国际母乳会

La Leche League International

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  • 哺乳中最容易忽视的要点（上）：哺乳姿势

    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》。




    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）.


    Before you begin – setting the stage for success

    Start with a calm baby. This can be tricky sometimes. If your baby is hungry or has just woken up, she may get upset very quickly. Watch for signs that your baby is hungry. Offer your breast before she starts to cry.

    Early hunger cues include:

    ●sucking on her hands.

    ●smacking her lips.

    ●turning her head toward your breast or the chest of the person holding her.

    ●fussing.


    If your baby is crying and upset, it can be tempting to rush to latch her as quickly as possible. However, it is often difficult for a little baby to latch when she is frantically upset.

    ●Take a few seconds or minutes to calm your baby. 

    ●Hold her upright on your chest and gently rock her.

    ●Place your baby in skin-to-skin contact on your chest.

    ●Offer the breast when your baby is calm.

    ●Express drops of milk so your baby can taste it.

    ●Express a little colostrum or milk onto a teaspoon. Give that to your baby to help calm her down.

    Hold your baby skin to skin. Even if your baby is already calm, skin-to-skin contact during feedings is helpful in the early weeks. It helps your baby to know where he is and what he is supposed to do at the breast. Think of your body as your baby’s “habitat” for the first several weeks. The more time your baby spends in skin-to-skin contact with you, the more opportunities your baby has to feed when he is hungry.

    For more information please see Skin-to-Skin Care（https://www.lllc.ca/skin-skin-care）. 


    Sleepy babies

    Your baby may be sleepy. This may be because of birth interventions, medical conditions in the baby or because your baby was born early. Use a laid-back position with skin-to-skin contact to get your baby interested in feeding. In a laid-back position, babies often latch and feed when in light sleep. Thus, it helps to spend a lot of time with your sleepy baby against you. When your baby moves into a light period of sleep and begins to stir, move her near your breast. Get into a comfortable breastfeeding position. This can encourage your baby to latch.


    Getting into Position

    There are many different breastfeeding positions. Some can be more helpful than others in the early stages when you and your baby are learning to breastfeed. These positions include: the cradle hold, the cross-cradle hold, the football hold, side-lying position, and more. One of the best positions for the early days and weeks (and longer!) is called the laid-back position.


    Laid-Back Breastfeeding

    The laid-back breastfeeding position is a helpful first place to start if:

    ●you are having difficulty getting a comfortable latch.

    ●your baby seems stressed while nursing.

    ●your baby’s arms are getting in the way.

    ●you can’t get into a comfortable position.


    This position allows your body to rest while you feed. It encourages your baby to use her breastfeeding instincts.


    Get comfortable. Even little babies get heavy when you are holding them at the breast for hours each day. 

    ●Find a bed or couch where you can lean back and be well supported. Lean back comfortably, like you might be if you were watching television. Laying flat on your back is not helpful for this position.

    ●Use a footstool to prop up your feet. It helps to raise your lap and take pressure off of your stomach muscles. Or better yet, put your feet up on the couch or bed with a pillow under your knees.

    ●Have some pillows nearby. Once your baby is comfortably latched, you can tuck pillows under your arms or elbows. Supporting your arms allows your shoulders and neck to relax.

    ●Support your head. You can use a pillow or the back of the couch.


    Ensure full body contact. If your baby feels completely secure, he will be able to focus on feeding. If he feels insecure, he may wave his arms around or kick his feet in an attempt to hang on to you.

    ●The laid-back breastfeeding position uses gravity to hold your baby close.

    ●This position molds his body to your body. It allows your baby to feel safe and secure, knowing that he is not going to fall.

    ●It is important that the whole front of your baby’s body has full contact with the front of your body. This means that your baby’s chin, tummy, and legs should be in contact with your body.

    ●Your baby can rest on you in any direction you both like, as long as his front is next to your front. Your baby could lie with his feet down towards either one of your thighs. Or he could be across your body with his feet under your other breast.

    ●Most babies do not like their feet dangling. It is helpful to provide your baby with somewhere to plant his feet. For example, your baby’s feet could rest on your belly, legs or a pillow.

    ●When you are in position, your baby’s cheek should rest somewhere near your bare breast.


    Adjust your breast as needed. It is important for you to have your breast in a place that allows you to rest comfortably while feeding. The following may be helpful:

    ●Use your upper arm to secure your breast so the nipple does not fall to the side of your body.

    ●Hold your breast while your baby latches. 

    ●Release your breast once your baby has latched deeply and started sucking. You may need to move a little to get into a more comfortable position.

    ●Bring your baby to your breast rather than moving your breast to your baby.


    Other breastfeeding positions

    There are other breastfeeding positions you may want to use in the early days. Some are easier once you and your baby are experienced at nursing. Remember, if one position is not working for you, try another one.


    Cross-cradle hold. The cross-cradle position can be useful in the early days. It gives you more control over the position of your baby and your breast. It is a common hold used when latching a premature or small baby. Once your baby is latched it can be helpful to switch your arms to the cradle position.



    ●Hold your baby in the opposite forearm from the breast you are using.

    ●Place your baby’s bottom near the crook of your arm.

    ●Use your forearm to support your baby’s back.

    ●Support your baby’s head with your hand. Your thumb and fingers will be at the base of the neck and your palm at the upper back.

    ●Use your other hand, if you need to support your breast or want to use the exaggerated latch technique.

    ●Make sure that your baby is turned tummy to tummy with you.

    ●Give your baby a gentle push between the shoulder blades with the palm of your hand as he latches. This will bring your baby close. Continue to hold him close so he doesn’t fall off when he sucks.

    ●Lean back or use pillows to  take some pressure off of your arm. This helps your baby feel secure.

    ●Avoid holding the top of your baby’s head. This can trigger your baby to pull away from the breast. 


    Football or Clutch hold. This hold can be helpful if you have had a cesarean birth. It keeps your baby away from your incision. It can also be helpful if you have larger breasts. You can feed two babies at the same time in a double football hold.



    ●Hold your baby’s front against the side of your body.

    ●Use your forearm to support your baby’s back. Your hand is at the base of your baby’s head. Your baby’s feet are near the back of your body.

    ●Use your elbow to tuck your baby in close to you.

    ●Ensure that your baby is far enough back that she latches with her chin first and her nose tipped away (see “Getting a Good Latch” below).

    ●If needed, place a cushion between your back and the back of the chair or sofa. Otherwise your baby’s feet may push away. If your baby is too far to the front, your baby’s chin will tuck into her chest causing a shallow latch.


    Cradle hold. This position may be difficult to master in the early days and weeks but once you are experienced at breastfeeding, it will likely become a regular position for you.


    ●Cradle your baby in the forearm on the same side as the breast you are using. Use your opposite hand to lift or adjust your breast.

    ●Turn your baby toward you so that his tummy is touching your tummy.

    ●Continue to hold your baby close as he reaches up to latch. This will help make sure that he does not fall off the breast when he sucks. If you are sitting upright, it can be tiring to hold your baby close enough that he feels secure. (Think about how close he would be if he was laying on top of you. That’s how close he needs to be against your body.)

    ●Lean back to take some pressure off of your arm.

    ●Have pillows nearby to put under your arms once your baby is latched. This can help take the strain off of your arms, shoulders and neck. A nursing pillow may be helpful to support your baby’s body.


    Side-lying position. The side-lying position is helpful if you are recovering from a cesarean birth or if your bottom is sore after giving birth. It is also extremely helpful for breastfeeding in bed during the night. This position can be a little tricky to master because you have limited use of the arm you are lying on. It is worth practicing as soon as possible so you can nurse lying down. Once you get the hang of it, it makes nighttime and naptime nursing much easier.

    For more information on sleeping safely with your baby in your bed see Safe Sleep and Breastfeeding Baby.




    ●Lie on your side with your knees bent up and a pillow under your head.

    ●Place your baby on his side facing you with his head on the bed.

    ●Make sure your baby’s nose is level with your nipple. Adjust how you are lying so your nipple is as far away from the bed as your baby’s mouth.

    ●Place your arm under your baby’s head if needed to get your nipple opposite your baby’s nose.

    ●Give your baby a gentle push between the shoulder blades with the palm of your hand, as she latches. This helps bring your baby close.

    ●Remember to bring your baby in chin first, with her head tipped back and her nose off the breast.

    ●Use one hand or temporarily prop yourself up on your elbow while latching. Propping yourself allows you to also use your lower hand to latch. Once your baby is comfortably latched you can lower yourself back down onto the bed.

    ●Use a pillow between your knees for comfort.

    ●Place a pillow under the small of your back to prevent you from rolling onto your back.


    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


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




    END



    译者 | 传艳

    审阅 | Lynn & Marien

    编辑 | 李热爱




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    本篇文章来源于微信公众号: 国际母乳会LLL

  • 催乳剂真的有效吗？真正的催乳方法是什么？

    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

    催乳：频繁吸吮才是有效手段




    食物药物催乳无效，刺激乳汁分泌有效：


    在母乳喂养奶量不够时，很多妈妈会考虑吃一些具有催乳效果的食物或者药物来增加奶量。

    但催乳剂真的有效果吗？

    研究表明，催乳剂对提高纯母乳喂养率的作用尚不明确；部分催乳剂可能对提高母乳产量非常有限，且研究质量不高；大部分催乳剂对母婴双方的副作用尚不明确。

    增加奶量（催乳）真正有效的原理是提高乳汁分泌量，增加吸吮频率。而非食物、药物等。


    点击视频，了解催乳的信息


    02

    妈妈的状态对奶量有重要影响




    催乳的真正方法来自妈妈自身内部

    对母乳妈妈来说最重要的是按需亲喂自己的宝宝。


    妈妈与婴儿增加肌肤接触的时间，妈妈心情好，都会增加奶量。


    妈妈快乐的心情，会分泌更多的乳汁；肌肤接触让妈妈有机会施展对婴儿全然的爱；按需喂养，频繁吸吮乳汁，提高奶量，建立供需平衡的健康哺乳模式。



    点击视频，了解更多详细信息




    以上视频内容出自新西兰母乳会Leader、营养学博士生贾丽立在国际母乳会“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




    找到我们

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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/




    分享

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    本篇文章来源于微信公众号: 国际母乳会LLL

  • 产后妈妈的抑郁情绪，需要并值得被重视

    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


    【编者按】


    表面开朗的人，内心或许并不快乐。


    一个鲜活的生命因抑郁而离去，愿逝者安息！抑郁症的危险提醒我们：关爱自己，及时求助。


    尤其是孕产期的妈妈，因激素变化更容易情绪波动，希望这篇文章对大家有帮助。




    婴儿的诞生通常被视为一段非常幸福的时光。看着臂弯里的孩子，父母们感觉到他们长久以来期待的梦想已经实现。


    初为人父母者所体验到的情绪可能与狂喜和满足相反。一些专家估计约百分之五十到八十的女人产后会被不同程度的沮丧情绪影响。(Komaroff 1999)她们可能会感到悲伤、疲劳，或者焦虑。有些情绪可能是由于产后荷尔蒙的改变引起的。


    照顾一个不能自理的婴儿，妈妈会缺少睡眠，失去对自我生活的掌控感，这些也会引起抑郁情绪。对大多数女人来说，这些“产后沮丧”只会持续一段短时间，一般出现于产后的慌乱期，而且完全可以融入于母职的工作中。


    但是，有些女人发现她们笼罩在一种无法言说的无尽的悲伤中。她们可能患上了产后抑郁症。产后抑郁症的症状包括无助感、情绪不稳定、焦虑、失眠、对生活没有兴趣。这些感觉持续不走，停留数星期，妈妈似乎无法自我改善。


    图|国际母乳会中国图片库


    产后抑郁症是一种但不是唯一一种在生产后显现的情绪障碍。情绪障碍是一个精神病学家和心理学家用来描述沮丧、焦虑和恐惧等感觉的术语。它也可以用来描述不适当的“情绪高涨”的感觉——称之为“躁狂”。


    由于科学研究已经更多地了解了大脑及其运作，心理健康专家和广大民众已经认识到抑郁和其它心理障碍，不是像以前人们所认为的那样是有性格缺陷或缺乏意志力所引起的。抑郁和其它情绪障碍是大脑中生理因素与人的生活经验交互影响造成的。


    抑郁是一种很常见的疾病。五分之一的成年人在他/她的一生中都会经历一次重大的抑郁。对易感的人来说，怀孕、生产和成为新手妈妈带来的生理和情感上的压力都可能引起抑郁和其它心理健康问题。


    在生产后的第一年，10%的新手妈妈会出现产后抑郁（ACOG 1999）。其它情绪障碍，如躁郁症（在此期间深度抑郁和极度活跃、快乐两种情绪交替出现），通常在成年早期首次出现。因此，沮丧和其它情绪障碍会影响许多妇女，在他们照顾和哺乳他们的孩子时。

    图|国际母乳会中国图片库


    情绪障碍的影响范围从对生活轻微的破坏到个体严重丧失能力。当妈妈可能经常敏感地察觉到什么事情不对时，家庭成员有时候是最先发现的。有些女人持续地悲伤、焦虑，对母亲的身份感到不开心。之后，症状严重的女人会有幻觉或妄想以及对现实的扭曲感。


    研究显示，与抑郁情绪做斗争的妈妈无法胜任好妈妈的角色。婴儿的发育依赖于一个能与之积极互动的照料者。通过母亲与婴儿之间的大量日常互动，婴儿的大脑神经和信息网络得以发展。婴儿通过与妈妈的眼神交会、妈妈生动的面部表情、口头的回应等等来学习社会行为、语言表达等一切技能。


    一个没有精力起床或没有精力与她的宝宝进行“交谈”的妈妈是不能满足这些需求的。同时，一个抑郁的妈妈已经失去了自己照顾婴儿与其他孩子所带来的日复一日的生活中的幸福感。


    这就是为什么及时治疗产后抑郁和其它情绪障碍很重要的原因。妈妈和宝宝的福祉都处于危险之中。

    图|国际母乳会中国图片库


    根据个体的需要，治疗产后抑郁和其它情绪障碍的方法也多种多样。在许多情况下“谈话”治疗很有效。一个心理治疗师能帮助一个母亲用对她自己及她的处境更实际的评价替换掉她给予自己的错误信息（如“我是世界上最差劲的妈妈”）。这种疗法称为认知行为疗法。它的目标是帮助人们了解关于自己对世界和自身的错误信念，进而学习以新的方式思考。


    专业咨询也可以帮助个体为自我建立起更好的支持系统，并且找到方法来满足自我的需求。


    有时候抑郁症也会用药物治疗，药物能在相对短的时间里很好地减轻症状。但是，只使用药物治疗产后忧郁是不明智的。药物或许能帮助一个人在数周内感觉好些，但是治疗能帮助人改变生活从而获得长期的健康。


    照顾产后情绪障碍的妈妈是对医护人员的独特的挑战，其中包含精神健康照顾者。治疗精神疾病的医护人员，有精神病学家和内科医生，他们可能会开抗抑郁药物；而心理学家、咨询师和治疗师，他们可能会提供“谈话”治疗。


    当他们治疗有新生儿的妈妈们时，他们需要考虑到有两个病人而不是通常说的一个病人。妈妈和孩子是相互依赖的，尤其是在哺乳期的时候。他们是个“二联体”，也就是说二者是一体的。对妈妈的治疗必须同时照顾到妈妈和孩子。

    图|国际母乳会中国图片库


    很多医护人员没有制定哺乳双方的治疗计划的培训经历和经验。因此，在治疗一开始妈妈们就被告知必须断奶，以便治疗她们的抑郁症，这种情况是非常普遍的。


    内科医生可能会告诉妈妈她必须停止母乳喂养，因为担心孩子会通过母亲的乳汁而受到药物的影响。治疗师也可能会建议断奶，因为他们相信如果家庭成员能用奶瓶喂养孩子，妈妈就能休息和放松。很多医护人员持有奶瓶喂养的心态，这是西方文化中的普遍观点。


    一个坚持母乳喂养作为她的“生活方式”的妈妈面临很多挑战，她常常会被认为是做了一个愚蠢的、有害的决定。那些为妈妈的病而恐慌、忧虑的家庭成员可能也无法帮助妈妈反对治疗建议，其中可能包括突然断奶。


    一个从躁狂发作中恢复过来的妈妈（她的医生坚持要她立刻断奶，因为她正在吃的药会影响到孩子）后来说：人们不能理解你和你丈夫希望获得帮助、恢复健康的愿望是如何迫切。经常三或者四个医护人员给出相互冲突的意见，我们不知道听谁的。精神病医生不会把孩子视为需要考虑的对象，儿科医生对我们又无能为力。给我的孩子断奶让我感到很伤心，尤其是现在，由于经常耳朵感染，我们正面临给孩子植入中耳通气管的手术。


    图|国际母乳会中国图片库


    但是，仔细研究断奶会发现，断奶对孩子和妈妈的潜在风险可能要高于所期待获得的任何好处。在一个妈妈有抑郁症或其它情绪障碍的情况下，有些风险与断奶密切相关。


    母亲的风险




    乳房疼痛。

    大多数女人在面临突然断奶时遭遇过乳房肿胀，包括乳房感染和脓肿的风险。一个将停止母乳喂养的妈妈需要采取几个步骤来减轻她的乳房肿胀。这些步骤当中包含获得一个适当的吸奶器或者学会手动挤奶，同时视乳房发炎和感染情况使用冰袋。有些用来治疗精神疾病的药物具有催奶效果，也就是说，他们会使乳房生产更多的奶。这会加剧涨奶的疼痛并减缓乳房停止产奶的进程。


    荷尔蒙的改变。

    突然断奶给母性的雌激素、黄体酮和催乳素带来巨大的改变。这样的变化可能导致情绪波动，也可能使母亲的抑郁症加剧。每当母亲哺乳宝宝时，她的心情就会正向地受到释放于血液中的催产素所影响；突然断奶剥夺了一个沮丧的妈妈的这种情绪促进荷尔蒙。


    长期照看孩子的额外压力。

    家人和朋友团结起来帮助处于危机中的妈妈，他们准备并且乐于用奶瓶喂养孩子，这样妈妈就能稍微休息一下。但是这种帮助是短暂的，因为生活需要帮助者们把注意力放到其它地方。当没有帮助者的时候，这个妈妈发现她有了额外的压力：清洗、准备奶瓶和其它相关用具，而在以前母乳喂养的时候她只需要舒服地坐下来，轻松地把孩子抱到她胸前。


    图|国际母乳会中国图片库


    额外的开支。

    断奶的代价不仅仅是购买婴儿配方奶的额外费用，还有孩子更频繁地生病的花费。奶瓶和其它喂养相关用具需要购买。这些经济负担会降临到年轻的夫妇身上，他们可能负担不起这些。


    生育能力恢复。

    对一个已经疲于应对的家庭来说又一次怀孕的可能性是一个重要的要关注的问题。给孩子断奶会导致妈妈的生育能力恢复，因此她必须考虑避孕。这也会增加花费。在选择不避孕的家庭里，哺乳期闭经提供了一种重要的控制生育间隔的途径。


    亲子连接的破坏。

    抑郁的妈妈们发现她们不能尽力与她们的孩子玩耍、拥抱她们的孩子等等。哺乳的时候，能确保孩子与她们的妈妈每天有数次充满爱意的接触。


    与母乳喂养相关的“母性荷尔蒙”促进妈妈与她的孩子的连接。如果奶瓶喂养成为养育孩子的一个选项，妈妈可能就不会花那么多的一样高质量时间给她的婴儿。


    无助感。

    一般而言，有情绪障碍的妈妈们感觉失控、无力、没有希望。母乳喂养可能是能帮助这些妈妈们对她自己以及履行母职感觉好一些的一件事。让她停止母乳喂养给了她又一个能力不足的信息。如果其他人接手照顾宝宝，她的不足和无力便被确定了。甚至在被强行断奶数十年后，妈妈们还会有巨大的悲痛和对医护人员的敌意。


    图|国际母乳会中国图片库


    婴儿的风险




    婴儿越小，过敏和其它营养问题的风险越大。

    对婴儿来说，替代母乳的配方奶有很大的健康风险，包括过敏风险增大，得I型糖尿病、肥胖、克罗恩氏病等的风险会增大。


    更频繁、更严重地生病。

    母乳喂养保护婴儿避免感染流行病。配方奶喂养的婴儿更频繁地感冒，耳部感染，腹泻以及胃肠不适。


    断奶不仅会给婴儿的健康带来风险，也会给婴儿的养育带来挑战。生病的婴儿一整天都需要并且要求更多的关心。


    依恋创伤。

    一个不许靠近乳房来取食和获取安慰的婴儿可能会极度悲伤。妈妈和婴儿的长时间的分离可能会带来持续的影响。


    研究清晰地表明，妈妈和婴儿极需彼此在一起，以便让婴儿能正常生长和发育。证据说明当他们不能互动的时候，终身的沮丧可能在婴儿时期就开始形成了。


    一个对新生老鼠的研究表明，在新生儿时期断奶并且与鼠妈妈隔离24小时后，帮助调节情绪的应激激素升高，下丘脑-垂体-肾上腺的系统被破坏。(Schmidt 2002)婴儿经历的由于突然断奶带来的悲痛是真实的，医护人员或是替代看护人不应忽略或看轻这一点。


    图|国际母乳会中国图片库


    由于妈妈的情绪障碍而挣扎的母乳喂养二联体可能尤其容易受到突然断奶的伤害。如果荷尔蒙的改变和负面信息导致妈妈的情绪螺旋式下降，她会变得不那么能有效地照顾她的孩子。


    如果婴儿由于消化不良或是过敏导致更虚弱，就对妈妈的养育能力提出了更大的挑战。一个更难满足的婴儿会使妈妈觉得自己更不足和无助。同时，由于很多专家相信精神疾病有遗传因素的影响，突然断奶带来的依恋的破坏将使孩子未来产生情绪障碍的可能性增加，得出这样的推论看起来就合乎情理。


    应该如何处理产后抑郁




    很多情况下，当妈妈由于产后抑郁或是其它类型的情绪障碍接受治疗时继续母乳喂养是可能的。为了继续照顾她的孩子和自我恢复，她需要医护人员和家人、朋友的支持。让每个支持她的人认识到并且尊重她和孩子的需求，这一点非常重要。


    亲朋的支持和实际的帮助对于产生积极的结果至关重要。很多抑郁的妈妈都有无力感和边缘化的感受。另外，那些照顾她的人可能会控制或者强迫她同意治疗计划，那些治疗计划没有考虑母乳喂养和亲自照顾她的婴儿对她来说是重要的。


    这也许是那些关心妈妈的人自身的恐惧感带来的结果，因为看到妈妈如此艰难会令人担心。事实是，虽然她有病，但是通常她完全有能力做决定。


    图|国际母乳会中国图片库


    妈妈们完全能在任何形式的危机来临前与家庭成员讨论母乳喂养的重要性。妈妈们可以分享她们对于亲子关系的感受，实行母乳喂养的目标与愿望，以及未来对她的伴侣与关心的人的希望。


    当家人和朋友理解了妈妈眼中母乳喂养的重要性，或许他们就不会把断奶的建议当作第一选择。有了这点认识也会使这些人准备好在发生危机时支持母乳妈妈和孩子。分享国际母乳会哺乳辅导的电话和国际母乳会朋友的名字可以帮助她的家人了解母乳喂养。


    找到一个理解母乳喂养共生体观点的精神健康照顾者对于妈妈的治疗也很重要。妈妈会经常看精神病医生和心理治疗师，因为他们在治疗中扮演着不同角色。如果可能的话她需要两者的帮助。


    精神病医生应该要愿意探索能让妈妈继续母乳喂养的治疗方案。包括寻找各种药物对母乳喂养和婴儿的影响的信息。了解很多用来治疗这些问题的药物与母乳喂养是不矛盾的是很重要的。


    另一方面，一种安全、有效的替代药物可能会用来治疗这个妈妈的情绪障碍。详细的药物信息可以通过多种渠道获得，包括国际母乳会专业联络部门和书面材料如Dr. Thomas Hale‘s的书籍《药物与母乳喂养》。这些信息在适当时可以与医护人员分享。


    图|国际母乳会中国图片库


    当医生决定开药时，除了药物会在妈妈乳汁里外还有几个因素要考虑。药物是否有害取决于进入到乳汁中的药物的含量和婴儿的年龄以及婴儿摄入的奶量。婴儿从妈妈乳汁中汲取少量药物的风险要与婴儿配方奶带来的风险做比较。当使用某些药物时，监测孩子的血中药物浓度、观察不良反应是明智的做法。在监测婴儿可能发生的药物反应上，妈妈的医生可以向婴儿的医生咨询。


    一个好的治疗师应该是乐于倾听和了解家庭特殊需要的，包括妈妈在母乳喂养关系上所赋予的价值。这位照料者可能乐于与其它医护人员交谈（经妈妈的同意）。与其劝妈妈断奶，治疗师不如倾听妈妈关于她对母乳喂养关系的感受，只要可能，不仅仅支持，而且向其它医护人员倡导。


    在一个妈妈有抑郁症的时候立即面临的问题之一就是她是否还能照顾她的婴儿和家里的其它孩子。如果这个妈妈被认为自己能照顾她的婴儿，那么母乳喂养肯定能让她轻松一些。如果她需要帮助，她的帮助者们能帮她做家务，或者帮她照顾大一点的孩子，以便她能集中精力照顾她的新生儿。


    有严重情绪障碍的女人（她们的症状或者对现实的扭曲妨碍到了婴儿甚至是她自己的安全）可能需要朋友和家人轮流在身边陪伴她和她的婴儿。这允许妈妈和宝宝之间的连接持续，同时也确保他们的安全。这位妈妈可以继续母乳喂养，即使她的帮助者必须帮助她把孩子抱到她的胸前。


    图|国际母乳会中国图片库


    如果必须住院，家里人要考虑定期把婴儿带给妈妈，同时准备吸奶器以及帮助她使用吸奶器。多数情况下，很可能是这样的：支持继续母乳喂养的想法是新鲜的，因此很可能会被怀疑甚至是被讥讽。如果妈妈无法面对这些麻烦，关爱她的人的支持再次变得非常重要。


    幸运的是，产后抑郁及其他情绪障碍已经有了有效的疗法。这些疾病不会带着过去的污名，而治疗也不需要中断任何妈妈和宝宝的连接。当妈妈和她的配偶、朋友以及其它家庭成员和医护人员一起努力，可以找到使妈妈能够在复原过程中继续母乳喂养又能治疗她的情绪障碍的办法，妈妈和她的婴儿都将获益。



    参考资料


    • American College of Obstetricians and Gynecologists (ACOG). Answers to Common Questions about Postpartum Depression. Washington DC: ACOG, 2002.

    • Hale, T.R. Medications and Mothers’Milk, Eleventh Edition. Amarillo, Texas: Pharmasoft Publishing, 2004.

    • Kendall-Tackett, K.A. The Hidden Feelings of Motherhood. Oakland, California: New Harbinger Publications, 2001.

    • Komaroff, A.L., ed. Harvard Medical School Family Health Guide. New York: Simon and Schuster, 1999.

    • Mohrbacher, N. and Stock, J. THE BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois: La Leche League International, 2003.

    • Schmidt, M. et al. Maternal regulation of the hypothalamic-pituitary-adrenal axis in the 20 day-old rat: consequences of laboratory weaning. Journal of Neuroendocrinology 2002; 14(6):450-57.

    • Taj, R. and Sikander, K.S. Effects of maternal depression on breast-feeding. Journal of Pak Med Assoc 2003; 53(1):8-11.



    END



    译者 | Season Yang

    审阅 | Shiuh-jane & Daisy

    编辑 | 李热爱




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  • 不用纠结：母乳妈妈也能喝咖啡！Caffeine and Breastfeeding

    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


    很多妈妈在生宝宝之前都有喝咖啡的习惯。一旦哺乳之后，妈妈就很担心咖啡对宝宝造成的影响，而心里却又对咖啡念念不忘。纠结之下，很多哺乳妈妈都选择为了宝宝好而不喝咖啡。


    其实对于大多数母乳妈妈来说，她们能够享用适量的咖啡因。重点是没有发现对宝宝有任何影响。


    重要的是，要全面考虑您一整天吃的食物中可能的咖啡因来源，包括：



    Caffeine and Breastfeeding


    Many people enjoy their morning cup of coffee, including breastfeeding mothers. But you might wonder what kind of impact this could have on your baby.


    Most nursing parents find that they are able to enjoy a moderate amount of caffeine without noticing any effects in their babies. It is important to take into account all of your potential sources of caffeine throughout the day. Sources of caffeine include:
    · coffee
    · black, white and green teas both hot and iced
    · colas, and other caffeine containing soft drinks
    · energy drinks
    · yerba mate or guarana
    · some over the counter medications including pain relievers, cold remedies and diuretics.

    Caffeine does pass into breastmilk, however, your baby gets only about 1.5% of the amount of caffeine that you drank. It takes longer for caffeine to clear out of your baby’s body if your baby is premature, younger than six months or has other health issues. The peak level of caffeine in breastmilk occurs 60 to 120 minutes (1 to 2 hours) after consumption. If you have a high caffeine intake it could make your baby irritable, fussy or wakeful. This is because caffeine stimulates the central nervous system and helps us stay awake.

    Examples of caffeine amounts in common beverages:
    · Coffee: A 250 ml (8 oz) cup of coffee contains between 80 and 179 mg of caffeine.
    · Decaffeinated coffee: A 250 ml (8 oz) cup contains between 3 and 15 mg of caffeine. Most colas: A 355 ml (12 oz) can contains between 37 to 50 mg of caffeine.
    · Black tea: A 250 ml (8 oz) cup contains between 43 and 50 mg of caffeine.

    Fussiness, jitteriness and sleeping problems have been found in babies whose mothers consumed high levels of caffeine, more than 5 cups of coffee each day. There is no agreed upon safe level of caffeine because every baby’s tolerance is different. However, Dieticians of Canada recommends a limit of 300 mg of caffeine (2 to 3 cups of coffee) daily for pregnant and breastfeeding mothers.

    Another reason to limit your caffeine intake is its potential effect on iron levels. Consuming more than 450 mg of caffeine in one day (4 or 5 cups) has been linked to lower iron levels in human milk. Since breastfeeding babies get the iron they need from breastmilk during the first 6 months this could affect the amount of iron in the baby’s body.

    Your caffeine intake is something to consider adjusting if your baby seems to be extremely fussy and has a hard time settling, even if you are drinking less than five cups of caffeinated beverages a day. You may want to consider having most of your caffeine early in the day. Or you could try substituting a decaffeinated or caffeine-free option for one, two or all caffeinated drinks for a week or two to see if it makes any difference. If caffeine is affecting your baby you should notice a difference within 3 to 7 days.




    参考资料


    References:


    La Leche League International. (2021, June). Caffeine. https://www.llli.org/breastfeeding-info/caffeine/


    Mohrbacher, Nancy. (2020). Breastfeeding Answers: A Guide for Helping Families, Second Edition. Nancy Mohrbacher Solutions, Inc.National Library of Medicine. (2022, June 20). Caffeine. Drugs and Lactation Database (Lactmed). https://www.ncbi.nlm.nih.gov/books/NBK501467/Dieticians of Canada. (2018, April 26). Facts on Caffeine. UnlockFood.ca. https://www.unlockfood.ca/en/articles/caffeine/facts-on-caffeine.aspx

    Updated 2022




    END



    译者 | Lynn

    审阅 | 传艳、楠楠

    编辑 | 李热爱




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  • 运动与母乳喂养（下） Elite athletes and breastfeeding


    关注“国际母乳会LLL”了解更多母乳喂养资讯

    近年来，对怀孕、母乳喂养（和奶瓶喂养）或照顾幼儿的高水平运动员的理解和支持有所增加。英国体育局是一家支持高水平运动员及其团队、还有运动项目的机构，为奥运会和残奥会高水平运动员群体发布了怀孕指南。（你可浏览此处阅读：https://www.uksport.gov.uk/resources/governing-body-and-athlete-guidance.

    理想情况下，高水平运动员会获得教练和医生的专业支持。持续母乳喂养的同时，以下针对高水平运动员训练和比赛的一些注意事项也很有帮助。

    职业高水平运动员恢复高强度训练计划时可能会感到有压力。自己要理解并掌握婴儿的正常需求，如小婴儿需要和母亲在一起、你需要及时回应去哺喂他。这样会有助于你计划安排，并满足团队或资助机构对你的期望。

    母乳喂养会影响身体的荷尔蒙，例如会释放“松弛素”影响关节和韧带。不过高水平运动员边母乳喂养边参加训练和比赛的例子比比皆是。如果理疗师了解荷尔蒙对身体的影响并能相应地调整训练，运动员与之合作会很有帮助。

    除了生理上的影响，母乳喂养还在母婴情感联结中扮演着重要角色。在奥运会官方网站的文章中，莎拉·斯托里女爵士和塞雷娜·威廉姆斯讨论了他们作为高水平运动员妈妈，这段经历让她们体会到母乳喂养关系的重要性。

     高水平运动员面临的一个现实挑战是需要离开孩子较长时间进行训练和比赛。解决这个问题往往要集聪明才智和灵活机动于一身。

    同样值得记住的是：小婴儿的高需求并不是长期的。许多女运动员反映有了孩子后她们优先考虑的事情就变了，发现不想和孩子分开。母亲的这一决定应该得到支持。

    同样地，如果你热切希望恢复训练比赛，总会有一些办法让宝宝融入其中。如果你确实需要离开宝宝较长时间，例如要去比赛，也存在一些实用的方法来支持母乳喂养。

    许多高水平女运动员，比如需要离开宝宝超过24小时的长跑运动员，会让人把孩子带到打卡点，以便她们自己补充能量的同时能给宝宝喂奶（有时是用手挤奶/吸奶器吸奶）。

    另一些女运动员也会挤奶/吸奶，留给照护人在分离期间喂给宝宝吃。更多有关挤奶和储存母乳等信息可以在我们的公众号或网站找到。

    有很多高水平运动员的楷模，在恢复高水平训练和比赛的同时还母乳喂养了孩子。


    英国的两位高水平运动员，娜奥米·福卡德（英国国家射击队）和杰思敏·帕里斯（高水平越野长跑运动员），与国际母乳会（英国）亲切地分享了她们在继续训练比赛的同时进行母乳喂养的感想。

    01

    娜奥米·福卡德

    我的体育项目是射箭，这是一项封闭技能型运动，需要站立并步行70米到箭靶收上箭再回来。

    怀孕前，我喜欢把跑步作为训练的一部分，还做健身和肩袖肌群锻炼，一直持续到怀孕八个月。


    除了产后第一周的休息外，我很快就恢复锻炼了，开始是用背巾抱着宝宝散会儿步、盆底锻炼、肩部锻炼以及做一点儿瑜伽。


    至少好几个星期里我的整个盆腔和腹部感觉就像果冻一样，所以我非常仔细地考虑什么运动我该做，再逐渐增加运动量。


    当我在产后两周开始恢复射箭时，可以带着孩子在身边，这样一旦她想吃奶，我就停止手上的事情，在休息室的沙发上哺喂她。


    到八周时，我给宝宝喂完奶，放她躺下（有时睡着了，更多的时候可能没睡），然后去训练，把她留给爸爸；就在这一刻，我发现从情感上真的很难离开她。


    在为孩子的到来和之后的照护做准备时，我与其他几位当了妈妈的运动员谈论了她们是如何安排分娩、母乳喂养和训练的。我还看了书籍和网上的文章。



    我在产后五天就用奶瓶喂给孩子挤出的母乳，因为我发现母乳喂养时无比疼痛。特别幸运的是，之后我去看过的助产士给我预约了一位泌乳顾问，很快就解决了我的问题；她给我演示了橄榄球抱法，自此我和宝宝就成了天作之合。


    我离家去比赛时，宝宝就用奶瓶喝挤出的母乳。我们团聚时，她有时会对开始的几次喂奶烦躁沮丧，因为乳房的乳汁流速不如奶瓶的快。我就让她松开乳头，试着让她平静下来。


    和孩子分开时，我必须按照和在家差不多的时间表挤奶，以此来护理好我的乳房健康。维持产奶量并预防堵奶对我很重要。


    就这样我曾两次飞到远东地区。我会确保在航班起飞前吸奶，以减少在飞机的卫生间里吸奶的次数！


    产后前几个月参加比赛时，我发现定时喂奶/挤奶非常棘手。比赛可能需要一整天，休息时间并不总合时宜或足够长，也并不总能找到可以用的设施。比赛的同时还要母乳喂养的话，很有必要提前询问组织者设施的情况。


    在国外参加赛事时，我发现真得很难保持吸奶器的部件完全干净。所以现在我会保证包里有一条毛巾，哪怕没有充足的时间把吸奶器完全擦干，至少也能接住滴下来的乳汁。回家后，我再把所有部件都彻底清洗干净。


    人们说宝宝睡时你也睡，但白天宝宝睡觉时我更想去训练！不过，我一定会在晚上9点左右和宝宝一同上床睡觉。


    我不得不在东京奥运会之前增加奶量并大量吸奶，因为疫情大流行的缘故，运动员不允许带上孩子。


    我花了一段时间才意识到，除了训练外增加奶量会额外消耗多少热量。尽管我胃口极好，但还是吃得不够，热量的不均衡再加上睡眠不足常常让我疲惫不堪。


    直到东京奥运会后一两个月，我才决定开始慢跑来恢复健身，原因有很多：动力、时间、心理健康、盆底、文胸尺寸的变化以及乳房充盈时的不适。


    体育用品商店里没有我的文胸尺寸特别令人沮丧，但我还是找到了一款特别棒的文胸，能提供额外支撑还适合我的尺寸。


    我遵循我的女性健康理疗师的建议，做了几周盆底锻炼；我已经在做着固定的深蹲式盆底锻炼，但她建议我还要做一些足尖轻点、半高抬腿、侧撤步等练习。


    当我确信我不再漏奶了，就用小三轮车推着宝宝慢跑了几次，她好喜欢呀。我会确保事先给孩子喂得饱饱的，这样乳房就会很舒服。

    02

    杰思敏·帕里斯

    我是一名越野长跑选手（我也参加山地跑和超距越野跑）。我在2017 年11月有了第一个孩子，2020年7月有了第二个孩子。我分别母乳喂养了他们15个月和22个月。


    在此期间，我参加了许多比赛，包括山脊挑战赛(2019)和巴克利马拉松赛(2022)，并赢得了不列颠丘陵越野跑锦标赛(2018)。


    我在产后3-4周左右开始带着罗恩慢慢跑步；生完布林后，我推迟到五六周才开始慢跑，因为我孕期骨盆有些疼痛，所以得等它恢复好了。


    刚开始我只是轻松地跑一跑，直到三个月左右才开始系统性训练。我在怀孕期间和之后采取的总策略是，倾听自己的身体，做感觉舒服的事情。


    我发现只要我在母乳喂养，就得吃点东西再训练（此前我经常早上先空腹跑步），所以我猜想这是倾听身体给自己发出信号的另一个例子。


    如果在母乳喂养期间进行大运动量训练，吃饱（以预防RED-S，即运动中相对能量不足）尤为重要。维生素D补充剂、钙和足够的膳食铁也很重要。


    我主要担心的是和宝宝分离，尤其是在他们喂养频繁的早期阶段。我们曾试过让他们喝奶瓶里挤出的母乳，但他俩对此都断然拒绝，更愿意直接从乳房上吃奶。


    保持常规节奏是很有帮助的。由于有两个孩子，我们养成的习惯是产假期间我早上6-8点间去跑步（他们只有几个月大时我一般跑60-90分钟），之后我丈夫再去上班。


    这个时间安排效果很好，因为孩子们要么是在睡觉，要么心情很好，因为整个晚上/清晨都吃了奶（同样的道理，我的乳房不会太涨，我也不用担心宝宝很快饿了）。


    我跑步时就穿着标准的运动文胸。穿着它在运动后马上喂奶有点困难，不过我只把它撩起来让孩子吃奶即可。


    我的孩子们似乎从不介意我出些汗，即使在大运动量的训练后也从不拒绝哺乳（据说这偶尔会改变母乳的味道）。


    我想作为一名高水平运动员，最大的挑战可能就是前去参加比赛——我往往带着孩子一起去。


    例如，我和丈夫在女儿六个月大时参加了为期两天的罗威山地马拉松比赛，我的妈妈把她带到中途的营地，和我们在帐篷里一起过夜（那时她才刚刚试着加辅食，几乎还是在纯母乳喂养）。


    另一个例子是在Els2900比赛中，当时我女儿来到了两座高山的起点和终点的住宿点，以此缩短我们分开的时间（再次感谢我的妈妈）。


    有关杰思敏的更多经历，请参阅她的博客：jasminfellrunner.blogspot.com

    总结

    你可能想要在产后恢复或开始锻炼。如果你觉得身体上准备好了，母乳喂养就不会成为障碍。


    通常可以做任何计划和安排，只要吻合宝宝在最初几周和几个月的正常需求即可。你可以通过当地的国际母乳会哺乳辅导小组获得这方面的更多支持。


    进行母乳喂养的高水平运动员可能有额外的考虑因素，但在母乳喂养的同时继续训练和比赛是可以实现的，只需要为她们的体能恢复提供正确的支持并提供一些赛事规划。


    非常感谢娜奥米·福卡德和杰思敏·帕里斯为本文提供她们的素材，并帮助展示母亲如何成功地将高水平的体育才能与母乳喂养相结合。






    Elite athletes and breastfeeding


    In recent years, there has been an increase in understanding and support for elite athletes who are pregnant, breastfeeding (and bottle-feeding) or caring for a young child. UK Sport, the body that supports high-level athletes, teams, and sports, has published pregnancy guidance for the Olympic and Paralympic high-performance community. (You can access that here: https://www.uksport.gov.uk/resources/governing-body-and-athlete-guidance)


    Elite athletes will ideally have access to additional skilled support from coaches and physicians. However, some of the following considerations for training and competing at elite level, while continuing a breastfeeding relationship, may also be helpful:


    Professional and elite athletes may feel pressure to return to strenuous training regimes. Understanding and arming yourself with information about the normal needs of young babies to be with their mother and to feed regularly and responsively may help to structure your own plans and the expectations of your team or funding body.


    Breastfeeding has a hormonal impact on the body, for example through the release of ‘relaxin’, which may impact on joints and ligaments. However, there are very many examples of elite athletes that have trained and performed while breastfeeding. Working with physiotherapists that understand the hormonal impacts and can adapt training may be helpful.


    As well as the physiological impacts, breastfeeding can play an important role in the formation of the psychological bond between mother and baby. In this article from the official website of the Olympic Games, Dame Sarah Story and Serena Williams discuss how important their breastfeeding relationship felt as part of their experience as elite athlete mothers.


    One of the practical challenges for elite athletes may be the need to be away from their baby for longer periods for training and competition. How you solve this is often a mix of ingenuity and adaptability.


    It’s also worth remembering that the intense needs of small babies are not long-term. Many sportswomen reflect that their priorities changed when they had their baby and they found that they did not want to be separated. Mothers should be supported in that decision. 


    Equally, if you are keen to get back to training and competing there are often ways of including your baby in that.Where you do need to be away for their baby for a longer period, e.g. to compete, there are often practical ways to support breastfeeding. 


    Many elite sportswomen, e.g. ultra-runners needing to be away from their babies for over 24 hours, have someone bring their baby to check points so that they can feed the baby (and sometimes express/pump milk) while refuelling themselves. 


    Others may also express/pump milk to leave with a caregiver for their baby whilst away. Further information and about expressing and storing breastmilk can be found here.

    There are many examples of elite athletes that have breastfed alongside the resumption of their high-level training and performance. 


    Two of the UK’s elite athletes, Naomi Folkard (Team GB, Archery) and Jasmin Paris (elite long-distance fell runner) have kindly shared with LLLGB their reflections on breastfeeding while continuing to train and compete:

    01

    Naomi Folkard

    “My sport is archery, a closed skill sport which requires standing and walking 70m to the target and back to collect the arrows. 


    Before my pregnancy I enjoyed running as part of my conditioning, as well as gym and rotator cuff work, which I continued with through to the eight months mark.


    With the exception of rest, which is what I did the first week, I began the recovery immediately, by introducing a little walking, wearing baby in a sling, pelvic floor exercises, shoulder exercises and a little yoga. 


    My whole pelvic and abdominal region felt like jelly for at least a couple of weeks, so I was very careful to consider what exercise I should do and gradually built up the quantity.


    When I started shooting again at two weeks post-partum, I was able to take my baby with me so if she wanted a feed I would be able to stop what I was doing and have a cuddle with her on the sofa in the lounge.


    By eight weeks I was able to give baby a feed, put her down (sometimes asleep and, probably more often, not asleep) and go training, leaving her with her dad; at this point I found it really difficult emotionally to leave her.


    In my preparation for the arrival of my baby and care afterwards, I spoke to a few other mum athletes about how they managed the birth, breastfeeding and training. I also read books and articles on the internet.


    I gave my baby bottles of expressed milk at five days because I found breastfeeding incredibly painful. I was extremely fortunate that the midwife I saw after that made me an appointment with a lactation consultant who sorted us out so quickly; she showed me the rugby ball hold and after that baby and I made a great team.


    When I’m away at competitions my baby has a bottle of expressed milk. Sometimes she gets frustrated with the first couple of feeds when we’re back together because the milk flow of the breast isn’t as quick as the bottle. I just de-latch and try to calm her down.


    While I’m away I have to care for my breast health by expressing at a similar schedule to what I do at home. It’s important to me to keep the milk production up and to prevent blocked ducts. 


    I’ve flown to the Far East twice while doing this. I ensure I express immediately before the flight to minimise the number of times I have to express in the plane toilets!


    When I was competing in the early months, I found timing feeding/expressing quite tricky. Competitions can take all day and the breaks are not always well-timed or long enough, nor are there always facilities available. If you are competing and breastfeeding, you may find it worthwhile to ask the organisers in advance about facilities.


    I found while travelling to events abroad that it’s really difficult to keep the pump parts all clean. So now I make sure there’s a towel in the bag to catch the drips at least, even if there’s not enough time to dry it off properly. I give everything a really good clean when I’m back home.


    They say sleep when your baby sleeps, but during the day I tended to train when baby slept! However, I’d definitely go to bed at night at the same time as baby, which would be about 9pm.


    I had to increase my supply and do lots of pumping ahead of the Tokyo Olympics, as athletes were not allowed to take their infants due to the pandemic. 


    It took me a while to realise just how many calories this was using on top of my training. Although my appetite was huge, I wasn’t eating enough, so the imbalance of calories along with my lack of sleep meant I was constantly exhausted.


    It wasn’t until a month or two after Tokyo that I decided to get fit again for jogging, for a number of reasons: motivation, time, mental health, pelvic floor, changing bra size and uncomfortable breasts, especially when full. 


    Sport shops do not stock my bra size which I find incredibly frustrating, but I did find a really good extra supportive bra in my size. 


    I followed my female health physio’s advice by doing a few weeks of work on my pelvic floor; I was already doing pelvic floor exercises stationary and in squat positions, but she advised me to do them while doing some toe taps, half high knees, side steps etc. 


    Once I was confident of no leakage, I did a couple of light jogs while pushing baby in a little tricycle, which she loved. I’d make sure I gave baby a good feed beforehand so my breasts would be most comfortable.”

    02

    Jasmin Paris

    “I’m a fell runner (I also do mountain and ultra trail running). I had my first baby in November 2017 and my second in July 2020. I breastfed them both, for 15 months and 22 months respectively. 


    During this time, I ran a number of races, including the Spine (2019) and Barkley Marathons (2022), and won the British Fell Running Championships (2018).


    With Rowan I started running gently around 3-4 weeks post-partum; with Bryn I left it until five-six weeks, as I’d had some pelvic pain during pregnancy so I waited for that to settle down. 


    I took it very easy at first, and didn’t start any structured training until around three months. My general approach during both pregnancies and afterwards was to listen to my body and do what felt comfortable.


    I found that I needed to eat something before training once I was breastfeeding (prior to that I’d often run fasted first thing in the morning), so I guess that was another example of listening to what my body was telling me. 


    Eating enough (to prevent RED-S, relative energy deficiency in sport) is particularly important if training hard whilst breastfeeding. So are Vitamin D supplementation, calcium and sufficient dietary iron.


    My main concerns were about being away from my baby, especially in the early days when they were feeding frequently. We did try to get both of them to take a bottle of expressed milk, but they were quite resistant to that, preferring it straight from the source.


    It helped to have a routine. With both children we got into the habit of me going running between 6-8am whilst on maternity leave (typically 60-90 minutes once they were a few months old), before my husband went to work. This time worked well as the baby would either be asleep, or awake in a good mood, having fed throughout the night/early morning (for the same reason, my breasts would not be too full, and I wouldn’t be worried about baby being hungry).


    I just ran in my standard sports bra. It was a bit tricky for immediate post run feeding, but I just hitched it up to allow access. 


    My babies never seemed to mind me being a bit sweaty, and never refused milk even after a hard training session (which reportedly can occasionally change the flavour of the milk).

    I guess as an elite athlete, the biggest challenge is probably travel to races – I tended to take my baby with me. 


    For example, my husband and I ran the Lowe Alpine Mountain Marathon two-day event when my daughter was six months old, and my mum carried her in to the midway camp for her to spend the night with us in the tent (she was only just starting to try solid foods and she was still mostly breastfed at the time). 


    Another example was Els2900 when my daughter came to the two high mountain refuges at the start and end of the race, to limit the time we’d be apart (again thanks to my mum).


    For more of Jasmin’s experiences please see her blog here: jasminfellrunner.blogspot.com

    Summary

    You may wish to return to, or start, exercising post-partum. If you feel physically ready to do so, then breastfeeding is not a barrier. 


    Any practical arrangements can usually be managed, in line with the normal needs of your baby in the early weeks and months. You can get additional support about this through your local La Leche League Leader and group.


    Elite athletes who are breastfeeding may have additional considerations, but continuing to train and compete while breastfeeding is achievable alongside the right support for their physical recovery and some planning for events.


    Thank you very much to Naomi Folkard and Jasmin Paris for their inputs to this article and for helping to show how mothers can successfully combine elite level athleticism with breastfeeding.


    参考资源


    1.https://www.laleche.org.uk/exercise-and-breastfeeding/

    2.http1.https://absolute.physio/wp-content/uploads/2019/09/returning-to-running-postnatal-guidelines.pdf

    3.Wallace JP, Rabin J. The concentration of lactic acid in breast milk following maximal exercise. Int J Sports Med. 1991 Jun;12(3):328-31.

    4.Gregory RL, Wallace JP, Gfell LE, Marks J, King BA. Effect of exercise on milk immunoglobulin Med Sci Sports Exerc. 1997 Dec;29(12):1596-601.

    5.Cary GB, Quinn TJ. Exercise and lactation: are they compatible? (Review) Can J Appl Physiol. 2001 Feb;26(1):55-75.

    6.Harris, J.E., Pinckard, K.M., Wright, K.R. et al. (2020). ‘Exercise-induced 3’-sialyllactose in breast milk is a critical mediator to improve metabolic health and cardiac function in mouse offspring’. Nature Metabolism, 2, 678-687. https://doi.org/10.1038/s42255-020-0223-8

    7.Guidelines for perinatal care. 7th American Academy of Pediatrics and the American College of Obstetricians and Gynecologists; Washington, DC: 2012

    8.Wiessinger, D., West, D., Pitman, T., & La Leche League International. (2010). The Womanly Art of Breastfeeding (8th ed.). New York: Ballantine Books.s://www.laleche.org.uk/exercise-and-breastfeeding/






    END

    翻译：传艳

    审稿：Lynn，楠楠

    编辑：幸宝


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  • 运动与母乳喂养（上） Exercise and Breastfeeding


    关注“国际母乳会LLL”了解更多母乳喂养资讯

    在产后，大多数女性发现和新生儿一起休息一段时间很有益处——只要你愿意或你能做到，这段时间持续多久都是可以的。

    当一些妈妈觉得得到充分休息了后，会选择继续以前的锻炼方式，或者是开始新的运动。

    你可能想知道她们是否能在母乳喂养的同时开始运动。对大多数人来说，答案是可以。适度锻炼并不会影响奶量或乳汁成分。

    本文将讨论与母乳喂养和运动相关的一些常见问题，下一篇文章则会分享一些特殊情况以及高水平运动员的实例。































    01
    哺乳期运动

    无论你是否继续母乳喂养，你的身体都会在孕期和产后发生很大变化。一方面是由于妊娠期荷尔蒙和化学物质的改变，另一方面是因为身体滋养了一个新生命这个事实。

    你会有一种期待（不管是你自己的还是他人的期待），想在生完孩子后恢复运动或是开始锻炼，并期望“恢复以往的身体状况”。

    然而，你也会发现“新”身体的力量和适应性，特别是当它持续滋养宝宝时，就成了新手妈妈极为骄傲的源泉。

    某种运动可能已经是你怀孕前和孕期生活的一部分了。你会渴望在产后很快恢复锻炼。大多数情况下，建议产后给自己的身体充足的时间休息和恢复。

    无论你怀孕和分娩时经历了什么，孕育孩子对身体来说都是一件重大事情。一般认为需要6~12周才能让身体逐步康复。最近的研究建议，像跑步这样的高强度运动最好是在产后3个月再开始。

    身体的康复很多是内在的，往往无法看见。这段休息的时光也弥足珍贵，当你花时间陪伴新生宝宝时——去了解他们，并从他们身上学习做母亲的新技能。


    如果你选择了母乳喂养，一旦身体从分娩和产后完全康复，恢复或开始锻炼都是安全的。

    一些研究表明，非常剧烈的运动可能导致母乳中的乳酸略有增加以及免疫球蛋白A水平略有下降，有些妈妈也反映她们的宝宝会稍微烦躁一小会儿，不过对奶量或婴儿的生长没有任何影响。

    2020年的一项研究提示，母乳喂养时运动会增加母乳中的一种化合物，可能会降低婴儿终身患糖尿病、肥胖症和心脏病等严重健康问题的风险。

    02
    实用技巧

    不论是否选择母乳喂养，都不影响你恢复锻炼的能力。对大多数女性来说，了解一些实用技巧往往对母乳喂养的同时进行锻炼变得更容易。

    婴幼儿想待在你身边，这很正常。产后最初的几周和几个月里，你会发现得富有想象力才能做想做的运动。

    有些妈妈在家锻炼，或跟着线上的健身课程进行运动。另一些妈妈则会尝试某些专为母婴量身定做的健身课程。

    对很多妈妈来说，最受欢迎的运动方式就是和宝宝一起散步，要么背在背带里（宝宝可以感觉到紧贴着你，而你也得到了额外的锻炼），要么放到婴儿车里。

    你会发现在运动前喂奶很有用。这点很有帮助，因为既可以减轻乳房的重量/饱胀感，又可以给你更长的时间间隔给宝宝喂下一次奶。

    找到一款合身且有支撑的运动文胸往往有助于更舒适地锻炼，也有助于确保你的胸部没有受到压迫。锻炼完就脱掉比较紧的文胸，有助于降低患乳腺导管堵塞和/或乳腺炎的风险。

    如果你担心自己可能已经堵奶或乳腺炎了，我们有关这方面的文章会对你很有帮助。

    你可能发现母乳喂养时会更渴，所以希望能随时喝到水。但是，请记住奶量与多喝水之间并没有联系。

    你会发现吃饱以增加能量很重要。研究表明母乳喂养每天可以消耗约500-700大卡热量。对一些妈妈来说，这会导致产后体重减轻；但情况并非总是如此，因为还有很多其它因素也会影响减重。

    母乳妈妈每天需要消耗至少1800大卡的热量，所以每周可以安全地减重约400-500克。母乳喂养时低碳水饮食也是安全的，只要你同时均衡食用水果、蔬菜和蛋白质。

    妈妈们的经历

    “我从来都不是个“爱运动”的人，也没有做很多健身运动，不过到了三十五六岁时，我想最好还是稍微改善一下自己的健康状况，就开始做了几件事：每周3~5次运动，去游泳、做瑜伽或散步一小时。

    宝宝出生后，我仍然不是个“运动达人”，也不为健身而担忧，就只喜欢出去到处走走，呼吸新鲜空气，换换环境，让身体感到精力充沛。”

    “我刚开始母乳喂养时很费劲，这对我整个自信心和心理健康都造成了不良影响。女儿九个月大时我重新开始打无板篮球，这对我自身以及对我做妈妈来说都是再好不过的事，我俩的母乳喂养之旅已近17个月了，仍然很顺利！”

                  ——克里斯蒂娜，无板篮球分队

    “我的漂亮宝贝出生后，我就开始母乳喂养他了。我发现只能根据他每天/每周的需求以及我的需求进行少量锻炼。有时为了让他小睡一会儿，我就把他放在婴儿车或背巾里一起散散步。”

    “产后恢复瑜伽的练习使我愉悦，尤其是在温暖的房间中上课。感觉就像在给我的身体做按摩，还能伸展手臂/背部/颈部的肌肉，自己都没有意识到这些肌肉已经因为哺乳和抱宝宝改变了拉伸的方式。”

    “休产假时，有时我会和朋友约一小时或90分钟边聊天边慢速骑行，这样我就可以做一些运动并与他人交往，而我的伴侣则抱着/背着宝宝出去玩。”

    “自从小家伙到来后，我就没买过任何专用的运动文胸了，实际上我发现哺乳文胸比常规的孕妇专用文胸更舒适。”

                  ——邦妮，骑行车迷，爱丁堡

    有很多高水平运动员的楷模，在恢复高水平训练和比赛的同时还母乳喂养了孩子。

    下一篇我们将分享英国的两位高水平运动员，娜奥米·福卡德（英国国家射击队）和杰思敏·帕里斯（高水平越野长跑运动员）在继续训练比赛的同时进行母乳喂养的感想。

    请妈妈们关注并期待！



    Exercise and Breastfeeding

    After birth, most women find it helpful to take a period of rest with their new baby – this can extend for as long as you wish or are able.

     When they feel ready, some mothers may choose to continue their previous forms of exercise, or start something new. 

    You may wonder whether they are able to  introduce exercise alongside breastfeeding. For most people, the answer is yes. Standard exercise does not impact on milk supply or content.

    In this article we discuss some of the common questions around breastfeeding and exercise, and consider instances where some more planning may be required, for instance for elite athletes.

    01
    Exercise whilst breastfeeding

    Your body will change a lot during pregnancy and post-partum, whether you go on to breastfeed or not. This is due to the shifts in hormones and chemicals of pregnancy, and the fact that your body has grown and nurtured a new human being. 

    You may feel an expectation (whether your own or others’) to return to exercise or start exercising after having a baby, to ‘get your old body back’. 

    However, you may also discover the strength and adaptability of your ‘new’ body, especially as it goes on to nourish your baby, is a source of great pride as a new mother.

    Exercise of some form or another may have been part of your life before and during pregnancy. You may feel eager to start exercising again soon after birth. In most cases it is recommended to give your body sufficient time to rest and recover post-partum. 

    Whatever your pregnancy and birth were like, having a baby is a significant event for your body. Six to twelve weeks is often considered a reasonable time frame to allow this healing. Recent research suggests that higher impact exercise like running should ideally only resume after 3 months. 

    Much of the recovery is internal and not always visible. This period of rest can also be incredibly valuable as you spend time with your new baby – learning about them, and learning from them the new skills of motherhood. 

    Once your body has fully recovered from birth and the immediate post-partum-period, it is generally safe to resume, or start, exercising if you have chosen to breastfeed.

    Some studies have shown that very strenuous exercise may lead to a slight lactic acid increase in milk and a slight decrease in IgA levels, with some mothers reporting that their baby was slightly fussier for a short period, but that there was no impact on milk supply or baby’s growth.

    A 2020 study suggests that exercising while breastfeeding increases a compound in breastmilk that may reduce a baby’s lifelong risk of serious health issues such as diabetes, obesity and heart disease.

    02
    Practical tips

    Whether you have chosen to breastfeed or not does not need to affect your ability to start exercising again. For most women, exercising alongside breastfeeding is more often a matter of sorting out a few practicalities.

    It is very normal for young babies and children to want to stay close to you. In the early weeks and months you may find that you have to be a bit more imaginative to fit in any exercise you want to do. 

    Some mothers work out at home or do fitness classes online. Others try some of the fitness classes especially for mums and babies. For many, the most popular form of exercise is going for walks with their baby, either in a carrier (where baby can feel close to you, and you get a bit of an added work-out), or with a buggy/pushchair. 

    If you do find that exercising requires to be away from your baby, you can read our article on separation here, which considers some of the practical tips.

    You may find it useful to breastfeed before you exercise. This can be helpful as it may lessen the weight/feeling of fullness in your breasts, and may give you a little longer before your baby will want to nurse again.

    Finding a well-fitting and supportive sports bra often helps to make exercising more comfortable and helps to ensure that your chest is not compressed. It is helpful to remove tighter fitting bras once you are finished exercising to reduce the risk of blocked ducts and/or mastitis.

     If you’re worried you may have a blocked duct or mastitis, you may find our article on that helpful.

    You may find that your are thirstier when breastfeeding, so may wish to have more water to hand. However, remember that breastmilk supply is not linked to drinking enough water. If you are worried about your supply, see here.

    You may find that eating enough to feel energised is important. Studies suggest that breastfeeding can burn around 500-700 calories per day. For some mothers this may lead to weight loss post-partum, but this is not always the case as many other factors can impact weight loss. 

    Breastfeeding mothers may need to consume at least 1800 calories a day and can safely lose around 400-500g per week. Low carb diets are also considered safe while breastfeeding, as long as long as you also consume a good mix of fruit, vegetables and proteins.

    Mothers’ experiences:

    “I’ve never been a “sporty” person or been much into fitness but when I got to mid-thirties, I thought I had better improve my health a wee bit so started doing a few things: three-five times a week I’d go swimming or to yoga or an hour’s walk. 

    Since my baby arrived, I still haven’t been “sporty” or worried about fitness, I have just enjoyed getting out and getting moving for fresh air, a change of scene, and to help my body feel energised.”

    “I really struggled with breastfeeding initially and it took its toll on my confidence and mental health in general. Returning to netball when my daughter was nine months old was personally the best thing I could have done for myself as a person and as a mum, and almost 17 months on our breastfeeding journey is still going strong!”  

                                ——Christina, Divisional Netball Team


    “After my beautiful baby arrived, I began breastfeeding him and I found I’d just fit little bits of exercise in around his needs/day/week, and my needs too. Sometimes for a nap I’d walk with him in the buggy or sling.”

    “I’ve enjoyed getting back into yoga post-baby, especially in the sessions where they warm the room. It feels like giving my body a massage, and stretching out the arm/back/neck muscles that I didn’t realise had been bending new ways for breastfeeding and cuddling my bundle of joy.”

    “When I was on maternity leave sometimes I’d meet a pal for an hour or 90 mins of gentle cycling while chatting, so I could get some movement and other human contact while my other half cuddled/hung out with the baby.”

    “I haven’t bought any special bras for exercise since my bub arrived, I have actually found breastfeeding bras much more comfy than my regular ‘pre-baby’ bras. ” 

                                     ——Bonnie, keen cyclist, Edinburgh

    There are many examples of elite athletes that have breastfed alongside the resumption of their high-level training and performance. 

    Two of the UK’s elite athletes, Naomi Folkard (Team GB, Archery) and Jasmin Paris (elite long-distance fell runner) have kindly shared with LLLGB their reflections on breastfeeding while continuing to train and compete. 

    please look forward to our next story!

    参考资源


    1.https://www.laleche.org.uk/exercise-and-breastfeeding/

    2.http1.https://absolute.physio/wp-content/uploads/2019/09/returning-to-running-postnatal-guidelines.pdf

    3.Wallace JP, Rabin J. The concentration of lactic acid in breast milk following maximal exercise. Int J Sports Med. 1991 Jun;12(3):328-31.

    4.Gregory RL, Wallace JP, Gfell LE, Marks J, King BA. Effect of exercise on milk immunoglobulin Med Sci Sports Exerc. 1997 Dec;29(12):1596-601.

    5.Cary GB, Quinn TJ. Exercise and lactation: are they compatible? (Review) Can J Appl Physiol. 2001 Feb;26(1):55-75.

    6.Harris, J.E., Pinckard, K.M., Wright, K.R. et al. (2020). ‘Exercise-induced 3’-sialyllactose in breast milk is a critical mediator to improve metabolic health and cardiac function in mouse offspring’. Nature Metabolism, 2, 678-687. https://doi.org/10.1038/s42255-020-0223-8

    7.Guidelines for perinatal care. 7th American Academy of Pediatrics and the American College of Obstetricians and Gynecologists; Washington, DC: 2012

    8.Wiessinger, D., West, D., Pitman, T., & La Leche League International. (2010). The Womanly Art of Breastfeeding (8th ed.). New York: Ballantine Books.s://www.laleche.org.uk/exercise-and-breastfeeding/



    END

    翻译：传艳

    审稿：楠楠、Lynn

    编辑：幸宝




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  • 为母乳喂养做准备 PREPARING TO BREASTFEED


    关注“国际母乳会LLL”了解更多母乳喂养资讯



    您可能想知道在怀孕期间需要做什么来为母乳喂养做准备。事实上，您的身体早知道该做什么。


    怀孕期间分泌的激素会让您的乳房做好准备，以便在宝宝出生后就有奶可以吃。


    因此，您能做的最佳准备是提前获取准确的信息，以及找到能够提供支持和鼓励的人。

    01

    怀孕期间

    怀孕期间，您的身体会经历许多变化。您可能会注意到以下变化：

    ·您的乳房增大且会一触即痛。

    ·您的乳头颜色变深，并对触摸很敏感。

    ·您可能会注意到几滴初乳（早期的乳汁）从乳房中溢出来。


    用清水清洗乳头就可以，尽量避免在乳头上使用肥皂，它们会把皮肤上的天然润滑剂洗掉。

    02

    吃什么

    怀孕时，为了自己和宝宝，健康的饮食非常重要。建议吃各种各样的纯天然食品。


    您不需要吃任何特殊的食物，也不必因为没有每天均衡饮食而感到担忧。身体产生的乳汁并不取决于饮食。母乳会从体内的储备中获得所需的营养物质。


    然而，吃种类丰富的健康食物对您的健康很重要，也为您的家庭成员树立好的榜样。


    03

    哺乳文胸的选择

    舒适的哺乳内衣有许多不同的选择。需要考虑的因素有:

    ✦舒适性——有许多无钢圈的内衣可以提供足够的支撑。如果您更喜欢有钢圈的内衣， 确保钢圈不会压迫您的乳腺组织。

    ✦便利性——理想情况下，文胸的任何扣环都可以单手操作。

    ✦轻薄透气的面料——当杯罩部分向下折叠时，应该很容易让婴儿喝奶。(由较厚织物制成的定型内衣体积很大，向下折叠时，可能会挡住宝宝，从而使宝宝贴近乳房变得困难。)

    ✦有扩张空间——等您的奶“下来”后，您的乳房会增大一个罩杯或更多。

    ✦哺乳背心——许多人发现这是个舒适的胸罩替代品。

    ✦购买时间——您可能想在妊娠最后几周购买1或2件胸罩，然后等分娩后几周再购买更多。大多数乳房会在三个月左右停留在比平时稍微大一点的罩杯。


    04

    服装的选择

    早期的肌肤接触使学习母乳喂养更容易。有关肌肤接触更多信息，请参见 https://www.llli.org/breastfeeding-info/skin-skin-care/ 。


    您不需要穿特殊的衣服！在家里，开衫或睡衣可以让妈妈很容易与宝宝进行肌肤接触。


    需要出门的时候，也有很多选择。世界各地的母亲穿着各种各样的服装进行母乳喂养。当穿着两件套时，上衣可以从底部掀起。或者如果领口足够大，可以将其从顶部拉下。


    有些人喜欢穿轻便的开衫式羊毛衫、解开扣子的衬衫或带拉链的运动衫。这些衣服可以让您在给宝宝喂奶时，同时遮住其他身体部位。


    您可以决定什么最适合您。您可以选择哺乳衣，但是许多人在没有任何特殊服装的情况下也舒适地母乳喂养了很多年。


    05

    乳头大小和形状

    乳头有各种形状和大小，每一种都非常适合母乳喂养。乳头的直径大小和长度因人而异。


    有些乳头在平时和触摸时会突出。有些乳头在平时看起来扁平，但触摸时会突出。也有些乳头即使被触摸也仍然扁平。


    有些乳头在平时看起来是凹陷的，就像缩在乳房里面一样。然而，当乳晕（乳头周围的深色区域）被轻轻挤压到乳头基底部后约2.5 cm处时，乳头就会挺出来。


    当轻轻挤压乳晕时，真正的凹陷乳头不会突出或外翻，甚至会回缩得更多。如果您认为您的乳头确实凹陷，请在怀孕时咨询医护人员。如果您的婴儿含乳困难，请考虑在产后咨询国际认证泌乳顾问（IBCLC）。


    一些乳头凹陷的女性担心这是否会影响母乳喂养。好消息是，婴儿可以非常成功地含着凹陷的乳头进行母乳喂养。而且通常不需要特别的准备，婴儿有几种自然反射可以帮助他们在没有突出的乳头的情况下也能含乳。


    有时，哺乳期妈妈会被告知，因为乳头凹陷她们应该使用乳头保护罩（乳盾）或奶瓶喂养。但目前没有证据支持这一点。


    无论是否存在乳头凹陷，一旦婴儿接触过质地较硬的硅胶奶嘴，都可能使他们更难直接含住妈妈的乳房。


    这种情况下，建议采用半躺式哺乳法，这种姿势能让婴儿更容易含乳。同时让婴儿花大量的时间与妈妈肌肤接触。


    如果有需要，您可以帮助您的宝宝。当婴儿很好地含乳时，他们通常能够将乳头深深地吸进嘴里。随着时间的推移，乳头和乳晕的组织会被拉伸。


    偶尔，当乳头被拉出时，牵拉感可能会有点不舒服。这种不适通常会在几周内消失。


    如果宝宝接触过人工奶嘴（包括安抚奶嘴），并且难以含乳，可以使用一些技术来帮助拉出凹陷的乳头。更多信息请参见“乳头凹陷和乳头扁平” https://www.llli.org/breastfeeding-info/inverted-flat-nipples/。(参考阅读：乳头凹陷咋进行母乳喂养？)

    06

    在婴儿出生前挤出初乳

    父母在为母乳喂养做准备时，可以做的一件事情就是练习用手挤奶的技巧，甚至还可以保存一些初乳。当需要的时候，这些初乳可以给刚出生的婴儿吃。


    初乳是女性身体在怀孕20周左右开始到产后三四天分泌的“早期乳汁”。用手挤奶需要练习才能熟能生巧。


    如果您一滴奶也没有挤出，也没必要担心，这并不要紧。怀孕期间是否能挤出初乳并不决定宝宝出生后您将生产多少母乳。


    不过，即使您没有挤出乳汁，提前了解您的乳房并练习用手挤奶仍然很有帮助。

    (参考阅读：在产前挤出初乳)

    07

    在产前学习母乳喂养知识

    在怀孕期间，了解您的身体和宝宝的身体是如何工作的可能会有所帮助。您可以了解到母婴该如何共同努力来获得成功的母乳喂养体验。


    可以通过“国际母乳会-LLL”微信公众号、视频号、以及我们其他社交媒体平台（我们开通抖音小红书B站等社交媒体了！）或访问www.muruhui.org，提前了解母乳喂养相关资讯，比如：

    ❶ 在最初几小时和几天里的母乳喂养 （我们的乳房是需要“催”了才能产奶的吗）

    ❷ 建立您的奶量

    ❸ 如何知道您的宝宝吃到了足够的母乳

    ❹ 如何避免喂养困难（乳腺炎、鹅口疮）

    08

    参加国际母乳会的月度聚会

    怀孕期间参加国际母乳会的月度聚会是为母乳喂养做准备的最佳方式之一。您可以遇见其他哺乳父母，看到婴儿如何母乳喂养，提出您的问题，并听到与您有相似经历的父母的意见。


    如果遇到问题，国际母乳会的哺乳辅导能够为您提供大量信息和支持，这些对您都将非常有帮助。


    您可以通过关注我们的微信公众号或访问官方网站（www.muruhui.org）来及时获知聚会信息。欢迎所有的准妈妈和家人一起来参加我们的聚会！




    PREPARING TO BREASTFEED

    You may be wondering what you need to do during pregnancy to prepare for breastfeeding or chestfeeding. Actually your body knows what to do. 


    The hormones produced during pregnancy prepare your breasts to make milk once your baby is born. 


    The best preparation is accurate information and people who can provide support and encouragement.

    01

    During Pregnancy



    Your body goes through a lot of changes during pregnancy. Here are some changes you may notice.

    ◆Your breasts will likely feel tender and get bigger.

    ◆Your nipples may get darker and may become sensitive to touch.

    ◆You may notice drops of colostrum (the first milk) leaking from your breasts.


    It is helpful to avoid using soaps on your nipples. They can strip the skin of its natural lubricants. Plain water is all you need.

    02

    What to Eat



    When pregnant, it is important to eat healthy food for yourself and your baby.  Think about eating a variety of foods in as close to their natural state as  possible. 


    You do not need to eat any special foods or be concerned if you don’t eat a balanced diet every day. The milk your body produces is not dependent on your diet. Your milk gets the right amount of nutrients from what is stored in your body.


    However, continuing to eat a variety of healthy foods is important for your health and role models healthy eating for your family.


    03

    Choosing a Nursing Bra



    There are many different options for comfortable nursing bras. Some considerations are:

    ✦Comfort —— There are many soft-sided bras that provide adequate support. If you prefer a bra with underwires make sure the underwires do not dig into your breast tissue.

    ✦Easy access to the breast —— Ideally any clasps should be manageable with one hand.

    ✦Light, breathable fabrics —— When the cup fabric is folded down it should be easy to tuck out of baby’s way for feeding. (Molded cup bras are made of thicker fabric that can be very bulky. When folded down they can make it difficult for baby to get close to the breast.)

    ✦Room for expansion —— Your breasts may increase by a full cup size or more when your milk comes in. Nursing tank top – Many people find these comfortable alternatives to a bra.

    ✦Time your purchases ——You may want to buy 1 or 2 bras during the final weeks of pregnancy and then wait until a couple of weeks after the birth to purchase more. It’s helpful to know that most breasts settle into a moderately larger size by about three months or so.

    04

    Clothing Options



    Skin-to-skin contact in the early days makes learning to breastfeed easier. For more information see https://www.llli.org/breastfeeding-info/skin-skin-care/.


    No special clothes are needed! Around the house, wearing a shirt or nightshirt that opens at the front allows parents to easily hold baby skin to skin. 


    When it’s time to get dressed to go out, there are lots of options. Mothers and parents all over the world breastfeed in a wide variety of outfits. When wearing two-piece outfits, tops can be lifted from the bottom. Or If the neck opening is wide enough, they can be pulled down from the top. 


    Some people like to wear a light cardigan-style sweater, unbuttoned shirt, or zip-up sweatshirt. It can cover the side of your body while your baby is feeding. 


    You can decide what will work best for you. Specialty breastfeeding clothes are available but many people breastfeed comfortably for years without any special clothing.

    05

    Nipple Size and Shape



    Nipples come in all shapes and sizes. Almost all are perfectly fine for breastfeeding. Nipples can vary in diameter from small to large. They can also vary in length from short to long. 


    Some nipples protrude while at rest and when touched. There are nipples that appear flat at rest but protrude when touched. Others remain flat even when touched. 


    Some nipples appear to be inverted at rest, like they are sunken into the breast. However, when the areola (dark area around the nipple) is gently squeezed about 2.5 cm behind the base of the nipple, the nipple becomes erect. 


    Truly inverted nipples do not protrude/evert and may retract even more when the areola is gently squeezed. If you think you have truly inverted nipples, consult a healthcare provider while pregnant. Consider seeing an International Board Certified Lactation Consultant (IBCLC) after the birth if your baby is having difficulty latching.


    Some women with inverted nipples wonder if this will impact breastfeeding. The good news is that babies can latch onto inverted nipples and breastfeed very successfully. Usually no special preparation is needed. Babies have several natural reflexes that help them to latch onto the breast even without a protruding nipple.


    Sometimes nursing parents are told that because their nipples are inverted that they should use a nipple shield or bottle- feed. There is no evidence to support this. 


    Once babies are exposed to a firm silicone nipple it can make it more difficult for them to grasp their parents’bare nipples whether they protrude or not. Instead, the recommendation is to use the laid- back feeding position and allow baby a lot of skin-to-skin time. In this position it’s easier for babies to latch. 


    You can help your baby, if needed. When babies are latched well, they are usually able to draw the nipple deep into their mouths. Over  time the tissues of the nipple and areola are stretched. 


    Occasionally, the tugging sensation may be slightly uncomfortable, as the nipple is drawn out. This discomfort usually passes within a few weeks.


    If your baby has been exposed to artificial nipples, including a pacifier, and is struggling to latch well onto the breast, there are techniques that can be used to help draw out an inverted nipple. For more information see “Inverted Nipples and Flat Nipples” https://www.llli.org/breastfeeding-info/inverted-flat-nipples/.

    06

    Expressing Colostrum Before Baby Arrives



    One of the things that parents can do to prepare for breastfeeding is practice the  technique of hand-expression. Even small amounts of colostrum can be saved and given to baby in the early days, if needed. 


    Colostrum is the “early milk” that a pregnant body begins to produce around the twentieth week and up until the first three or four days after a baby is born.


    Hand-expression takes some practice. There is no need to be concerned if you don’t get any drops at all. That’s okay. Whether or not you are able to remove any colostrum in pregnancy does not reflect how much milk you will make once your baby arrives. 


    Even if you express no milk, it is helpful to get to know your breasts and practice hand-expression before the birth. (See “Prenatal Colostrum Expression” https://www.lllc.ca/sites/default/files/Prenatal+Colostrum+Expression_3.pdf) or (Prenatal Colostrum Expression)

    07

    Check out LLL’s Prenatal Breastfeeding Information



    During your pregnancy, it can be helpful to learn about how your body and your baby’s body works. You can learn how the two of you can work together to have a successful breastfeeding experience. Visit our homepage www.muruhui.org or follow us in our different social media accounts to learn more about breastfeeding  (Start New Social media):

    ❶ breastfeeding in the early hours and days；

    ❷ Establishing your milk supply；

    ❸how to know your baby is getting enough milk and

    ❹ how to avoid difficulties.(Mastitis,Thrush)

    08

    Attend LLL Monthly Meetings



    Attending La Leche League meetings during pregnancy is one of the best ways to prepare for breastfeeding your baby. 


    You can meet other nursing parents, observe babies breastfeeding, ask your questions and hear from others who have been on the same journey as you. 


    If questions arise, being able to call a La Leche League Leader who can provide you with good information and support can be very helpful.


    To access the LLL meeting calendar please go to (Meetings of This Week).




    END

    翻译：LLL Canada加拿大母乳会

    审稿：Julia，Lynn， Marien

    编辑：幸宝




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  • 母乳奇妙的味道 The Curious Taste of Human Milk


    关注“国际母乳会LLL”了解更多母乳喂养资





    对母乳的好奇之心

    生孩子之前，我对哺乳知之甚少。我仅有的体验是，我在一岁前喝的是母乳。但我这段非凡的体验并不普遍，我身边的很多家庭并没有母乳喂养。


    作为一名护士在产科轮科期间，我对人类乳汁和母乳喂养的机制产生了好奇心。在产科病房里，宝宝们努力去含乳，他们甜蜜地享受着乳汁，这些都唤起了我的这种好奇心。


    寻找乳头并有意识地去吃奶是新生儿与生俱来的本能—他们的觅食、吸吮和抓握反射共同作用，保证了他们在子宫外的早期生命健康。


    我还注意到新生儿满怀热情地含乳以及吸吮时的兴奋激动。他们对含乳的渴望是无与伦比的暖人心房。从那时起，我就很想知道母乳的味道。








    哺喂第一个孩子

    后来我生下了第一个孩子小R，他开始母乳喂养时没有任何问题。我完全按照如何正确含乳的视频来做，以确保我做得没有任何瑕疵（好像就只有这一种方法）。


    我的儿子长得很健壮，跟我在护理学院照护过的那些婴儿很相似，那些生理反射帮助他满怀愉悦、热情和迷恋地去吸吮乳汁。


    随着他长大，那些吞咽声和肢体动作，包括头部的扭动以及手的挥舞都表明他吃得很满足。那他品尝到什么滋味了呢？又是什么让他这么开心？








    哺喂第二个孩子

       两年后，我生下了二儿子小O。这一次出师不利。我专门找到了一位愿意让我尝试剖宫产后阴道分娩 (VBAC)的医生，结果没成功，我被紧急推入手术室实施剖宫产。


       后来，我得了产后子宫内膜炎；同时，涨奶又导致了乳腺炎。我筋疲力尽，痛苦不堪。


       尽管如此，小O吃奶吃得相当好，看到他长得好我也很满足。和小R一样，我很关注小O的动作、声音和吞咽，还有顽皮的小手、嘴以及头部的扭动。这些都表明他吃了一顿很满意的大餐。


       这时，我的大儿子小R也表现出了我曾经有过的好奇心。他用最甜美的声音问我：“妈妈，你的母乳是什么味道呢？”他的好奇心让我猝不及防。








    解锁母乳成分

    就在那一刻我急中生智。我们干嘛不尝尝我的母乳呢？它很安全，它来自我的身体呀。小O以此为食，而小R也因为吃了足够的乳汁而茁壮成长。


    小R兴奋地睁大了眼，他对着我咧嘴笑，那是一个学龄前幼儿给父母的最开心的笑。


    我们都尝了一点儿。我没想到它会如此美味、让人放松。小R也认为它是甜甜的奶。他笑着走开了，继续玩自己的。而我则依旧很好奇它那甜美的味道，因此决定进一步了解母乳的成分。

    那么事实是这样的：母乳富含对婴儿有益的必需天然营养成分。我最近在美国国立卫生研究院 (NIH) 的平台上找到一项研究，详细解释了各个成分及其相关的益处。


    这是一项2021年的研究，标题为《人类母乳的成分和对人类健康的功效：从营养成分到微生物组和微核糖核酸》。当然，这是一篇冗长的科学文献。


    不过，它重点强调了以下几点，简而言之，说明了为什么母乳味道甜美。母乳由以下成分组成：

    · 87-88%  水

    · 7%   碳水化合物（乳糖）

    · 3.5-4.5% 脂肪

    · 1%   蛋白质


    这些都是促进婴儿生长发育的纯天然的营养成分。当然，这项研究论述得很详实，但我的观点是，碳水化合物/乳糖的比例很高，就赋予了母乳天然的甜杏仁味。这就是我们看到婴儿吃奶时的热情、迷恋、兴奋和满足的原因。


    每种成分都发挥一个特定的作用来使婴儿受益。乳糖不仅赋予了甜味来安抚婴儿，而且也是人类大脑早期发育所必需的。婴儿需要很高的能量来增加体重、发育大脑、帮助吸收。


    乳糖提供了必需的能量，与此同时，蛋白质和脂肪在全身系统的生长发育中起着至关重要的作用。在这个关键的成长阶段，所有这些成分都在满足儿童健康的免疫和营养需求方面发挥着重要作用。


    此外，有证据表明，人类的乳汁还有助于肠道菌群定植、增强免疫力和预防疾病。这真是互惠互利的双赢！


    乳汁甜美的味道和香气令婴儿愉悦，同时母乳也在每一阶段促进了他们的生长和发育。我很开心我尝过它，也很满意自己为孩子们的健康做出了贡献。我希望你也享受自己的哺育之旅，相信甜蜜的乳汁可以塑造一个健康的孩子。



    The Curious Taste of Human Milk



    I didn’t know much about lactation before I had children. The only fact was that my mother had nursed me during my first year of life. A community of breastfeeding family members did not surround me to normalize this phenomenal experience. During the postpartum rotation in nursing school, my curiosity about human milk and breastfeeding dynamics started. The babies in the postpartum unit attempting to nurse and the sweet commonality among the ones put to the breast ignited that curiosity. It was the inborn knowledge of the newborn looking for a nipple and the awareness to nurse – their rooting, sucking, and grasping reflexes working together to give them a healthy start outside the womb. I also noticed the excitement of a newborn latching and sucking with so much enthusiasm. The thirst for latching was nothing other than heartwarming. For the first time, I wondered about the taste of human milk.









    Then I gave birth to my firstborn, R, who did not have any issues getting started breastfeeding. I even followed videos on how to latch correctly, videos that gave me validation that I was doing it just right (as if there is just one way to do it.) My son was thriving, and similar to those babies I had once cared for during nursing school, R was doing the same — reflexes aiding him to take in breast milk with delight, gusto, and passion. The audible gulps, body movements, head nodding, and playful hands indicated satisfaction as he grew. What was he tasting? What was making him happy?









    Two years later, I gave birth to my second son, O. It was a rough start. I had specifically researched to find a doctor who would let me try for a vaginal birth after cesarean (VBAC). It didn’t work, and I was rushed to the operating room for a cesarean. Afterward, I developed postpartum endometritis, a uterine infection. Simultaneously, engorgement led to a bout of mastitis. I was exhausted and in pain. Despite that, O nursed pretty well, and I was content to see him thrive. Like R, I noticed O’s movements and sounds, the gulps, and the playful hands, mouth, and head rotation. All indicated a satisfactory meal. This time around, R, my eldest, showed the same curiosity I once had. In the sweetest of voices, he asked, “Mama, what does your milk taste like?” He caught me off guard with his curiosity.









    At that moment, I came up with an idea. We would try my milk. Why not? It’s safe; it’s mine. O is living on it, and R was a thriving baby due to its abundance. R’s eyes widened with excitement, and he gave me the most delighted grin a preschooler could give a parent. We both tasted a little. I did not expect it to be so tasty and soothing. R agreed that it was sweet milk. R smiled, walked away, and continued with his play. On the other hand, I was left intrigued as it tasted sweet with a dash of delicacy, and I decided to find out more about the composition of human milk.

    So here is the thing: human milk is full of essential natural components that benefit the baby. I recently found a study on the National Institutes of Health (NIH) platform explaining the components and associated benefits in detail. It was a 2021 study entitled “Human Breast Milk Composition and Function in Human Health: From Nutritional Components to Microbiome and MicroRNA.” Sure, it’s a scientific piece that goes into scientific ramblings. Nevertheless, it highlights the following points that showcase, in a nutshell, why human milk is sweet tasting.


    Human Milk is composed of the following:

    ·87-88% Water

    ·7% Carbs (Lactose)

    ·3.5-4.5% Fats

    ·1 % Proteins


    These are all-natural components that support the growth and development of a baby. Of course, the study went into much more detail, but my point is that a high percentage is from the carb lactose, which gives human milk that natural sweet almond taste. This is the reason we see the gusto, the passion, the excitement, and the satisfaction when the baby nurses.


    Each component has a specific role to fill to benefit the baby. Lactose not only gives the sweetness that brings comfort to the baby, but it’s needed in early human brain development. Babies have high energy demands to increase weight, develop the brain, and aid absorption. Lactose provides necessary energy, while, concurrently, proteins and fats play a crucial role in the growth and development of all systems. All these components play a critical role in fulfilling the immunological and nutritional needs for a child’s well-being during this crucial growth phase. In addition, evidence has shown that human milk also contributes to intestinal colonization, immunization, and prevention of diseases. It’s a win-win situation.


    The sweet taste and aroma are enjoyable to babies, while human milk promotes their growth and development in every phase of the breastfeeding journey. I am glad I tasted it and feel content knowing I contributed to the well-being of my boys. I hope you are also enjoying your journey, knowing the sweet-tasting milk is in the works of building a healthy child.


    END


    作者：以色列 罗拉·拉万

    翻译：美国母乳会

    审稿：传艳, Lynn, Marien

    编辑：幸宝





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    本篇文章来源于微信公众号: 国际母乳会LLL

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


    关注“国际母乳会LLL”了解更多母乳喂养资讯


    支持者的重要性

    伴侣和其他亲人往往很难知道该如何帮助哺乳期的母亲。虽然喂养关系存在于母亲和宝宝之间，但伴侣和其他人也可以做许多事情来给予支持。


    对于哺乳期妈妈来说，有一个可以一起庆祝小胜利的伴侣、家庭成员或朋友会有很大的帮助。比如，宝宝能舒适地衔乳了、或者宝宝能很好地喝奶了，这些都值得庆祝。


    同样，当新手妈妈面临挑战时，听到伴侣或其他亲人鼓励的话语对她来说意义重大。妈妈的支持者所扮演的重要角色就是在妈妈哺育她的婴儿的同时去“哺育”她。



    图|国际母乳会中国图片库(图文无关)


     1.母乳喂养的妈妈为什么需要支持

    产后恢复需要时间，在最初的几天和几周里，母乳喂养的妈妈在增强信心和技能的同时，要是身边有其他人能提供支持，这会对妈妈很有帮助。


    即便母亲和婴儿都具有本能来帮助引导他们开始母乳喂养，但母乳喂养也是一项在哺乳妈妈之间传授、代代相传的需要学习的技能。


    在不断学习这些技能的同时，母乳喂养的母亲通常也受益于她们所爱的人的支持。


    图|国际母乳会中国图片库(图文无关)


    2.如何帮助您的伴侣

    每个新手妈妈会希望得到不同形式的帮助，因此与伴侣讨论她们希望获得怎样的支持对她们来说很重要。以下是一些建议：


    ☝在喂奶期间给伴侣提供水和零食。

    ☝说一些鼓励的话，比如“你做得很好”、“坚持住，你行的”。 

    ☝如果还需要更多的支持，替伴侣主动联系国际母乳会哺乳辅导或国际认证泌乳顾问(IBCLC)。

    ☝想办法在任何困难的时刻带来幽默和欢乐。

    ☝当哺乳妈妈在洗澡或出去喘口气时，直接皮肤贴着皮肤地抱着婴儿，或用背巾或背带抱着婴儿。

    ☝当你在陪伴你的伴侣喂奶时，趁这个机会与她沟通和交流。

    ☝做家务：负责购物、买菜、做饭、预约、洗衣服、 打扫卫生等杂事。

    ☝管理访客：限制访客数量和停留时间，以避免干扰母乳喂养。

    ☝告诉您的伴侣哪些事情进展顺利，并在任何挑战中提供情感支持。

    ☝给婴儿洗澡、换尿布、给婴儿穿衣服、洗净/烘干婴儿衣物等。

    ☝随着计划的改变灵活变通，例如，考虑安全的同床睡眠，或母婴同睡（让婴儿在几臂距离之内与妈妈同室不同床睡觉）。

    ☝帮助年长的兄弟姐妹适应有了弟弟/妹妹的新生活。

    ☝记住：一个吻、一句好听的话，或一杯茶都能创造奇迹！


    图|国际母乳会中国图片库(图文无关)
    母乳喂养基础知识

    · 人类的乳汁经历了几千年的进化，为人类婴儿量身打造，就像其他哺乳动物的乳汁为喂养它们的婴儿进化而形成一样。

    · 母乳容易消化。婴儿需要按需频繁进食；在24小时内哺乳至少8-12次是很正常的，这对建立健康的奶量很重要。

    · 在出生后三天到六周之间，一个健康的足月婴儿如果能吃到足够的母乳，他每天会有5- 6片湿尿片（如果是布尿布的话则会更多)，和至少3次排便，大小相当于一枚一元人民币的硬币。

    · 母乳喂养是一个完美的供需系统——婴儿喝的母乳越多，身体分泌的乳汁就越多。这就是为什么补充配方奶粉会减少母乳供应量的原因。

    · 皮肤贴皮肤抱着婴儿有利于Ta们的发育，可以改善乳汁供应，也可以帮助父亲或和其他照顾者与婴儿建立亲密连接。

    · 更多信息，请访问www.muruhui.org。

    图|国际母乳会中国图片库(图文无关)


    支持母乳喂养的其他方式

    ☞了解母乳喂养的基础知识：参考上文的建议“母乳喂养基础知识”，考虑参加线上产前母乳喂养课程，并通过国际母乳会的《母乳喂养的女性艺术》第8版或者可靠的网络资源，比如www.muruhui.org和www.llli.org，来获取相关信息。


    ☞告知医院工作人员，母乳喂养对您的家庭很重要。寻求可能需要的其他帮助来实现您家庭的目标。

    ☞支持、保护和促进：让您的伴侣知道您支持母乳喂养的决定，并且通过您的行动和语言来表达您相信这是正常和重要的。如果朋友或家人不支持你们的喂养选择，确保您传达了您的对她的支持并认可

    她的努力，这样您的伴侣就不会感到受打击和被孤立。只要孩子和母亲希望母乳喂养持续下去，就支持他们。


    ☞通过国际母乳会LLL官网（www.muruhui.org）或公众号、视频号，查询母乳喂养资讯和母乳妈妈聚会信息。同伴支持已经被证明能帮助提高母乳喂养的成功率。我们也鼓励和欢迎更多的爸爸或照顾宝宝的其他家人一起参加聚会。


    图|国际母乳会中国图片库(图文无关)


    参考资源

    https://www.lllc.ca/sites/default/files/How Partners and Supporters Can Help-11.pdf





    HOW PARTNERS AND SUPPORTERS CAN HELP


    THE IMPORTANCE OF SUPPORT PEOPLE

    Partners and other loved ones can often struggle to know how to help the mother, or nursing parent. Although the breastfeeding relationship exists between the nursing pair, there are many things that partners and others can do to provide support.


    It can make a big difference to a nursing parent to have a partner, family member or friend who can celebrate the little victories like achieving a comfortable latch or watching the baby drinking well. 


    Similarly, it can mean a lot to a new mother to hear encouraging words from the baby’s father or her partner or other loved ones when she is experiencing challenges. An important role for support people is to nurture the mother while she nurtures the baby.

    1.WHY BREASTFEEDING PARENTS NEED SUPPORT

    Recovering from birth takes time and in those early days and weeks it can be very helpful to have others around who can provide support while the breastfeeding parent grows in confidence and skill. 


    Both mothers and babies have reflexes that can help guide them, but breastfeeding is also a learned skill passed from parent to parent and generation to generation.


    While all of this learning is taking place, breastfeeding parents usually benefit from the support of their loved ones.


    2.HOW TO HELP YOUR PARTNER

    New nursing parents will want help in different ways so it can be valuable for them to discuss with their partners how they want to be supported. Here are some ideas:

    ☝Bringing water and snacks during breastfeeding sessions

    ☝Saying encouraging words like, “You’re doing a wonderful job” and “Hang in there, you can do it.”

    ☝Offering to contact a La Leche League Canada Leader or professional lactation consultant (IBCLC) for additional support. (www.lllc.ca/get-help)

    ☝Finding ways to bring humour and fun into any difficult moments

    ☝Holding the baby skin-to-skin and/or carrying the baby in a sling/wrap while the nursing parent takes a shower or gets a bit of fresh air

    ☝Keeping your partner company during nursing sessions, taking the opportunity to connect with each other.

    ☝Taking care of errands and chores: grocery shopping, meal preparation, booking appointments, laundry, cleaning, etc.

    ☝Managing visitors: limiting the number of visitors and length of stay so that breastfeeding is not disrupted

    ☝Reminding your partner of what is going well, and providing emotional support amidst any challenges

    ☝Bathing the baby, changing diapers, getting the baby dressed, taking care of baby’s laundry, etc.

    ☝Being flexible as plans change, for example, considering safe bed-sharing or having baby within arm’s reach by co-sleeping

    ☝Helping older siblings adjust to life with a new baby

    ☝Remembering that a kiss, a kind word or a cup of tea can do wonders!


    BREASTFEEDING BASICS


    • Human milk evolved over millennia for human babies, just as other mammals’ milk evolved to feed their babies.

    • Human milk is easy to digest. Baby needs to feed frequently and on cue; a minimum of 8-12 times in a 24-hour period is normal and builds a healthy milk supply.

    • Between three days and six weeks, a healthy full term baby who is getting enough milk produces 5- 6 wet diapers (more if cloth) and at least 3 bowel movements the size of a $2 coin per day.

    • Breastfeeding is a perfect supply and demand system— the more breastmilk the baby drinks, the more milk the body makes. This is why supplementation with formula can reduce a mother’s milk supply.

    • Holding a baby skin-to-skin is good for baby’s development, can improve milk supply, and can also help the father, or other parent, and baby bond.

    • Find out more at www.lllc.ca or [www.muruhui.org].


    OTHER WAYS TO SUPPORT BREASTFEEDING



    ☞Know the basics of breastfeeding: (See Breastfeeding Basics, above) Consider taking LLLC’s online Prenatal Breastfeeding course and reading reliable information online at www.lllc.ca and www.llli.org, for example, or in LLLI’s The Womanly Art of Breastfeeding, 8th ed.

    ☞Tell hospital staff that breastfeeding is important to your family. Find the extra supports you may need to meet your family’s goals.

    ☞Support, protect and promote: Let your partner know that you support the decision to breastfeed or chestfeed and that you believe this is normal and important through your actions and your words. If friends or family are not supportive of your feeding choices, ensure that you communicate your support and recognize her efforts so that your partner does not feel undermined and alone. Support the breastfeeding relationship for as long as the child and mother want it to last.

    ☞Find your local LLLC Group or online meeting at www.lllc.ca. Peer-to-peer support has been proven to help increase breastfeeding success. Some Groups even offer Couples’ meetings that non-breastfeeding partners can attend.


    END

    翻译：LLL Canada加拿大母乳会

    审稿：Julia, Lynn, Marien

    编辑：幸宝、沐凡




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  • 鹅口疮 THRUSH


    关注“国际母乳会LLL”了解更多母乳喂养资讯


    编者注


    本文中的“鹅口疮”包括婴儿口腔、臀部的酵母菌病和母亲乳房、乳头、阴道的酵母菌感染，狭义的“鹅口疮”通常仅指婴儿口腔酵母菌病。

    2022年3月更新

    鹅口疮(念珠菌病或酵母菌病)是一种由念珠菌引起的真菌感染。念珠菌通常栖息于口腔、胃肠道和阴道。它几乎可以生长在身体的任何部位。


    念珠菌喜好温暖、黑暗、潮湿的环境，如乳房、乳头和婴儿臀部。妊娠、疾病、抗生素使用等因素都可能导致念珠菌过度增生。这就是我们说的“鹅口疮”。


    鹅口疮疼痛又恼人，但是它通常不会导致严重疾病。在治疗感染的同时可继续母乳喂养。


    了解鹅口疮的原因可以帮助您减少念珠菌在体内的生长。如果您怀疑您可能患有鹅口疮，请咨询医护人员。

    01
    乳头/乳房疼痛的其它原因


    在确定是鹅口疮之前，需要考虑乳头疼痛的其他原因。如果在没有鹅口疮症状的情况下出现疼痛，则应首先考虑引起疼痛的其他原因。乳头疼痛最常见的原因是哺乳姿势和含乳问题。其他原因可能包括：

    ·舌系带和唇系带过短

    ·乳头损伤

    ·细菌感染

    ·雷诺氏现象或血管痉挛

    ·乳管堵塞或乳腺炎

    ·皮肤问题：接触性皮炎、湿疹、牛皮癣（银屑病） 

    ·过敏

    ·疱疹

    ·毒葛皮炎

    ·皮癣

    ·吸奶器使用不当


    此外，如果您在最初的几个月后出现奶量减少的情况，乳汁流动缓慢可能会导致婴儿含乳不良。这时的乳头疼痛可能会被误诊为鹅口疮。

    02
    症状和诊断

    医护人员通常根据症状就可诊断鹅口疮，很少需要进行诊断性检查。酵母培养试验通常不可靠。如果出现至少两种症状，则鹅口疮的可能性很大。


    如果妈妈的乳头受损和/或最近服用过抗生素，则患鹅口疮的可能性增加。


    首先出现的症状通常是乳头疼痛，有时也涉及到乳房疼痛。疼痛可能发生在喂奶过程中，并在两次喂奶之间持续存在。泵奶时通常也很痛。疼痛性质一般为烧灼痛或刺痛或扎痛。


    乳头和/或乳晕的症状可能包括:

    · 发痒、起皮屑 

    · 皮肤发亮

    · 皮肤发红，有炎症，有时伴有小水泡

    · 白斑(罕见)


    婴儿也可能有鹅口疮症状，例如:

    ✦舌头、牙龈和颊粘膜上有白色斑点。擦拭后可呈红色，甚至可能出血。(注意：婴儿口腔里经常会有白色的奶渣，但奶渣仅出现在舌头上。)

    ✦尿布疹则呈现红色或带有红斑，且常规治疗无效。

    ✦喂养时婴儿表现烦躁、胀气或不适。这可能会导致婴儿频繁含乳又不断松开乳房。


    其他可能的症状:

    ✦乳房深部的疼痛

    ✦当前或近期患阴道酵母菌感染


    03
    治疗


    ①药物

    医护人员一般会开具局部抗真菌药物(软膏或乳膏) ，如咪康唑、酮康唑或克霉唑，用于乳头外用。


    有些则会开具一种含有抗真菌药物（咪康唑粉）、抗菌药和皮质类固醇的乳膏配方。该处方有时被称为“杰克·纽曼医生通用乳头膏”或“APNO霜”。


    如果局部治疗无效，则可能会开具氟康唑等全身性处方或口服抗真菌药物。


    遵照处方用药很重要。即使症状在治疗周期结束之前消失，也要按照所需要的周期（通常为两周或更长时间）完成治疗。


    更重要的是，即使婴儿没有任何症状，在您治疗自己的同时也要治疗婴儿。治疗通常包括咪康唑、克霉唑、氟康唑或制霉菌素的口服滴剂或口服凝胶。


    值得注意的是，制霉菌素的效果明显不如其他抗真菌药物。制霉菌素仅有三分之一的鹅口疮治愈率。


    如果婴儿有与鹅口疮相关的尿布疹，医护人员可能会开一种臀部抗真菌软膏或乳膏。


    ②替代疗法

    自然疗法对有些妈妈可能有效，可以咨询自然疗法医生(ND)寻求指导。


    一汤匙醋与一杯水混合的溶液可能会有效，尤其是作为辅助方案与其他治疗同时进行时。每次喂奶后，用干净的布或棉球涂抹在乳头和乳晕 (乳头周围的深色区域)上，并让乳头自然风干。


    可以口服益生菌补充剂，有助于抑制消化道中的念珠菌。为了取得最佳效果，应在症状消失后继续服用益生菌两周。有些人甚至发现吃含有有益菌的天然酸奶很有帮助。


    ③家庭护理措施

    任何潮湿或接触婴儿唾液及母乳的物品都可能含有酵母菌。为了预防酵母菌感染，以下方法可能会有所帮助:

    ✦经常洗手，每天更换手巾或用纸巾擦干双手。

    ✦每天将所有玩具、安抚奶嘴、奶瓶奶嘴、奶泵套件零件、乳头保护罩以及任何接触到您乳房或婴儿口腔的物品煮沸20分钟。即使每天都煮沸，安抚奶嘴、奶瓶奶嘴和磨牙玩具也应每周更换一次。

    ✦胸垫、胸罩、布尿布和毛巾在每次使用后，用洗涤剂在热水中清洗。在水中加入一杯漂白剂或醋也能有效杀灭酵母菌。物品可在烘干机中烘干或在阳光下晒干。

    ✦酵母菌感染可能以多种不同形式出现，例如：阴道酵母菌、股癣、手指/脚趾指甲酵母菌感染和尿布疹。宠物也可能感染酵母菌。治疗家庭中任何形式的酵母菌感染可以降低再次发生鹅口疮的几率。

    ✦有些人发现饮食改变（如减少糖分摄入），有助于减少酵母菌生长。自然疗法医生(ND)或注册营养师可提供指导。

    ✦酵母菌感染期间挤出来的的乳汁无需丢弃。







    THRUSH

    UPDATED MARCH 2022

    Thrush (candidiasis or yeast) is a fungal infection caused by an overgrowth of the Candida organism. Candida normally inhabits the mouth, gastrointestinal tract and vagina. It can grow in almost any part of the body. Candida likes warm, dark, moist areas such as the breasts, nipples and baby’s bottom. Pregnancy, illness, antibiotic use and other factors can lead to an overgrowth of Candida yeast. When this happens it is often called“thrush”.

    The symptoms of thrush are annoying and often painful. However, they do not cause severe illness. Breastfeeding can continue while treating the infection. Understanding the causes of thrush can help you to decrease the growth of Candida yeast in your body. Consult a healthcare provider if you think you might have thrush.

    01

    Other Causes of Nipple/Breast Pain

    It is valuable to consider other causes of nipple pain before concluding it is thrush. If pain is present in the absence of thrush symptoms then other causes of the pain should be considered first. The most common cause of nipple pain is positioning and latch problems. Other causes may be:

    ◆tongue-tie and lip-tie

    ◆nipple injury

    ◆ bacterial infection

    ◆Raynaud’s phenomenon or vasospasm

    ◆plugged ducts or mastitis

    ◆skin issues: contact dermatitis, eczema, psoriasis

    ◆allergies

    ◆herpes

    ◆poison ivy

    ◆ringworm

    ◆improper use of a breast pump


    Also, if you experience a decrease in milk supply after the first couple of months, the slower milk flow can cause your baby to latch poorly. Your sore nipples may be misdiagnosed as thrush.

    02

    Symptoms and Diagnosis

    Healthcare providers usually diagnose thrush based on the symptoms present. Rarely are diagnostic tests done. Yeast culture tests are often unreliable. Thrush is more likely if there are at least two symptoms present.


    There is an increased likelihood for thrush if the mother has damage to the nipples and/or has recently taken antibiotics.


    The first symptom is usually pain in the nipples and sometimes also in the breasts. The pain may begin during a feeding and continue between feedings. Pumping is usually painful as well.


    BABY MAY ALSO HAVE SYMPTOMS OF THRUSH SUCH AS:

    ✦White patches in the mouth on the tongue, gums and cheeks. They  will appear red or may even bleed when scraped. (Note that babies  often have milk residue that is found only on the tongue.)

    ✦Diaper rash that is red or contains red spots and does not respond to usual treatments.

    ✦Fussiness or gassiness or discomfort while nursing. This may cause the baby to pop on and off   the breast frequently.


    PAIN IS OFTEN DESCRIBED AS:

    ✦lBurning

    ✦lStabbing

    ✦lShooting


    OTHER POSSIBLE SYMPTOMS:

    ✦Pain deep in the breast

    ✦A current or recent vaginal yeast infection


    SYMPTOMS ON THE NIPPLES AND/OR AREOLAE CAN INCLUDE:

    ✦Itchy, flaky skin

    ✦Shiny skin

    ✦Red, inflamed-looking skin sometimes with small  blisters

    ✦White spots (rarely)

    03

    TREATMENT

    ①Medications

    Healthcare providers often begin by prescribing a topical antifungal (ointment or cream) such as miconazole, ketoconazole or clotrimazole to be used on the nipples. Many will begin by prescribing a cream formulation containing an antifungal called miconazole powder, in addition to an antibacterial and a corticosteroid. This prescription is sometimes called “Dr. Jack Newman’s All-Purpose Nipple Ointment” or “APNO cream”. If topical treatment has been tried and is unsuccessful, a systemic or oral antifungal like fluconazole, may be prescribed. It is important to follow the prescription instructions. Treatment is usually needed for two weeks or longer, even if the symptoms disappear sooner.


    It is important to treat your baby at the same time as yourself even if your baby has no symptoms. Treatment usually consists of oral drops or an oral gel of miconazole, clotrimazole, fluconazole or nystatin. It should be noted that nystatin is significantly less effective than other antifungals. Nystatin cures thrush in only about one third of cases. If your baby has a diaper rash associated with thrush, the healthcare provider may prescribe an antifungal ointment or cream for your baby’s bum.


    ②Alternative Treatments

    Natural remedies may be effective treatments for some mothers. Parents can consult with a naturopathic doctor (ND) for guidance.


    A solution of one tablespoon of vinegar mixed with one cup of water may be effective particularly when used with other treatments. Apply to the nipples and areola (darkened area around nipple) with a clean cloth or cotton ball after each feeding. Allow the nipples to air dry.

    Oral supplements of probiotics contain good bacteria. They can help to limit the Candida in the digestive tract. For best results, probiotics should be taken for two weeks after the end of your symptoms. Some people even find eating natural yogurt containing good bacteria to be helpful.


    ③Home Care Measures

    Any items that are damp or come into contact with your baby’s saliva or your breast milk may contain yeast. To prevent or treat another yeast infection, the following can be helpful:

    ✦Wash your hands and baby’s hands frequently. Replace the hand towel daily or use paper towels to dry your hands.

    ✦Boil for 20 minutes daily all toys, pacifiers, bottle nipples, pump kit parts, nipple shields and anything else that comes in contact with your breast or the baby’s mouth. Even with daily boiling, pacifiers, bottle nipple/teats and teethers should be replaced weekly.

    ✦Wash breast pads, bras, cloth diapers, and towels in hot water with detergent after every use. One cup of bleach or vinegar added in the rinse water can also be effective in killing yeast.

    ✦Items should be dried in a hot dryer or line dried in the sun.

    ✦Yeast infections appear in many different forms, for example: vaginal yeast, jock itch, finger/toe nail yeast infections, and diaper rash. Even pets can have a yeast infection. Treating any and all yeast infections in the family can reduce chances of thrush happening again.

    ✦Some people find dietary changes such as reducing sugar intake helpful to decrease yeast growth. A naturopathic doctor (ND) or registered dietician can provide guidance.

    ✦Milk expressed during an overgrowth of yeast does not need to be discarded.


    References 

    ❶ La Leche League Canada, (2022). Thrush Info Sheet. http://www.lllc.ca/sites/default/files/Thrush+Info+Sheet-6.pdf

    ❷ Berens, P., Eglash, A., Malloy, M., et al. (2016). ABM Clinical Protocol #26: Persistent pain with breastfeeding. Breastfeeding Medicine, 11(2).

    ❸ Hale, Thomas (2021). Medications and Mothers’ Milk (19th ed.). New York, NY: Springer Publishing Company.

    ❹Morbacher, Nancy (2020). Breastfeeding Answers (2nd ed.). A rlington Heights, IL: Nancy Morbacher Solutions, I nc., 726-31.

    ❺Newman J. (2021) Candida Protocol. International Breastfeeding Centre. https://ibconline.ca/information-sheets/candida-protocol/

    ❻ Wambach, K. (2021). Breast- related problems. In K. Wambach & B. Spencer (Eds.), Breastfeeding and Human Lactation (6th ed., pp. 281-312). Burlington, MA: Jones and Bartlett Learning.



    END

    翻译：LLL Canada加拿大母乳会

    审稿：Julia, Lynn, Marien

    编辑：幸宝、沐凡





    设“星标”
    即时收到最新资讯


     

      中国移动手机和宽带用户可访问：

    muruhui.com 或muruhui.cn  

    获取更多资讯

    欢迎转发，点赞，在看，让更多母乳妈妈受益！

    本篇文章来源于微信公众号: 国际母乳会LLL