母亲觉得医生的建议和母乳喂养不相容，而这对她来说非常重要。她所在的镇子上也没有任何产后抑郁症的支持团体可推荐给她参加。幸运的是，当地的国际母乳会哺乳辅导和小组是很好的资源。母乳会小组中的其他母亲从自身经历中给她提供了建议。

    许多人认为，用药物来治疗心理健康状况是不建议母乳喂养。这种想法会使一些母亲不太愿意考虑将药物作为治疗选择。如果您想继续母乳喂养，请告知医疗保健专业人员您需要与母乳喂养兼容的药物。如果建议的药物与母乳喂养不相容，您可以询问是否还有其它选择。

    其它的治疗包括：

    • 增加长链脂肪酸（omega3）的摄入

    • 做运动

    • SAMe（S-腺苷-L-蛋氨酸），这是一种天然存在于体内的化合物，其合成物可作为膳食补充剂。

    • 认知行为疗法（小组或个人）

    上述的大多数治疗方法都可以减轻体内的炎症。新罕布什尔州母乳喂养工作组的文件《患抑郁症的新手妈妈母乳喂养的好方法》（http://www.uppitysciencechick.com/ppd_curric_final_2009.pdf），对于想要查看治疗产后抑郁症的所有方案（包括药物治疗）的父母和专业人士来说是一个很好的资源。

    更多的相关资源，请参阅产后抑郁症资源网页：http://www.uppitysciencechick.com/postpartum-depression.html

    成功的母乳喂养是可以预防患这些疾病的。它也是一种有用的应对策略。把更好的衔乳技巧与学习如何躺着哺乳结合起来，有助于克服困难。

    一些女性发现停止母乳喂养可以改善她们的抑郁症，而另一些人则发现这会加重她们的抑郁症状。是否母乳喂养，完全有您来决定。

    如果您怀疑您或您所爱的人患有产后抑郁症、产后焦虑症或产后创伤后应激障碍，联系医疗保健专业人员非常重要。国际母乳会的哺乳辅导可以提供有用的支持和信息

                 

    Baby Blues, PPD, PPA, PPOCD, and Postpartum PTSD

     

    Like many mothers or new parents, you may have the experience of being completely overwhelmed caring for your new baby.

    “Baby Blues”
    You may find yourself feeling sad and weepy. This often starts on the day your milk supply increases (‘comes in’) between days three and five. This feeling of sadness may come and go in waves over a few hours or days. We call this the “baby blues”. It improves as breastfeeding is established and as the pregnancy and birthing hormones leave your body. This is usually within one to two weeks. 

    About 50 to 80% of mothers experience the “baby blues”. It can be very stressful if you are having difficulty breastfeeding or if you think your baby may not be getting enough. It helps to get the support you need from healthcare professionals and those you love. Be patient with yourself and your baby in these early days. Talking with other new mothers at La Leche League meetings lets you know you’re not alone.

    Additional related information:
    How Partners and Supporters Can Help  
    Positioning and Latching 
    How to Know Your Baby is Getting Enough Milk
    Establishing Your Milk Supply

    Postpartum Depression (PPD)
    Unlike the baby blues, postpartum depression (PPD) symptoms don’t fade away after a few weeks. They can start any time during the first year after birth. About 13% to 20% of mothers and 2% to 25% of fathers experience PPD. If the underlying causes aren’t dealt with, the symptoms may continue to get worse over time. Mothers experiencing PPD report:

    • feeling that they are not doing a good job of parenting.

    • feeling guilty for having had a child.

    • despairing that they will never feel happy again.

    • having difficulty concentrating and making decisions.

    • having disrupted appetite and sleep patterns (beyond what is normal with a young baby in the house).

    • being isolated because they don’t have the energy to get out of the house or to interact with other people.

    Very occasionally (less than 1%) mothers with PPD have thoughts of hurting themselves or their baby. Immediate mental health help is needed in these cases. Often hospitalization and medication is required to stabilize their symptoms and to keep themselves and their babies safe.

    Some of the predictors of postpartum depression are:

    • previously diagnosed depression or other mental illness.

    • history of abuse.

    • high levels of systemic inflammation, for example from an infection or from severe trauma, burns or bleeding.

    • pain from childbirth or breastfeeding.

    • the mother’s perception that she had a negative birth     experience. This is different from having an actual negative outcome of     the birth.

    • having a baby with a “high needs”  or “intense” temperament.

    • lack of social support.

    Physical and psychological stressors increase inflammation. Recent research suggests that inflammation may be a risk factor for depression. Current treatments for PPD include reducing maternal stress and decreasing inflammation. Breastfeeding and exercise help reduce maternal stress. Medications may be needed to reduce inflammation.

    The Edinburgh Postnatal Depression Scale (https://psychology-tools.com/epds/) is a self-screening tool that you can use to identify whether or not you are depressed. Perinatal Services BC http://www.perinatalservicesbc.ca/health-professionals/professional-resources/public-health/edinburgh-postnatal-depression-scale-(epds)has printable copies in English and several other languages.

    If you are experiencing relatively mild postpartum depression, you may not recognize what is happening to you. Our society expects new parents to be happy to have their babies. It can be hard to talk about your feelings if you do not feel safe speaking about them. You may be afraid of being judged for not being thrilled about life with a baby.

    Postpartum Anxiety (PPA)
    Some new parents experience constant worry or fear after having their babies. They may have difficulty sleeping, experience fatigue (beyond what is to be expected with a newborn) and have other symptoms of anxiety. This is called Postpartum Anxiety (PPA). Symptoms of PPA are often similar to symptoms of PPD. Parents may have both conditions. About 6% to 28% of women may experience PPA during the first six months after giving birth. Women are twice as likely to experience PPA than men.

    Postpartum Obsessive Compulsive Disorder (PPOCD)
    Between 3 to 5% of new parents may experience a type of postpartum anxiety called Postpartum Obsessive Compulsive Disorder (PPOCD). Parents with PPOCD experience persistent, repetitive, frightening thoughts they cannot control. These obsessive thoughts are about perceived dangers to the baby. Parents are very unlikely to act upon these thoughts. 

     

    Instead they are often hypervigilant (overly careful) and compulsive about protecting the baby from these perceived dangers. Many new parents do not report these feelings due to fears that the baby will be removed from their care. Untreated PPOCD can lead to difficulty bonding with and caring for the baby. Obsessive thoughts and compulsions can also impact a mother by affecting her ability to sleep or care for herself.

     

    Common obsessive symptoms of PPOCD are:

    • worries that the baby will be injured accidentally or intentionally.

    • worries that the baby will develop a serious illness.

    • worries that the baby will be poisoned by food or chemicals in the environment.

    • fears of being left alone with the baby.

    • fears of making decisions that will negatively affect the baby.

     

    Common compulsive behaviours of PPOCD are:

    • removing sharp objects such as knives and scissors from the home.

    • obsessively checking on the baby when she sleeps.

    • constantly cleaning.

    • asking others for reassurance that the baby has not been harmed or abused.

    • avoiding certain behaviours because of fears of harming the baby such as bathing, feeding or holding the baby.

    These symptoms usually appear around 2 to 3 weeks postpartum. They often come on gradually and get worse over time.

    Postpartum Post-Traumatic Stress Disorder (PTSD)
    Trauma experienced during childbirth may lead to postpartum PTSD. It is important to note that even a birth that many see as “successful” can still be experienced as traumatic by the mother or parent. Postpartum PTSD can increase the risk of developing PPD. Traumatic events can include:

    • feeling very worried about your health or your baby’s health during birth.

    • extreme pain. complications during childbirth. feeling unsupported by staff. feeling like you have no control over your body or birth.

    • feeling disrespected, abused, humiliated, or mistreated during childbirth.

     

    Symptoms of Postpartum PTSD include:

    • Re-living or re-experiencing traumatic aspects of the birth

    • Nightmares and flashbacks

    • Avoidance of people, places or situations related to the birth (for example: avoidance of hospitals)

    • Sleep difficulties

    • Feelings of detachment (for example: feeling distant from your baby)

    • Episodes of frequent crying

    • Changes in appetite

    • Feeling hopeless

    • Loss of interest in things you used to enjoy

    Getting Help
    If you have any of these mental health conditions it can also be confusing for those around you. Partners may be unsure of how to help. They don’t understand that you can’t just “snap out of it and cope like other new mothers.” Older children may feel uncertain about the changes in your behaviour. You may struggle to respond to your newborn. Breastfeeding can help you maintain the relationship with your baby. If you are chronically depressed or anxious, your newborn may be negatively affected. Thus, getting treatment is important. When symptoms are severe, it is often those around you (partners, relatives and friends) who put together the clues. They may be the ones to suggest that you get a proper diagnosis and support.

    Treatment
    The treatment of these mental health conditions generally focuses around three major strategies:

    ·medication,

    ·getting enough good quality sleep,

    ·and family/community support.

    It is important to work with your healthcare provider to find a strategy that works for you and your family. Ideally, this strategy will include all three of these approaches.

    Lack of sleep is one of the biggest factors in making symptoms worse. If you are breastfeeding and struggling with sleep deprivation, ask for help from your support network. You’ll want to find ways to get more sleep while maintaining your milk supply and breastfeeding relationship with your baby.

    Many people are under the impression that breastfeeding is not recommended when treating mental health conditions with medication. This belief can make some mothers reluctant to consider medication as a treatment option. If you want to continue breastfeeding, let your healthcare professional know that you want a medication that is compatible with breastfeeding. If the suggested medication is not compatible with breastfeeding, you can ask for a different one.

     

    Other treatments include:

    ·Increased consumption of long-chain fatty acids (omega 3s)

    ·Exercise

    ·SAMe (S-adenosyl-L-methionine) It is a compound found naturally in the body. A synthetic version may be available as a dietetic supplement.

    ·Cognitive-Behavioural Therapy (group or individual).

    Most of the above treatments reduce inflammation in the body. The New Hampshire Breastfeeding Task Force’s document “ABreastfeeding-Friendly Approach to Depression in New Mothers” http://www.uppitysciencechick.com/ppd_curric_final_2009.pdf is an excellent resource for parents and professionals who want to look at all the options for treating PPD including drug therapy. See this PPD resource webpage for more resources.http://www.uppitysciencechick.com/postpartum-depression.html

    Successful breastfeeding can be protective against developing these conditions. It can also be a helpful coping strategy. A combination of better latching technique and learning how to nurse lying down can help overcome difficulties.

    Some women find that stopping breastfeeding improves their depression while others find that it worsens their depression. The decision to breastfeed or not is entirely up to you.

    If you suspect that you or someone you love has PPD, PPA or postpartum PTSD, it is important to contact a healthcare provider. A La Leche League Leader  can provide helpful support and information. If you think any of your mental health symptoms are related to a difficult birth experience see Moving Forward After a Traumatic or Difficult Birth Experience for more information.

    参考资源

    Resources:

    Abramowitz, Jonathan. (2023). What are Postpartum and Perinatal OCD? International OCD Foundation.

    Ali, E. Women’s experiences with postpartum anxiety disorders: A narrative literature review. International Journal of Women’s Health, 2018; 10: 237-249. DOI: 10.2147/IJWH.S158621

    Balan, I., Patterson, R., Boero, G., Krohn, H., O’Buckley, T.K., Meltzer-Brody, S., Morrow, A.L. (2023). Brexanolone therapeutics in post-partum depression involves inhibition of systemic inflammatory pathways. eBioMedicine, (89).

    Bass, P. F.; & Bauer, N. S. Parental postpartum depression: More than “baby blues”. Contemporary Pediatrics, Sept. 2018; 35(9): 35-38. (accessed 8 October 2022).

    Bränn, E., Fransson, E., White, R. A., Papadopoulos, F. C., Edvinsson, Å., Kamali-Moghaddam, M., Cunningham, J. L., Sundström-Poromaa, I., & Skalkidou, A. (2020). Inflammatory markers in women with postpartum depressive symptoms. Journal of neuroscience research, 98(7), 1309–1321.

    Fairbrother N, Collardeau F, Albert AYK, et al. (2021). High prevalence and incidence of obsessive-compulsive disorder among women across pregnancy and the postpartum. J Clin Psychiatry.

    Kendall-Tackett, K., Cong, Z., & Hale, T. W. (2011). The effect of feeding method on sleep duration, maternal well-being, and postpartum depression. Clinical Lactation, 2(2), 22-26.

    Nierengarten, M. B. Why screen new fathers for postpartum depression? Contemporary Pediatrics Journal, 2018; 35(9) September 2018. (accessed 8 May 2022).

    Sawyer K. M. (2021). The role of inflammation in the pathogenesis of perinatal depression and offspring outcomes. Brain, behavior, & immunity – health, 18, 100390.

    Srimoragot, M., Hershberger, P. E., Park, C., Hernandez, T. L., & Izci Balserak, B. (2023). Infant feeding type and maternal sleep during the postpartum period: a systematic review and meta-analysis. Journal of sleep research, 32(2), e13625.

    2023年更新

    END

     

    译者 | Lynn

    审阅 | 传艳、Marien、笑仪、Victoria

    编辑 | 李热爱

    更多阅读资料，

     

    欢迎大家访问“国际母乳会LLL”官网：

    https://www.muruhui.org/

     

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  • 乳头疼痛是新手妈妈的必经之路吗？

    点击上方“国际母乳会LLL”   “设为星标”，获取哺乳信息



    图|国际母乳会中国图片库


    新手妈妈在哺乳初期总是会面临一些挑战，比如不恰当的姿势导致的乳头疼痛、胀奶的烦恼等等。


    今天这篇文章我们汇总了珠海的国际母乳会资深哺乳辅导Varya示范的一些实用小技巧，希望对大家有帮助。


            喂奶不疼三要点




    舒服的姿势是避免疼痛的关键


    最初几天妈妈的乳头有些敏感是很正常的。如果哺乳时很疼或有损伤，那就是身体发出了需要我们调整的信号。


    检查一下宝宝的腹部是否紧贴着您的腹部，宝宝的头是否可以自由活动并稍稍往后仰。确保乳头自然地滑进宝宝的嘴里而不是把乳房塞到他嘴里。


    点击下面链接了解更多关于哺乳姿势的内容

    哺乳中最容易忽视的要点（下）：含乳姿势



    点击视频，了解详细信息







    通常情况下国际母乳会更倾向于推荐哺乳妈妈尽可能多和宝宝呆在一起，我们认为让宝宝频繁地吸奶是解决胀奶等问题的最好途径。

    点击链接可了解相关内容：哺乳期乳腺炎，妈妈们“信奉”的按摩手法，其中利弊你知道吗？

    当遇到一些特殊情况，如乳汁流速太快，胀奶时宝宝不在身边或不愿意含乳等，您也可以尝试以下的方法：

    点击视频，了解详细的信息
























    国际母乳会妈妈课堂开播了


    2023年国际母乳会中国“回归本能的母乳喂养”国际研讨会已于5月19日结束回放。课后通过问卷调研，收到反馈结果：零差评！感谢各位（准）妈妈和专业人士的支持和积极反馈！





    大家的反馈


    有些学员反馈课程太好了，想多听几遍。我们日常遇到妈妈求助时，也深感有些科普课程的内容有助于她们降低焦虑，科学育儿。


    于是，我们和部分嘉宾商量，把适合普通（准）妈妈收看的科普课程放到国际母乳会知识店铺“妈妈课堂”。


    目前“妈妈课堂”7节课程已全部上线，同时还上线了“专业课”、“大师课”，敬请关注。


    欢迎进入国际母乳会LLL“知识店铺”，选择您喜欢的课程：

    扫码听课


    幸福妈妈，母乳宝宝！

    知识就是力量！

    “知识店铺”加上国际母乳会线上线下聚会

    和粉丝群的支持网络，

    希望能全方位地

    给予各位希望或正在母乳喂养的女性支持！




    END



    视频剪辑 | 林晓星

    审阅：Victoria、笑仪

    编辑 | 沐凡







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    搜索关键字“国际母乳会LLL”




    更多阅读资料，


    欢迎大家访问“国际母乳会LLL”官网：


    https://www.muruhui.org/




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    本篇文章来源于微信公众号: 国际母乳会LLL

  • 你经历过产后情绪不良吗？

    点击上方“国际母乳会LLL”   “设为星标”，获取哺乳信息

    图|国际母乳会中国图片库


    1

    产后情绪不良很常见




    产后情绪不良持续超过2周需及时寻求专业帮助


    大概有30-80%的产妇可能会在产后1、2天出现情绪不稳定的情况，5-7天是情绪波动的高峰期，正常情况2周左右会自行缓解。这个时期产妇需要多休息，家人多给予关注和照顾。必要时可以寻求心理咨询或心理治疗。


    点击视频，了解详细的信息






    2

    早期情绪对孩子有深远影响



    妈妈的情绪直接影响宝宝一生的身心健康！


    早期过多的负面情绪体验会导致成年后的大脑皮层发育障碍。国外很多研究表明：促进早期母婴联结可以让妈妈情绪更稳定，有利于孩子后期的身心发育。




    点击视频，了解详细信息








    3

    如何获得积极心态




    首先切断过去失败带来的消极情绪


    消极心态出现的时候，首先不要再反复回想经过让自己不断地受伤。切断过去是重新开始的第一步。重要的是寻找自己当下的目标（以何种方式照顾新生儿），通过确定目标的意义和可行性来坚定信心。然后制定计划并不急不躁地将计划进行下去。




    点击视频，了解详细信息





    以上视频内容均出自广州市妇女儿童医疗中心妇产科主任医师伍少莹在国际母乳喂养周论坛“实现母乳喂养，为在职父母谋福利”的精彩演讲。


    伍少莹主任在《积极心态的哺乳引领快乐妈妈养出健康宝宝》中提到：来自全球各地的数据显示，超过半数的生育女性出现过产后情绪不良，严重者会出现精神障碍或异常行为。


    患者症状持续时间长短及严重程度各有不同；角色的巨大变化、支持体系的明显缺失、应对技能的严重不足……不仅对女性的一生造成不可磨灭的身心伤害，还有可能对后代健康成长及社会稳定性造成巨大冲击。


    伍少莹主任通过各种实实在在的案例或活生生的社会教训为大家揭开这恶魔的面纱，指导大家如何识别它的缠绕、应对它的伤害；最终得以获得哺乳的乐趣、成就快乐妈妈、养出健康宝宝、缔造幸福家庭。


    关于国际母乳喂养周论坛的课程详细信息，可点击下方链接了解：

    本次论坛结合今年世界母乳喂养周主题“实现母乳喂养，为在职父母谋福利”涉及科学喂养的知识、哺乳期常见问题、家庭支持、心理疏导、沟通技巧和职业发展等。


    我们有幸邀请到千万粉丝级大V虾米妈咪、三位产科和乳腺科主任作为主讲嘉宾，同时还有资深IBCLC、全球职业规划师为大家带来精彩分享，让你收获全面且具有积极导向的哺乳知识。


    欢迎孕妈妈、母乳妈妈，母乳喂养从业者或关注母乳喂养的医护人员参加回看！

    此次论坛提供含学分、不含学分两种套餐。

    如果错过了直播可以在6个月有效期内无限次回听。

    扫码报名享受三人成团优惠价：


    无学分套餐


    选择学分套餐可获得8个IBCLC继续教育学分或备考学时（6.5L，1R，0.5E）

    获取知识技能与考核分数，一举两得！


    含学分套餐



    END



    视频剪辑 | 林晓星

    审阅：Victoria、笑仪

    编辑 | 沐凡






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  • 母乳妈妈能吃药吗？哺乳期重要的用药准则

    点击上方 国际母乳会LLL 设为星标 ，获取哺乳信息

    图|国际母乳会中国图片库



    ▼


    “我刚刚做了个手术。我可以服用这种止痛药吗？”


    “我得了流感,我能吃什么药？”


    “这种感冒药会让我的乳汁变少吗？”



    我们经常收到关于哺乳期间用药安全性的问题。很多家庭不仅关心药物对婴儿的影响，还关注药物是否会影响母乳的量。幸运的是，现在有很多关于药物和母乳的信息可以提供给哺乳期的妈妈。


    ?

    常见问题

    我可以在哺乳期服用药物吗？ 

    可以。

    绝大多数处方药和非处方药都与母乳喂养相容，或者可以找到与母乳喂养相容的替代药物。


    根据美国儿科学会（American Academy of Pediatrics）的说法，“母乳喂养时，只有少数药物是禁忌的（不推荐）。尽管许多药物确实会进入乳汁，但大多数药物对乳汁供应或婴儿的健康几乎没有影响。”重要的是要告知您的医疗保健提供者您正在哺乳期。

    服药期间我需要“吸奶并丢弃”吗？ 

    很多人经常被告知在哺乳期服药时需要“吸奶”并“丢弃”。


    这些建议往往没有证据支持，因此我们需要核对可靠的信息来源，以获取最新的基于研究的信息。


    许多医疗保健者依赖于他们所开药物的包装说明书，而包装说明书几乎总是警告“孕期或哺乳期禁用”。然而，通过许多可靠的资源，我们可以找到更准确的答案。

    有关您是否需要暂时或永久停止母乳喂养的信息，请咨询当地哺乳辅导或以下资源。



    ?

    常见问题

    国际母乳会的哺乳辅导如何提供帮助？ 

    哺乳辅导是经过培训的志愿者，而不是医疗保健专业人员。


    虽然哺乳辅导不被允许告诉您药物是否安全，但他们可以提供药物信息和可能的替代方案，帮助您做出明智的决定。


    如果您确实需要暂时停止哺乳或断奶，哺乳辅导也可以帮助您制定一个吸奶方案来维持您的乳汁供应。


    药物资源和数据库有哪些？

    以下是我们发现的一些有用的资源。许多资源也被医生和药剂师用于帮助患者。


    LactMed

    LactMed（www.ncbi.nlm.nih.gov/books/NBK501922/）

    是由美国国立卫生研究院(NIH)下属的美国国家医学图书馆 (NLM) 维护的网站数据库。其在线数据库和移动应用程序都包含了有关母乳和婴儿血液中的药物含量以及对哺乳婴儿可能产生的不良影响的信息。并在适当的情况下，推荐了替代药物。所有数据均来自科学文献，有完整的参考文献。同行评审小组审查数据的科学有效性并保持及时更新。


    InfantRisk

    InfantRisk（www.infantrisk.com）

    是由注册药剂师Thomas Hale博士及其在德克萨斯理工大学健康科学中心的团队发布和维护的热线电话、网站和移动应用程序。热线电话 – 致电专家询问有关怀孕或哺乳期非处方药 (OTC) 或处方药的问题。周一至周五，上午8点至下午5点（美国东部时间），电话号码：1-806-352-2519。


    InfantRisk有2个移动应用程序（www.infantrisk.com/infantrisk-center-resources）：MommyMeds是提供给母亲的免费App，InfantRisk提供给医疗保健专业人士。这些应用程序为您提供有关药物以及怀孕和母乳喂养的信息。在某些情况下，这些应用程序还会列出能安全母乳喂养的可能的替代药物。


    E-Lactancia

    E-Lactancia（https://e-lactancia.org）是一个西班牙语-英语在线数据库，由 APILAM（促进母乳喂养文化和科学研究协会）维护。这个数据库由医生和药剂师共同维护。



    译者注：

    1）本文介绍的国外资源和数据库，使用的语言都不是中文，如有需要，大家可借助翻译工具来参考阅读。

    如果希望寻找中文界面的工具，也可参考适合国内读者的一些资源（如，医学界医生站、用药助手等等）来查询哺乳期药物的安全等级。


    2）由于缺乏安全性数据，中药是查不到安全等级的。


    关于非处方药 (OTC)  


    许多家长对服用非处方药(OTC)尤其是治疗感冒和流感的药物有疑问。
    由于缺乏安全性数据，包括InfantRisk在内的许多专家普遍建议哺乳期母亲避免服用膳食补充剂和草药。

    在美国，FDA只监管膳食补充剂的标签，而不监管其含量或质量。

    Frank J. Nice博士分享道，“在很多情况下，非处方药药物含有针对不同症状的多种成分。许多非处方药的同一产品具有常规剂量和大剂量的不同规格。药物可能是短效的，也可能是长效的。

    此外，妈妈们可能会发现药品说明书很复杂，难以遵循。她们可能会服用不合适的OTC药物，或者可能从家人或朋友那里得到了不正确的建议。

    因此，服用非处方药可能并不像最初看起来那么简单。对于母乳喂养的妈妈们来说，情况可能会更加复杂。

    • 避免服用几乎没有母乳喂养信息的非处方药。药剂师应该能够协助提供更多信息。
    • 避免服用有更安全的替代产品的非处方药。同样，药剂师可以帮助确定这一点。
    • 避免服用含有多种成分的复方非处方药。母亲最好服用含有单一或两种特定成分的非处方药来治疗她的特定病症；没有必要让母亲或哺乳期婴儿接触不必要的成分。
    • 避免服用大剂量的非处方药。如果哺乳期婴儿不需要，没有必要让他接触大剂量的药物。
    • 避免服用长效非处方药。没有必要让哺乳期婴儿长时间接触药物，尤其是在婴儿可能出现不良反应的情况下。”

    关于草药或膳食补充剂


    由于缺乏安全性数据，包括InfantRisk在内的许多专家普遍建议哺乳期母亲避免服用膳食补充剂和草药。

    在美国，FDA只监管膳食补充剂的标签，而不监管其含量或质量。

    大多数草药都贴上了膳食补充剂的标签，因此必须包含免责声明，即它们“未经美国食品和药品管理局评估”，并且“不用于诊断、治疗、预防和/或治愈任何疾病”。

    膳食补充剂制造商不必为其产品声称获得FDA的批准，也不必证明该产品有效或安全。草药产品中的成分经常与标签上的不符。

    在对来自12家不同公司的44种草药产品进行的DNA研究中，研究人员发现：
    • 59%的样品含有标签上未列出的植物物种
    • 33%的样品含有标签上未列出的污染物或填料
    • 32%的样品含有不同于产品主要标签成分的植物来作为替代，但标示的成分在样品中却未检测到
    • 9%的样品仅含有小麦或大米，而不包含标签上的植物种类。

    例如，其中一个研究中标有圣约翰草的产品仅含有番泻叶——这是一种不应长期服用的泻药。在其他产品中，一些未标示的填料和污染物是过敏原，可能会导致敏感人群出现严重反应。

    如果您正在寻找有关特定膳食补充剂的信息，上面列出的药物资源中列出了一些。如果您正在寻找有关草本催乳剂的信息以帮助增加您的奶量，可查看这篇文章：催乳剂真的有效吗？真正的催乳方法是什么？

    国际母乳会的提供


    如果这些还不能解决您的疑虑或问题
    请联系当地国际母乳会的哺乳辅导，并提出您的具体问题。如果有医疗问题和法律问题，请咨询相应的医疗保健和法律专业人士。




    Medications and Breastfeeding

    “I’ve just had surgery. Can I take this pain medication?”

    “I have the flu. What can I take?”

    “Will this cold medication make my milk dry up?


    We often receive questions about the safety of medications while breastfeeding. Families are concerned not only with how a medication might affect their baby but also how it might affect their milk supply. Fortunately, there is a great deal of information out there about medications and human milk.


    Can I take medicines while nursing? 


    Yes, the vast majority of prescription and over the counter medications are compatible with breastfeeding or have a breastfeeding-compatible alternative.


    According to the American Academy of Pediatrics(https://www.cdc.gov/breastfeeding/faq/index.htm#contraindications), Only a few medications are contraindicated (not recommended) while breastfeeding. 


    Although many medications do pass into breast milk, most have little or no effect on milk supply or on an infants well-being. It is important to share that you are nursing with your healthcare provider.


    Do I need to pump and dump while taking medications? 


    Families are frequently told to pump and dump when taking a medication. These recommendations are often not backed up by evidence, so it is important to check reliable sources for up-to-date research-based information.

    Many health care providers rely on the package insert of the medication that they are prescribing. The package insert almost always cautions against prescribing the medication to pregnant or lactating people. However, there are many reliable resources for finding more accurate answers.

    For information about whether you will need to temporarily or permanently cease breastfeeding, check with your local Leader(https://lllusa.org/locator/) or the resources below.


    How can an LLL Leader help? 

    Leaders are trained volunteers and not health care professionals. While Leaders are not permitted to tell you if a medication is safe, they are able to provide information about medications and possible alternatives to help you make an informed decision. 


    Leaders are also able to assist you in creating a pumping regimen to maintain your supply in the event that you do need to temporarily stop nursing or wean.

     

    Medication Resources and Databases 


    Here are a few resources that we have found helpful. Many are also used by medical doctors and pharmacists for assisting their patients.


    LactMed

    LactMed(https://www.ncbi.nlm.nih.gov/books/NBK501922/) is a website database maintained by the US National Library of Medicine (NLM) at the National Institutes of Health (NIH). Both the online database and mobile app include information on the levels of substances in breast milk and infant blood and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided, where appropriate. All data come from scientific literature, and entries are fully referenced. A peer review panel reviews the data for scientific validity and currency.


    InfantRisk

    InfantRisk(https://www.infantrisk.com/) is a hotline, website, and mobile app that are published and maintained by Dr. Thomas Hale, a registered pharmacist, and his team at the Texas Tech University Health Sciences Center.

    Hotline- Call to ask experts your questions about over the counter (OTC) or prescription medications while pregnant or nursing. Monday Friday, 8am-5pm CT 1-806-352-2519

    InfantRisk maintains 2 mobile apps(https://www.infantrisk.com/apps): MommyMeds for Mothers (free) and InfantRisk for Health Care Providers. The apps provide you with information about medications and both pregnancy and breastfeeding. In some cases, the apps also list possible breastfeeding-safe alternative medications.


    E-Lactancia 

    E-Lactancia(http://e-lactancia.org/) is an Spanish-English online database maintained by APILAM, Association for Promotion of and Cultural and Scientific Research into Breastfeeding. It is maintained by both medical doctors and pharmacists.

     

    What about over-the-counter (OTC) medications? 


    Many parents have questions about taking over-the-counter (OTC) medications especially to treat cold and flu(https://www.infantrisk.com/content/over-counter-treatments-cough-and-cold).

    Dr. Frank J. Nice shares(https://www.llli.org/over-the-counter-otc-medications-and-breastfeeding-2/), In many cases, OTC medications consist of multiple ingredients for multiple symptoms. 


    Many OTC medicines have both regular-strength and extra-strength forms of the same product. The medication may be short-acting or long-acting. In addition, mothers may find it difficult to follow complex package directions. 


    They may take an inappropriate OTC medication or may have been given incorrect advice by family or friends. Thus, taking an OTC medication may not be as simple as it initially appears. It will probably be even more complex for consumers who are breastfeeding.


    • Avoid taking OTC medications for which little breastfeeding information is available. A pharmacist should be able to assist with additional information.

    • Avoid taking OTC medications for which safer products are available. Once again, a pharmacist can help determine this.

    • Avoid taking combination OTCs, which are those with multiple ingredients. It is better for the mother to take an OTC that has the one or two specific ingredients that will treat her specific condition; there is no need for mothers or nurslings to be exposed to unnecessary ingredients.

    • Avoid taking extra strength forms of OTC medications. There is no need for the nursling to be exposed to extra amounts of a drug when it is not needed.

    • Avoid taking long-acting OTC medications. There is no need for the nursling to be exposed to a drug for a longer period of time, especially if an adverse reaction is possible in the nursling.

     

    What about herbal medicines or dietary supplements? 


    Because of the lack of safety data, many experts including those at InfantRisk generally recommend that nursing parents avoid taking dietary supplements and herbal medicines.


    In the US, the FDA only regulates the labeling of dietary supplements, not their content or quality.

    Most herbals are labeled as dietary supplements, and so have to include the disclaimer that they have not been evaluated by the Food and Drug Administration , and are  not intended to diagnose, treat, prevent and/or cure any disease.


    The supplement manufacturer does not have to get FDA approval for its products or claims, and it does not have to prove that the product is either effective or safe.


    The ingredients in herbal products often do not match what is on the label. In a DNA study of 44 herbal products from 12 different companies(https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-222), the researchers found that:


    • 59% of the samples contained plant species not listed  on the label

    • 33% of the samples contained contaminants or fillers  not listed on the label

    • 32% of the samples contained a different plant  in place of the products main labeled ingredient, which was NOT detected within the sample

    • 9% of the samples contained only wheat or rice,  and not the plant species on the label


    For example, one of the products in the study that was labeled St. Johns Wort contained only senna, which is a laxative that should not be taken on a long-term basis. In other products, some of the unlabeled fillers and contaminants were allergens that could cause severe reactions in sensitive people.


    If you are looking for information about a specific dietary supplement, some are listed in the medication resources listed above. 


    If you are looking for information about herbal galactagogues to help increase your milk supply, check out this article .


    IS YOUR CONCERN OR QUESTION NOT COVERED HERE?


    Please contact a local LLL Leader  with your specific questions.


    Medical questions and legal questions should be directed to appropriate health care and legal professionals.

     




    参考资源


    Resources:


    https://lllusa.org/medications-and-breastfeeding/

    Breastfeeding and Surgery, LLL USA


    Over the Counter Medications and Breastfeeding, Dr. Frank Nice, RPH, DPA, CPHP for LLLI


    Medications: A Quick Guide for Parents, LLLI

    Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother Academy of Breastfeeding Medicine

    Cold and Flu Medications While Breastfeeding, InfantRisk

    Over-The-Counter Treatments for Cough and Cold, InfantRisk

    Prescription Medication Use and Breastfeeding, American Academy of Pediatrics (AAP)

    Clinical Protocol #13: Contraception During Breastfeeding— Academy of Breastfeeding Medicine

    Clinical Protocol #18: Use of Antidepressants in Breastfeeding Mothers— Academy of Breastfeeding Medicine

    Vitamin D Supplements, InfantRisk

    Vitamin D, Your Baby, and You, LLLI

    Vitamins and Other Nutritional Supplements, LLLI

    The Nursing Mother’s Herbal by Sheila Humphrey

    Nonprescription Drugs for the Breastfeeding Mother by Frank J. Nice,



    END



    译者 | Michelle

    审阅 | Victoria、笑仪、Lynn、Marien

    编辑 | 李热爱





    更多阅读资料，


    欢迎大家访问“国际母乳会LLL”官网：


    https://www.muruhui.org/




    分享

    收藏

    点赞

    在看



    本篇文章来源于微信公众号: 国际母乳会LLL

  • 可以将母乳和配方奶粉混在一起喂养吗？Should you mix human milk with formula?

    点击上方 国际母乳会LLL 设为星标 ，获取哺乳信息

    图|国际母乳会中国图片库


    世界卫生组织建议在婴儿出生后6个月内进行纯母乳喂养，在婴儿出生半年左右开始添加辅食后并继续母乳喂养至2岁或更久。


    纯母乳喂养意味着除了母乳以外什么都不喂：不喂水、不喂果汁、不喂配方奶。


    许多妈妈在得知自己的乳汁就能满足宝宝前六个月或更长时间的需求，感到很高兴。


    当你母乳不足时也许会补充配方奶粉，或因为其他原因使用配方奶粉。无论是哪种情况，你可能都会有疑问：是否可以将母乳和配方奶粉混在一起喂养？

    不建议将母乳和配方奶粉混在一起喂养，原因如下：


    建议分开喂养

       

        建议将母乳与配方奶粉分开喂养以最大限度地发挥母乳的功效。


    • 配方奶粉和母乳有不同的储存条件和允许保存的时间。
      奶瓶（或杯子）里喝剩下的配方奶必须在喂养后丢弃，而喝剩下的母乳则可以在冰箱里保存1-2小时后再丢弃。如果把母乳和配方奶粉混合在一起喂但宝宝没有一次喝完，那就必须把剩下的奶丢弃。这会造成对母乳不必要的浪费。
    • 将配方奶粉混合到母乳中会减弱母乳中的一些保护成分。
      研究发现，在喂养前将牛奶配方奶与母乳混合后，奶中的溶菌酶（一种抗菌酶）的活性会显著下降（41-74%）。因此，奶中的有害菌——大肠杆菌的生长会显著增加。
    • 配方奶粉中的成分在与母乳中的活性成分结合后使其更难被宝宝的身体吸收。
      例如，配方奶粉中添加的铁实际上会干扰母乳中铁的吸收。
    • 你可能会挤奶或使用吸奶器来增加你的奶量。
      如果你的乳汁不够每次的喂养，可根据需求多次吸奶收集到足够的母乳完成一次纯母乳喂养，其他喂养时如需要再使用配方奶。你可以选择在哺乳后补充配方奶，也可以在哺乳前给予少量配方奶，哺乳后如需要再给予剩下的配方奶。
    • 你可能因为母乳不足而经常使用配方奶粉。
      在这种情况下了解配方奶对母乳的影响可以帮助你决定何时提供配方奶，何时提供母乳。
    • 如果你有一个早产儿需要服用母乳强化剂，可以把它添加到挤出的母乳里。


    如果你对奶量或其他母乳喂养问题有疑问，请联系国际母乳会哺乳辅导以获取信息和支持。点击链接：国际母乳会哺乳辅导联系方式




    Should you mix human milk with formula?


    World Health Organization recommends exclusive breastfeeding for the first six months of life, with continued breastfeeding for two years or more after the introduction of complementary foods around the middle of the first year of life. 


    Exclusive breastfeeding means nothing but breastmilk: no water, no juice and no formula. Many mothers are happy to know that their milk is all their baby needs in the first six months or longer.


    You may be supplementing because you are not producing enough milk for your baby. Or you may be using formula for other reasons. In either case, you likely have questions about whether or not it is okay to mix formula into your milk.


    It is recommended that formula not be mixed with human milk for the following reasons:


    It is recommended that you feed human milk separate from formula to maximize the benefits of human milk.


    • Formula and human milk have different storage guidelines.

      Any formula that your baby doesn’t drink from the bottle (or cup) must be discarded after the feeding. Human milk that your baby does not drink can be kept for between 1-2 hours in the refrigerator before being discarded. If you mix your milk with formula and your baby doesn’t finish the bottle (or cup), it must be discarded. This could lead to unnecessary wastage of your milk.


    • Mixing formula into human milk decreases some of the protective components of human milk.

      Research has found that when cow milk formula is mixed with human milk prior to feeding, there is a significant (41-74%) decrease in the activity of lysozyme, an antimicrobial enzyme in the milk. As a result, there is a significant increase in the growth of the harmful bacteria, E-coli, in the milk.


    • Components in formula might bind to live components in human milk making them less absorbable by your baby’s body.

      For example, the added iron in formula can actually interfere with the absorption of the iron that is found in human milk.


    • You may be expressing milk or pumping to increase your milk supply.

      If you are not producing sufficient milk for each feeding, collect as many pumpings as necessary to make one exclusive human milk feeding and use formula at the other feedings as needed. You can give this supplement after nursing or you can give a small amount before nursing and give the remainder after nursing, as needed.


    • You may be using formula regularly because of a low milk supply.

      In this case, knowing how formula interacts with your milk, can help you decide when to offer formula and when to give your milk.


    • You may have a premature baby who requires human milk fortifiers. These can be added to your expressed milk.


    If you have concerns about your milk supply or any other breastfeeding questions, please contact a La Leche League Leader for information and support.






    参考资源


    Resources:


    Quan, R., Yang, C., Rubinstein, S., Lewiston, N. J., Stevenson, D. K., & Kerner, J. A., Jr (1994). The effect of nutritional additives on anti-infective factors in human milk. Clinical pediatrics, 33(6), 325–328.


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

    Updated 2022

    更新于2022年


    参考资料：

    Should you mix human milk with formula? | La Leche League Canada – Breastfeeding Support and Information (lllc.ca)





    END



    译者 | Sophie

    审阅 | Victoria、笑仪、Lynn、何弢

    编辑 | 李热爱





    更多阅读资料，


    欢迎大家访问“国际母乳会LLL”官网：


    https://www.muruhui.org/




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  • 哺乳妈妈更容易渴，夏天喝水怎么喝？

    点击上方国际母乳会LLL 设为星标，获取哺乳信息

    图|国际母乳会中国图片库


    您会发现自己比生宝宝前更容易口渴。您有可能在哺乳期需要多喝水。到宝宝六周左右大的时候，他将会吃650-1000毫升的母乳，也可能 更多些。


    因此，您可能每天至少需要多喝那么多的水。但是您不需要喝得都让自己不舒服了。过多的液体摄入并不会增加母乳量。


    对普通人群来说，常规建议是每天喝1.5到2升的水。如果您在哺乳期，就可以每天在这个基础上再增加1升水，总量在2.5升到3升之间。


    您不需要为了产奶而喝牛奶。水是最好的饮品，但您也可以再喝些果汁、草本茶等。


    很多哺乳妈妈会继续享用适量的咖啡和红茶。这些饮料是温和的利尿剂，就是说它们可以帮助消除您体内多余的液体。然而，它们仍然有助于满足您日常对水的需求，只是不如白开水。


    吃西瓜、橙子等富含水分的水果也可以帮助您从饮食中获得更多水分。更多信息请参阅《不用纠结：母乳妈妈也能喝咖啡！》。


    一旦有口渴的迹象就喝点东西，会让您的身体保持正常运转。这有助于清除体内的废物，并帮助调节体温。尿液呈淡黄色、没有便秘的迹象都表明您得到了足够的液体。


    在您平时喂奶的地方放一个装满水的水瓶总能触手可及，这会很有帮助。试试只要您在水龙头旁边、或一坐下来喂奶，或只觉得有点口渴时，就有意喝口水。






    Water — How Much Should I Drink?

    You may find that you are thirstier than you were before your baby arrived. You will likely need to drink more when you are breastfeeding. 


    By the time your baby is six weeks old or so, your baby will be drinking between 650 ml and 1000 ml, perhaps more. So you will likely need to drink at least that much more each day. 


    But you do not need to drink so much water that you are uncomfortable. Excess fluid intake does not improve milk supply.


    A common recommendation is to drink 1.5 to 2 L of water each day. If you are breastfeeding you could add another 1 L for a total of between 2.5 L to 3 L of water each day.


    You don’t have to drink cow’s milk to make human milk. Water is the best thing to drink but you can also add fruit juices, herbal teas, etc. Many breastfeeding parents continue to enjoy coffee and black tea in moderate amounts. 


    These beverages are mild diuretics meaning they can help to eliminate excess fluids in your body. However, they still help to meet your daily water needs, just not as much as plain water. Eating watery fruits like watermelon and oranges can also help you get more water into your diet. See 不用纠结：母乳妈妈也能喝咖啡！Caffeine and Breastfeeding for more information.


    Having something to drink at the first sign of thirst will keep your body working properly. It helps to remove waste products from your body and helps regulate your temperature. Pale yellow urine and no sign of constipation are indications that you are getting enough fluids. 


    It can be helpful to keep a filled water bottle handy in your usual nursing locations. Try to make a point of having a drink of water whenever you are near a tap, whenever you sit down to nurse, and whenever you feel even a little bit thirsty.





    参考资料


    https://www.lllc.ca/water


    参考文献：

    MyHealth.Alberta.ca (2021, September 8). Drinking Enough Water. Government of Alberta. https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=abk5466




    END



    译者 | Lynn

    审阅 | 传艳 & Betty

    编辑 | 李热爱



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  • 正值炎热酷暑，母乳喂养需要注意哪些？戳这里

    点击上方国际母乳会LLL 设为星标，获取哺乳信息

    图|国际母乳会中国图片库


    即使在非常炎热、潮湿的日子里，只要母乳喂养已经稳固下来，您的宝宝在出生后头六个月也只需要纯母乳喂养就够了。


    令人惊讶的是，您的母乳会自行调节，以确保宝宝获得所需的全部液体，补够水分。


    水没有任何热量和营养。您给宝宝喝多少水都会替代本应喝到肚子里的母乳量。这意味着在下次喂奶时她喝的母乳会减少。


    母乳可以给宝宝解渴，同时还提供宝贵的营养和热量。您可能会发现，宝宝在炎热的天气里吃奶可能会更频繁。请记住，宝宝喝的母乳越多，您的身体产奶就越多。给宝宝频繁地喂奶，而不给她喝任何其他液体，包括水和果汁，这样可以维持您的奶量。


    大热天里抱着暖乎乎的宝宝喂母乳会让你俩都觉得又热又汗津津的。在手臂上搭一条法兰绒婴儿毯或干毛巾，把宝宝和您的皮肤分隔开，会让你们俩都觉得更舒服。您可能想在浴缸或儿童泳池里哺乳。

    在炎热的天气里，您会发现比平时需要饮用更多的水。如果您打算在大热天出门，不要忘记包里多带点水。


    当宝宝开始吃固体食物时，您可以添加少量的水。


    大热天时，宝宝可能也会喜欢吃健康的冰棒，它是用稀释的果汁、压碎的水果、酸奶或者绿色蔬菜泥（比如菠菜泥）制成的。如果有的话，您甚至可以加入挤出的母乳。一年当中任何时候，正在长牙的宝宝和学步儿，都会觉得这些东西令人舒服。






    Breastfeeding in Summer or Hot Weather


    Exclusive breastmilk is all your baby needs in the first six months, as long as breastfeeding is well-established, even on very hot, humid days. 

    Amazingly, your milk will adjust to ensure that your baby gets all the fluids needed to stay hydrated. Water does not have any calories or nutrition. Any water you give your baby takes the place of breastmilk in her tummy. This means that she will drink less of your milk at the next feeding. 

    Breastmilk quenches your baby’s thirst and provides valuable nutrition and calories at the same time. You may find that your baby might nurse a little more frequently in hot weather. 

    Remember that the more milk your baby drinks, the more milk your body makes. Nursing your baby frequently, and not giving your baby any other liquids, including water and juice, will maintain your milk supply.  

    Breastfeeding a warm baby on a hot day can leave both of you feeling hot and sweaty. A flannel receiving blanket or a dish towel draped over your arm between your skin and baby’s can help both of you feel more comfortable. 

    You may want to consider nursing in a bathtub or children’s pool. In hot weather, you’ll find that you need more water than usual. Don’t forget to pack extra water if you plan to go out on a warm day.

    When your baby begins to eat solid foods, then you can introduce small amounts of water. On hot days your baby might also enjoy healthy popsicles made of diluted juice, crushed fruit, yogurt or even pureed green vegetables like spinach. 

    You can even add expressed breastmilk, if you have any. Teething babies and toddlers may find these comforting at any time of the year.





    参考资料


    https://www.lllc.ca/breastfeeding-summer-or-hot-weather




    END



    译者 | Lynn

    审阅 | 传艳 & Betty

    编辑 | 李热爱



    推荐阅读


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  • 哺乳中最容易忽视的要点（下）：含乳姿势

    点击上方国际母乳会LLL 设为星标，获取哺乳信息

    图|国际母乳会中国图片库


    母乳喂养就像跳舞一样。如果你要学习跳舞，就需要先知道如何摆放自己的身体，然后再学如何移动脚步。

    刚开始会觉得很别扭。或是轻而易举，或是千辛万苦。

    不过通过练习，给婴儿哺乳就会变成你的天然习性。

    母乳喂养时首先要考虑的就是：你如何摆放好自己和婴儿的身体姿势。一旦你的姿势对了，婴儿含乳就会更容易。

    好的哺乳姿势和含乳姿势对奶量的建立和维持很重要。当婴儿含乳很深时，他就能有效地吸出乳汁来。

    如果你的乳房乳汁排出通畅，身体就会收到信号去产更多的奶。若你担心自己的产奶量的话，改善哺乳和含乳姿势就是关键的第一步。


    正确、较深的含乳和有效吸吮的清单


    • 婴儿的下巴紧贴着乳房


    • 婴儿的嘴巴张得很大，上下嘴唇都外翻没有卷进去


    • 婴儿的头稍微往后仰，鼻子没有碰到、或只是轻轻碰到乳房。鼻子不应该埋到乳房里


    • 乳头不疼痛


    • 婴儿吸得很牢，不容易松口掉下来


    • 吸吮稳定，可听到吞咽声



    有关婴儿出生后立即开始第一次母乳喂养的信息，可阅读该篇文章《建立奶量》。



    一

    如何含好乳房


    一个舒适、安全的姿势可以让婴儿利用他的本能深深地含住乳房。含乳含得好，婴儿就会含入一大口乳房组织，从而可以轻柔地将乳头伸展到他的口腔后部。


    这样的话，婴儿就能有效地吸出乳汁。较深的含乳可以确保婴儿得到足够的奶量，你的身体也得到信号要产更多的乳汁。舒适安全的姿势还可以预防乳头疼痛和损伤。


    01

    下巴紧贴乳房

    图|加拿大母乳会


    如果婴儿的下巴没有碰到乳房，他就会经常转动头去寻找乳房。如果婴儿的下巴碰到了乳房，他会闻到你的乳头。这会促使他张大嘴巴，抬头去含一大口乳房。


    • 婴儿的下巴紧贴乳房时远离乳头底部会更好

    • 如果你手扶着乳房，手指要远离乳晕（即乳头周围的暗肤色区域），这样就不会妨碍婴儿含乳

    • 婴儿的下颌离乳头底部越远，他能含入的乳房组织就越多。这有助于含乳更深。

    02

    头往后仰，鼻子向上倾斜


    图|加拿大母乳会


    • 抱好婴儿，让他在寻找乳房时头能往后仰
    • 你的拇指和食指放在他的颈部、手掌放在背部上方来支撑住头部。如果你按住他的头顶，他很可能会挣脱开
    • 让婴儿的下巴紧贴乳房，乳头靠近他的鼻子
    • 当他的头向后仰、下巴紧贴着乳房时，婴儿就能把嘴巴张得大大的
    • 随着嘴张大，他可以抬头触到并吃上乳头，含入大面积的乳房组织（想想你是如何咬一大口汉堡的。开始你把汉堡的下边放在下巴上。然后抬起头、仰起上颚咬汉堡的上边。这和婴儿含一大口乳房的动作是异曲同工之妙）。
    • 轻轻地推婴儿的肩胛骨间让他含上乳。重要的是，你不把婴儿按到乳房上，而让他自己去探索

    一旦婴儿含上乳，他的鼻子可能会碰到乳房，但不应埋进去。你不该觉得必须按住乳房婴儿才能呼吸。下巴紧贴乳房、鼻子向上倾斜、头往后仰，就跟你喝水的姿势一样 （现在就试试，假装喝杯水。看看你的下巴是如何向前、头是如何往后仰的）。

    03

    两侧脸颊贴上乳房


    图|加拿大母乳会


    一旦含上乳，一侧脸颊没有挨到乳房的话，就要考虑调整婴儿的姿势，让两侧脸颊都贴上乳房。这有助于确保乳头直直地含到婴儿的口腔深处。


    根据需要调整婴儿的姿势。婴儿在哺乳时经常向上或向前爬行。

    • 如果婴儿的下巴缩到了他的胸前，嘴就不能含紧乳房。他也会发现吞咽费力（现在就试试。把你的下巴缩到胸前然后吞咽。难乎其难啊！）。

    • 哺乳期间你可能需要时不时调整婴儿的姿势，往下或往外挪一挪他的身体。

    • 你也可能需要从肩胛骨后面轻轻地推婴儿，就会让他的下巴上仰，紧贴到乳房上。还会使婴儿的头往后仰。用这个姿势，婴儿能像你一样喝得舒服。

    图|加拿大母乳会


    二

    乳头翘起的技术


    为了让含乳更深，你可以尝试用乳头翘起技术。

    • 用手托住乳房，拇指放在上面，其余手指放在下面，拇指要离乳头底部远一些。手指的位置是和婴儿含上乳的上唇平行的。确保手指远离婴儿下巴触到的乳房部位。

    • 用大拇指按住乳房，会使乳头翘起来并离开婴儿一些。

    • 把婴儿抱向乳房，下巴紧贴着

    • 当婴儿仰头去大口含乳时，在最后一刻松开拇指让乳头垂下。这样可以使乳头滑入婴儿的口腔深处

    • 避免把乳头塞入婴儿嘴里


    喝奶 vs吸吮

    “喝奶”和“吸吮”是有区别的。婴儿吸吮可以是为了安抚或是为了喝奶。这两种情况都会看到下巴在动。重要的是要知道婴儿什么时候是在喝奶。


    吞咽是婴儿吃到乳汁的主要标志。当有嘴里有奶时，婴儿的下颌下降，“暂停”一下以便吞咽。你可能会听到“卡”的声音，这是因为婴儿吞咽后呼气。


    吃奶时他会有一个稳定的“吸吮—吞咽—呼吸”的模式。婴儿会在两次奶阵之间休息一会儿。一来奶阵，他就又开始吃奶了。


    如果吞咽或吸吮速度减慢下来，你可以用整只手轻轻挤压或按压乳房几秒钟。这样会增加乳汁流速，从而鼓励婴儿一直吃奶。


    图|加拿大母乳会


    疼痛怎么办？

    较深的含乳可预防乳头被婴儿的舌头和硬腭夹扁。较浅的含乳常常导致乳头疼痛。


    如果婴儿含乳不正确，你的乳头顶端可能会有折痕，压平或夹扁。当它被婴儿吐出来后，看起来就像是一管新口红。乳头顶端可能呈白色。


    图|加拿大母乳会


    如果你觉得婴儿没有含好，即使有人说看起来含得很好，就需要立即处理。


    疼痛是身体在提示你某地方出现问题，需要改善。疼痛的含乳往往较浅。含乳浅的话，婴儿就无法轻松吸出乳汁。所以忍受疼痛的含乳是没有用的。有效较深的含乳是让你舒服的。婴儿同时也会吃到大量乳汁。


    • 如果感觉疼痛，可以将一根手指顺着婴儿的嘴角塞入中断吸吮让他松口。然后你试着重新含乳。

    • 通常婴儿还在含着乳房的时候就可以调整含乳姿势。这样可以防止婴儿因含上、松开乳房而受挫。如果乳头已经破损，调整含乳会让你避免重复经历含乳刚开始几秒钟的疼痛。如果你听到“咔嗒”或者吧唧声，或看到婴儿的脸颊凹陷下去，试着把婴儿的下巴紧紧贴在乳房上来改善含乳。或者你可以轻轻往下按婴儿下巴让下嘴唇外翻出来。


    一小部分婴儿由于舌系带过紧或过短而舌头活动受限。因此婴儿可能无法将乳头吸入口腔深处。如果尝试改善后含乳仍然疼痛，鼓励你寻求国际认证哺乳顾问（IBCLC）的帮助。之后必要的话，你可以咨询诊断和治疗舌系带过紧的医疗专家。






    以下视频你可能觉得有帮助

    半躺式哺乳：

    Https://www.biologicalnurturing. com/sample-of-biological-nurturing/


    如何在乳房上含好乳、吃好奶（点击“阅读原文”可观看）：

    https://ibconline.ca/breastfeeding-videos-english/










    Positioning and Latching


    Breastfeeding is like dancing. If you are going to learn to dance you need to know where to put your body and then how to move your feet. It may feel awkward at first. It might come easily or it may be difficult. But with practice nursing your baby can become second nature. The first thing to think about when breastfeeding or chestfeeding is how you are going to position your body and your baby’s body. Once you are in a good position, it will be easier for your baby to latch.


    Good positioning and latching is important for building and maintaining your milk supply. When your baby latches deeply onto your breast, your baby is able to remove milk effectively. When your breasts are well-drained, your body gets the message to make more milk. If you are concerned about how much milk you are making, improving positioning and latching is an important first step.


    Checklist for a good, deep latch and effective suck

    ●Baby’s chin is pressed deeply into the breast.

    ●Baby’s mouth is wide open with both lips uncurled.

    ●Baby’s head is tipped back slightly with the nose not touching, or lightly touching the breast. The nose should not be poking into the breast.

    ●No nipple pain.

    ●Good suction; baby doesn’t fall off easily.

    ●Steady sucking with audible swallows.


    For information on your baby’s very first feeding immediately after birth, please see The First Hours After Birth（https://www.lllc.ca/first-hours-after-birth-nine-instinctive-stages）and Establishing Your Milk Supply（https://www.lllc.ca/sites/default/files/Establishing%20Your%20Milk%20Supply-1.pdf）.


    Getting a good latch

    A comfortable, secure position allows your baby to use her instincts to latch deeply onto the breast. With a good latch your baby takes in a large mouthful of breast tissue. This gently stretches your nipple to the back of her mouth. When this happens, your baby is able to effectively remove the milk. A deep latch ensures that your baby gets plenty of milk and your body gets the message to keep making more. It also prevents pain and damage to your nipples.

    Chin planted on the breast.


    If your baby’s chin is not touching your breast, your baby will often turn his head searching for your breast. When your baby’s chin touches the breast, he smells your nipple. This triggers him to open his mouth wide, reaching up for a big mouthful of breast.

    ●It’s helpful if your baby plants his chin well away from the base of the nipple.

    ●If you are holding your breast, your fingers need to be far enough away from your areola (dark area around the nipple). Then they will not be in your baby’s way.

    ●The farther away your baby’s lower jaw is from the base of your nipple, the more breast tissue your baby will be able to take into his mouth. This helps to get a deeper latch.


    Head tipped back and nose tipping away.

    ●Position your baby so that her head can tip back as she approaches your breast.

    ●Support your baby’s head with your thumb and fingers at her neck and your palm at the upper back. If you touch the top of her head, she will likely pull away.

    ●Allow your baby’s chin to touch your breast with your nipple near her nose.

    ●With her head tipped back and her chin planted on your breast, your baby is able to open her mouth wide.

    ●With a wide open mouth she can reach up and over your nipple, taking in a large amount of your breast tissue. (Think about how you take a big bite of a burger. You start by placing the bottom of the burger on your lower jaw. Then you reach up and place your upper jaw up and over the top of the burger. This is the same motion your baby uses to get a big mouthful of breast.)

    ●Gently press between your baby’s shoulder blades as she reaches up to latch. It is important that you not shove your baby onto your breast. Allow her to lead the way.


    Once your baby is latched, her nose may touch the breast but it shouldn’t be poking into it. You shouldn’t feel like you have to hold your breast back so your baby can breathe. Chin in, nose tipping away, head back is the same position you take when you drink something. (Try it now, pretend to take a drink of water. See how your chin goes forward and your head tips back?)


    Both cheeks touching the breast. 

    If once latched, one cheek is not touching the breast, consider adjusting your baby so that both cheeks are touching your breast. This will help to make sure your nipple is straight and deep into your baby’s mouth.


    Adjust your baby as needed.Babies often creep upwards or forwards while feeding.

    ●If your baby’s chin is tucked into his chest, he will not be able to hold onto the breast with his mouth. He will also find it hard to swallow. (Try it now. Tuck your chin into your chest and swallow. It is very difficult.)

    ●You may need to occasionally adjust your baby during feedings by sliding him downwards or backwards towards his feet.

    ●You may also need to pull your baby in gently from behind the shoulder blades. This will push your baby’s chin forwards, deeper into your breast. And it will tip your baby’s head back. In this position your baby can drink comfortably, just like you do.


    The Nipple Tilt Technique

    To get an even deeper latch, you can try using the nipple tilt technique. This is also known as the “flipple” technique.

    ●Hold your breast with your thumb on top and your fingers on the bottom. Place your thumb well back from the base of the nipple. This is in line with where your baby’s upper lip will be once she has latched. Make sure your fingers are far away from where your baby’s chin will be.

    ●Press in with your thumb. This will tilt your nipple away from your baby.

    ●Bring your baby to your breast so that her chin is touching.

    ●When your baby reaches up for a big mouthful of breast, release your nipple at the last moment by removing your thumb. This allows your nipple to fall deeply into your baby’s mouth.

    ●Avoid pushing your nipple into your baby’s mouth.


    Drinking vs. Sucking

    There is a difference between “drinking” and “sucking”. Babies can suck for comfort or to drink. You’ll see chin movement for both. It’s important to know when your baby is drinking your milk.

    Swallowing is the main sign that your baby is getting milk. When there is a mouthful of milk, your baby’s chin will drop with a “pause” in order to swallow. You may hear a “kah” sound as the baby breathes out after a swallow. When your baby is drinking, she has a steady suck, swallow breathe pattern. Your baby will take short breaks between letdowns of milk. When another letdown of milk occurs, your baby will begin drinking again.

    If swallowing or sucking slows down, you can gently squeeze or compress your breast with your whole hand for several seconds. This will increase milk flow and encourage your baby to keep drinking.


    What if it hurts?

    A deep latch prevents the nipple from being pinched by the tongue and the hard palate of your baby’s mouth. A shallow latch often results in sore nipples. If your baby is not latched correctly, the end of your nipple may be creased, flattened or pinched. It may look like a new tube of lipstick, when it comes out of your baby’s mouth. The end of the nipple may be blanched (white).

    If you feel that your baby is not latched well, it is important to deal with it right away, even if other people tell you that the latch looks fine.Pain is your body’s way of letting you know that something is wrong and needs to be changed. A painful latch is usually a shallow one. With a shallow latch your baby is not able to remove milk easily. It is not helpful to suffer through a painful latch. A good, deep latch will be comfortable for you. And your baby will get lots of milk. 

    ●If it feels painful, you can unlatch your baby by slipping a finger in the corner of her mouth to break the suction. Then you can try latching again.

    ●Often the latch can be adjusted while your baby is still attached. This will prevent your baby from getting frustrated by being taken on and off the breast. And if your nipples are already damaged, this prevents you from continually experiencing the pain of the first few seconds of latching. If you are hearing a “clicking” or smacking sound, or see dimples in your baby’s cheeks, try improving the latch by bringing your baby’s chin deeply onto your breast. Or you could gently pull down on the baby’s chin to uncurl the lower lip.


    For more information see The Sounds of Breastfeeding(https://www.lllc.ca/skin-skin-care).


    In a small percentage of babies, the tongue is restricted because of a tight frenulum, or tongue tie. Because of this the baby may not be able to pull the nipple deeply into the mouth. If the latch is still painful even after trying to improve it, you are encouraged to seek the help of an International Board Certified Lactation Consultant (IBCLC). Then, if necessary, you may want to consult with a healthcare professional who specializes in diagnosing and treating tongue ties.


    Videos You May Find Helpful

    For the laid-back position:

    https://www.biologicalnurturing.com/sample-of-biological-nurturing/


    For latching and good feeding at breast: https://ibconline.ca/breastfeeding-videos-english/






    参考资料


    参考资源：

    www.lllc.ca/sites/default/files/Positioning%20and%20latching.pdf





    往期推荐



    哺乳中最容易忽视的要点（上）：哺乳姿势

    END



    译者 | 传艳

    审阅 | Lynn & Marien

    编辑 | 李热爱




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  • 哺乳时长不是判定奶足的标准，真正的标准是什么？

    点击上方“国际母乳会LLL”   “设为星标”，获取哺乳信息

    图|国际母乳会中国图片库



    01

    乳汁摄入是否充足，需多方面评估




    关注宝宝的生长曲线


    很多母乳妈妈在喂奶的过程中，特别纠结一点：对宝宝来说，多长的时间间隔及哺乳时长才是正常的？真正让宝宝吃饱的安全标准是什么？作为妈妈如何能守住底线保证婴儿的奶汁摄入？

    妈妈们都知道，最适合宝宝的喂养方式就是按需喂养。

    妈妈奶汁充足，但因无法评估宝宝摄入的奶量，所以顾虑：宝宝真正摄入了多少？需要多少毫升的乳汁才是吃饱？

    判断宝宝有没有吃饱母乳的标准，不仅仅是哺乳时长，更重要是宝宝的生长发育是否正常？生长曲线是否正常？是否有因乳汁摄入不足而导致的脱水现象？需要多方面评估，而不再是单纯的哺乳时长。


    点击下图了解宝宝在吃奶过程中出现的一些状况以及应对方法：



    点击视频，了解哺乳信息



    温馨提醒：关注母乳喂养的妈妈及专业人士，一定不要错过即将开展的活动~


    8月1日至7日为「世界母乳喂养周」


    本次主题为：实现母乳喂养，为在职父母谋福利。


    这是由「国际母乳喂养行动联盟(WABA)」组织发起的一项全球性的活动，旨在促进社会和公众对母乳哺育重要性的正确认识和支持母乳哺育。



    本次主题主要为母乳妈妈在职场中更加便捷、顺利的进行母乳喂养；倡导改善工作场所及条件，提高母乳喂养的便利性。


    母乳喂养，不只是妈妈一个人努力的结果，需要更多人的参与、支持和理解。




    关于母乳喂养周论坛



    文中视频内容出自IBCLC范崇纯在国际母乳会“回归本能的母乳喂养”国际研讨会的演讲。


    有些学员反馈课程非常好，想多听几遍。我们日常遇到妈妈求助时，也深感有些科普课程的内容有助于她们降低焦虑，科学育儿。


    于是，我们和部分嘉宾商量，把适合普通（准）妈妈收看的科普课程放到国际母乳会知识店铺“妈妈课堂”。


    “妈妈课堂”第一期精选的5节课程已上线，之后还会不定期更新内容，敬请留意。


    欢迎进入“国际母乳会-中国“妈妈课堂，选择您喜欢的课程：

                        


    END



    视频剪辑 | 林晓星

    审阅：Victoria、笑仪

    编辑 | 李热爱、沐凡




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    搜索关键字“国际母乳会LLL”




    更多阅读资料，


    欢迎大家访问“国际母乳会LLL”官网：


    https://www.muruhui.org/




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    本篇文章来源于微信公众号: 国际母乳会LLL