母乳不足的原因

母乳不足是過早斷奶最常見的原因之一。母乳不足的原因包括影響寶寶有效吸乳的醫療狀況,例如舌繫帶過短、齶裂、神經系統問題、營養吸收不良以及代謝問題。如果不是寶寶健康問題,則可能是媽媽自身因素導致母乳不足。

 

媽媽初期泌乳不足的發生率為百分之五,誘因是乳房異常、乳房或乳頭手術(可能出於醫療原因或美容)或其他問題導致的腺體組織不足。二期泌乳不足的問題更加常見,通常是因為哺餵過程不正確或使用補品導致母乳合成能力下降,最終導致母乳供應量不足。

 

 

母乳不足的跡象

寶寶可能會出現排便延遲、尿量少、黃疸病、分娩後體重減輕以及嗜睡症狀。在母乳餵養期間,寶寶吸乳時可能表現出嗜睡或沮喪或只是短時間的連續吸吮。

泌乳評估

 

第一步必須咨詢哺乳顧問或保健專業人員。為診斷母乳是否不足,媽媽需在保健專業人員的指導下測量器泌乳量,即 24 小時內測量哺餵前以及哺餵後寶寶體重(不得更換寶寶衣物或配件)。健康寶寶平均正常吸乳量為 750 - 800 ml/天(478-1356 ml/天屬正常範圍) - 請參閱母乳餵養「正常」範圍是多少?

 

管理

 

應在哺乳顧問或保健專業人員的配合下實施並監測管理計劃。提高乳汁供應量的關鍵是頻繁有效地排乳。由於大多數寶寶可吸出乳房中 67% 的可用乳汁,通過頻繁有效地排乳有助於更好地排空乳房,幫助媽媽更加快速地合成乳汁。

 

結合保健專業人員建議,為提高母乳供應量可實施的循證方案包括:

 

  • 輔助哺餵姿勢和寶寶銜乳
  • 母乳餵養期間,盡量有肌膚接觸,提高哺餵時的身心舒適度
  • 增加母乳餵養頻率,兩次哺餵間隔不要超過三個小時,每天哺餵 8-12 次
  • 每次哺餵之後暫時吸乳; 雙邊吸乳(同步吸乳)有助於提高排乳速率以及更好地排空乳房
  • 在吸乳期間按摩乳房
  • 吸乳期間穿戴合身的吸乳護罩: 不得擠壓乳房,否則將損傷乳頭。如果管道過緊,則有多種吸乳護罩尺寸可選
  • 吸乳時要使用放鬆技巧,例如音樂或深呼吸
  • 醫療人員可考慮使用催奶劑藥物,幫助刺激泌乳。 
研究摘要
Medications for increasing milk supply in mothers expressing breastmilk for their preterm hospitalised infants(英語)

Breastmilk remains the optimal form of enteral nutrition for term and preterm infants until up to six months postnatal age. Mothers of preterm infants who ...

Donovan TJ, Buchanan K (2012)

Impact of Measuring Milk Production by Test Weighing on Breastfeeding Confidence in Mothers of Term Infants(英語)

The duration of exclusive breastfeeding is affected by maternal confidence and perception of milk supply, but objective measurement of milk supply is rarely used. ...

Kent JC, Hepworth AR1, Langton DB2, Hartmann PE (2015)

參考文獻

American Academy of Pediatrics and The American College of Obstetricians and Gynecologists. Breastfeeding Handbook for Physicians 2006).

Donovan, T.J. & Buchanan, K. Medications for increasing milk supply in mothers expressing breastmilk for their preterm hospitalised infants. Cochrane. Database. Syst. Rev 3, CD005544 (2012).

Hill, P.D., Aldag, J.C., Chatterton RT. Initiation and frequency of pumping and milk production in mothers of non-nursing preterm infants. J Hum Lact. 2001;17(1):9-13

Hill, P.D., Aldag J.C., Chatterton RT, Zinaman M. Comparison of Milk Output Between Mothers of Preterm and Term Infants: The First 6 Weeks After Birth. J Hum Lact. 2005 February 1, 2005;21(1):22-30.

Kent, J.C. et al. Importance of vacuum for breastmilk expression. Breastfeed Med 3, 11-19 (2008)(英語)。

Kent, J.C. et al. Longitudinal changes in breastfeeding patterns from 1 to 6 months of lactation. Breastfeed Med 8, 401-407 (2013).

Kent, J.C., Hepworth, A.R., Langton, D.B. & Hartmann, P.E. Impact of Measuring Milk Production by Test Weighing on Breastfeeding Confidence in Mothers of Term Infants. Breastfeed Med (2015).

Morton, J., Hall, J.Y., Wong, R.J., Benitz, W.E. & Rhine, W.D. Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. J Perinatol 29, 757-764 (2009).

Parker, L.A., Sullivan, S., Krueger, C. & Mueller, M. Association of timing of initiation of breastmilk expression on milk volume and timing of lactogenesis stage II among mothers of very low-birth-weight infants. Breastfeed Med (2015).

Prime, D.K., Garbin, C.P., Hartmann, P.E. & Kent, J.C. Simultaneous breast expression in breastfeeding women is more efficacious than sequential breast expression. Breastfeed Med 7, 442-447 (2012)(英語)。