Factors Related to Milk Supply Perception in Women Who Underwent Cesarean Section

計畫性剖腹產婦女乳汁分泌感知之相關因素

10.1097/JNR.0b013e31821988e9

林素瑛(Su-Ying Lin)；李絳桃(Jian-Tao Lee)；楊誠嘉(Cherng-Chia Yang)；高美玲(Meei-Ling Gau)

母乳哺餵 ； 計畫剖腹生產 ； 乳汁分泌感知 ； breastfeeding ； planned cesarean section ； perceived milk supply

The Journal of Nursing Research

19卷2期（2011 / 06 / 01）

94 - 101

英文

背景　主觀性乳汁分泌不足常見於產後婦女，也是造成早期斷奶的主要原因。研究指出，剖腹產婦女感受到乳汁分泌不足的發生率高於陰道產之婦女。 目的　探討計畫剖腹生產產婦乳汁分泌感知之相關因素。 方法　採描述相關研究，以方便取樣方式於台灣北部某區域教學醫院，於產後第三天，針對141名計畫剖腹生產產婦進行收案。研究工具包括人口學屬性、生產措施調查表、視覺疼痛評估量表以及H&H乳汁分泌量表，以檢測影響計畫剖腹產產婦乳汁分泌感知的相關因素。 結果　以複迴歸分析發現，胎次、麻醉方式、首次哺乳的時間、配方奶的使用是計畫剖腹產婦女乳汁分泌感知的重要預測因子，共可解釋23.1%的變異量。採用硬膜外止痛、第一次哺乳時間延遲、哺乳頻率較少、添加配方奶之剖腹產婦女有較低的乳汁分泌感知分數。 結論／實務應用　醫護人員應該鼓勵剖腹產產婦儘早依嬰兒需求開始哺乳，減少配方奶的使用，及增加嬰兒吸吮乳房的次數；縮短手術後硬膜外止痛使用日數，改以非麻醉性口服止痛藥以促進產婦成功哺乳。

Background: Perceived insufficient milk supply is common among postpartum women and is a major reason for early weaning. Studies indicate a significantly higher incidence of insufficient milk supply in women who undergo cesarean section as compared with women who undergo vaginal delivery. Purpose: This study was designed to determine perceived milk supply in postpartum women who underwent a planned cesarean section, as well as related factors. Methods: Authors employed a descriptive correlational study design. Factors associated with milk supply perception in postpartum women (at 3 days postpartum) were collected from 141 postpartum women who planned to undergo cesarean section at a regional teaching hospital in northern Taiwan. A demographic data sheet, the Birth Practice Inventory, a visual pain analog scale, and the Hill and Humenick Lactation Scale were used to identify factors affecting the perceived milk supply of participants. Results: The study used multiple linear regression to identify significant predictors of milk supply perception. Four factors, including parity, type of anesthesia, time to initial breastfeeding, and use of formula, explained 23.1% of total variance among participants. Women who experienced epidural patient-controlled analgesia, those with delayed initial breastfeeding or lower breastfeeding frequency, and those who used formula supplementation earned relatively lower perceived milk supply scores. Conclusions/Implications for Practice: Study results indicate that medical staff should encourage postpartum women to commence breastfeeding, based on infant need, as early as possible and reduce formula use to increase breastfeeding frequency. Shifting to nonnarcotic analgesic medications from epidural patient-controlled analgesia as early as possible is also recommended to increase breastfeeding success.

1. Chiu, J. Y.,Gau, M. L.,Kuo, S. Y.,Chang, Y. H.,Kuo, S. C.,Tu, H. C.(2010).Effects of Gua-Sha therapy on breast engorgement: A randomized controlled trial.The Journal of Nursing Research,18(1),1-10.
   連結：
2. Al-Takroni, A.M. B.,Parvathi, C. K.,Mendis, K. B. L.,Hassan, S.,Qunaibi, A. M.(1999).Early oral intake after caesarean section performed under general anaesthesia.Journal of Obstetrics and Gynaecology,19(1),34-37.
3. Baxter, J.(2006).Women's experience of infant feeding following birth by caesarean section.British Journal of Midwifery,14(5),290-295.
4. Chapman, D. J.,Perez-Escamilla, R.(1999).Identification of risk factors for delayed onset of lactation.Journal of the American Dietetic Association,99(4),450-454.
5. Chapman, D. J.,Perez-Escamilla, R.(1999).Does delayed perception of the onset of lactation shorten breastfeeding duration?.Journal of Human Lactation,15(2),107-111.
6. Chapman, D. J.,Perez-Escamilla, R.(2000).Maternal perception of the onset of lactation is a valid, public health indicator of lactogenesis Stage II.The Journal of Nutrition,130(12),2972-2980.
7. DiGirolamo, A. M.,Grummer-Strawn, L. M.,Fein, S.(2001).Maternity care practices: Implications for breastfeeding.Birth,28(2),94-100.
8. Gatti, L.(2008).Maternal perceptions of insufficient milk supply in breastfeeding.Journal of Nursing Scholarship,40(4),355-363.
9. Gift, A.(1989).Visual analogue scales: Measurement of subjective phenomena.Nursing Research,38(5),286s-288s.
10. Grajeda, R.,Perez-Escamilla, R.(2002).Stress during labor and delivery is associated with delayed onset of lactation among urban Guatemalan women.The Journal of Nutrition,132(10),3055-3060.
11. Hildebrandt, H.M.(1999).Maternal perception of lactogenesis time:A clinical report.Journal of Human Lactation,15(4),317-323.
12. Hill, P. D.,Humenick, S. S.(1996).Development of the H&H Lactation Scale.Nursing Research,45(3),136-140.
13. Hirose, M.,Hara, Y.,Hosokawa, T.,Tanaka, Y.(1996).The effect of postoperative analgesia with continuous epidural bupivacaine after cesarean section on the amount of breast feeding and infant weight gain.Anesthesia and Analgesia,82(6),1166-1169.
14. Howie, W. O.,McMullen, P. C.(2006).Breastfeeding problems following anesthetic administration.The Journal of Perinatal Education,15(3),50-57.
15. Huang, Y. Y.(2006)。Taiwan, ROC.，Chang Gung University Graduate Institute of Nursing Sciences。
16. Huang, Y. Y.、Huang, C. M.(2006)。Nipple confusion and breastfeeding:A literature review。The Journal of Nursing，53(2)，73-79。
17. Huang, Y. Y.、Lee, J. T.、Gau, M. L.、Huang, C. M.(2007)。Factors related to sucking ineffectiveness and negative behavior in newborns。Journal of Evidence-Based Nursing，3(1)，35-44。
18. Karlstrom, A.,Engstrom-Olofsson, R.,Norbergh, K. G.,Sjoling,M.,Hildingsson, I.(2007).Postoperative pain after cesarean birth affects breastfeeding and infant care.Journal of Obstetric, Gynecologic, & Neonatal Nursing,36(5),430-440.
19. Kroeger, M.,Smith, L. J.(2004).Impact of birthing practices on breastfeeding. Protecting the mother and baby continuum.Sudbury, MA:Jones and Bartlett.
20. Lau, C.(2001).Effect of stress on lactation.Pediatric Clinics of North American,48(1),221-234.
21. Lawrence, R. A.,Lawrence, R. M.(1999).Breastfeeding:A guide for the medical profession (5th ed.).New York:Mosby.
22. Lin, C. H.,Kao, S. C.,Lin, K. C.,Chang, T. Y.(2008).Evaluation effects of a prenatal breastfeeding education programme on women with caesarean delivery in Taiwan.Journal of Clinical Nursing,17(21),2838-2845.
23. Mohrbacher,N.,Stock, I.(2003).The breastfeeding answer book (3rd ed.).Schaumburg, IL:La Leche League International.
24. Nolan, A.,Lawrence, C.(2009).A pilot study of a nursing intervention protocol to minimize maternal-infant separation after Cesarean birth.Journal of Obstetric, Gynecologic, &Neonatal Nursing,38(4),430-442.
25. Peaker,M.,Wilde, C. J.(1996).Feedback control of milk secretion from milk.Journal of Mammary Gland Biology Neoplasia,1(3),307-315.
26. Rabbo, A. S.(1995).Early oral hydration: A novel regimen for management after elective cesarean section.Asia-Oceania Journal of Obstetrics and Gynaecology,21(6),563-567.
27. Ransjo-Arvidson, A. B.,Matthiesen, A. S.,Lilja, G.,Nissen, E.,Widstrom, A.,Uvnas-Moberg, K.(2001).Maternal analgesia during labor disturbs newborn behavior: Effects on breastfeeding temperature, and crying.Birth,28(1),5-12.
28. Rowe-Murray, H. J.,Fisher, J. R. W.(2002).Baby friendly hospital practices: Cesarean section is a persistent barrier to early initiation of breastfeeding.Birth,29(2),124-131.
29. Sacco, L. M.,Caulfield, L. E.,Gittelsohn, J.,Martinez, H.(2006).The conceptualization of perceived insufficient milk among Mexican mothers.Journal of Human Lactation,22(3),277-286.
30. Scott, J. A.,Binns, C. W.,Oddy, W. H.(2007).Predictors of delayed onset of lactation.Maternal and Child Nutrition,3(3),186-193.
31. Segura-Millan, S.,Dewey, K. G.,Perez-Escamilla, R.(1994).Factors associated with perceived insufficient milk in a lowincome urban population in Mexico.The Journal of Nutrition,124(2),202-212.
32. Torvaldsen, S.,Roberts, C. L.,Simpson, J. M.,Thompson, J. F.,Ellwood, D. A.(2006).Intrapartum epidural analgesia and breastfeeding: A prospective cohort study.International Breastfeeding Journal,1(24),1-7.
33. Waltz, C. F.,Strickland, O. L.,Lenz, E. R.(1991).Measurement in nursing research.Philadelphia:F. A. Davis.
34. Yamauchi, Y.,Yamanouchi, I.(1990).Breast-feeding frequency during the first 24 hours after birth in full-term neonates.Pediatrics,86(2),171-175.