[[alternative]]Efficacy of Antenatal Breast Expression Milk at Term in Improving on Milk Production and Exclusive Breastfeeding Rate

[[abstract]]研究背景母乳是最適合嬰兒的食物，大多數的婦女於產後想要採完全母乳哺育，但往往因產後疲憊、擔心奶水不足或是母嬰分離等問題而無法達成。產前擠乳提供了另一種選擇，將擠出的初乳儲存起來，在產後初期奶水尚未完全建立時提供嬰兒最初的需要。研究目的探討產前擠奶對產後住院期間首次泌乳時間、完全母乳哺育率、自覺乳汁分泌量及母乳哺餵自我信心程度。研究方法本研究採類實驗性研究，以連續方便取樣於民國104年12月至105年7月在北部某區域醫院產前門診收案，依照個案意願分派至實驗組（n= 52）及對照組（n=58）。實驗組於產前37週始每天擠乳兩次，對照組則不進行產前擠乳。採結構式問卷收集資料，研究工具包含基本人口學及產科學資料、自覺泌乳分泌量表、母乳哺育自我效能簡易量表及語言疼痛評估量表。陰道生產追蹤產後24小時、48小時、72小時，剖腹生產則追蹤至產後第五天。以SPSS 18.0統計軟體進行資料整理及分析，統計包含描述性統計、獨立樣本t檢定、卡方檢定、皮爾森積差相關分析、二元邏輯斯迴歸分析、線性複迴歸分析及廣義估計方程式等推論性統計。研究結果本研究共計110位個案參與，以首次泌乳時間來看，初產婦比經產婦延遲泌乳24.13小時（Z=-3.22, p< .01），剖腹生產比陰道生產延遲泌乳36.98小時（Z=-3.22, p< .01），引產比未引產延遲泌乳19.44小時（Z=-2.72, p< .01），添加配方奶比未添加配方奶延遲泌乳18.56小時（Z=- 3.06, p< .01），嬰兒每日吸吮次數小於8次比大於等於8次延遲泌乳11.88小時（Z= -1.97, p< .05）。首次泌乳時間也與第二產程時間（p< .05）、首次哺乳時間（p< .01）、產後立即肌膚接觸（p< .05）有顯著相關。陰道生產（p< .01），施行親子同室者（p< .01），未添加配方奶有較高的完全母乳哺育率（p< .01）。介入措施在首次泌乳時間、完全母乳哺育率及自覺泌乳分泌量並無顯著差異。但母乳哺育自我效能，進行組別與時間之主要效果，分數隨著產後天數慢慢增加，分數的變化有顯著差異（p< .01）。組別與時間的交叉效果來看，兩組母乳哺育自我效能分數於產後第四天及第五天有顯著差異（p< .05），產前擠乳對產婦在哺餵母乳自信心上有幫助。結論及應用產次、生產方式、第二產程時間、首次哺乳時間、產後立即肌膚接觸、親子同室、添加配方奶及嬰兒每日吸吮次數是影響首次泌乳時間、自覺乳汁不足及完全母乳哺育率重要相關因素。產前擠乳對首次泌乳時間、完全母乳哺育率、自覺泌乳分泌量無顯著差異，對母乳哺育自我信心程度有效果。以本研究結果看來，雖然醫療為主流的生產環境之下，產前擠乳要影響首次泌乳時間及完全母乳哺育效果並不明顯。但提前練習手擠乳的技巧，若產前有擠出初乳則可提供新生兒出生前三天的需求，產後儘早開始刺激及維持泌乳，因應醫療過度介入生產時而導致泌乳及哺乳問題時，產前擠乳仍不失為一種選擇。期望產科照護者了解產前擠乳的相關知識及技能，產前實際協助及教導正確手擠乳的技巧，幫助婦女建立哺餵母乳的自信心，以延長哺乳時間及提昇完全母乳哺育率。[[abstract]]BackgroundBreast milk is the most suitable food for babies. Most women want to adopt the postnatal exclusive breastfeeding. However, they cannot realize their wish due to the difficulties such as postnatal tiredness, insufficiency of breast milk or separation of the baby and mother. Fortunately enough, antenatal breast expression provides another option. The expressed colostrum can be stored for baby’s need when the breast milk is not fully produced on the postnatal initial stage.Purpose The purpose of the study is to explore how antenatal breast expression affects the onset of lactation, the exclusive breastfeeding rate, perception of milk production, and the self-confidence of breastfeeding.MethodsThis study adopts the quasi-experimental method using the consecutive sampling to recruit participants at the antenatal outpatient unit at a regional hospital in northern Taiwan from December 2015 to July 2016. According to their preference, the participants were assigned to the experimental group (n=52) and the control group (n=58). The members of the experimental group were milked twice a day from the 37th week before birth, while the control group did not adopt antenatal breast expression. The structural questionnaire was used to collect data, including the demographic and obstetrical information, Hill & Humenick Lactation Scale, Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), and Verbal Rating Scale (VRS). For those who adopted vaginal birth, the tracing lasted until 24 hours, 48 hours, or 72 hours after birth. For those who adopted Caesarean section, the tracing lasted until the fifth day after birth. Data were analyzed using the SPSS 18.0 statistic software. Values were expressed as mean, standard deviation, frequency, percentage, independent sample t test, Chi-square test, Pearson Product-moment correlation analysis, binary logistic regression analysis, linear multiple regression analysis, and generalized estimating equations.ResultsThis study included 110 participants. In terms of the onset of lactation, primiparous delayed their lactation 24.13 hours (Z=-3.22, p< .01) compared to multiparous. Those who adopted Caesarean section delayed lactation 36.98 hours (Z=-3.22, p< .01) compared to those who adopted vaginal birth. And those who adopted induced labor delayed lactation 19.44 hours (Z=-2.72, p< .01) compared to those who did not adopt induced labor. Those who used formula delayed lactation 18.56 hours (Z=- 3.06, p< .01) compared to those who did not use formula. Those whose baby sucked less than eight times per day delayed lactation 11.88 hours (Z= -1.97, p< .05) compared to those who sucked more than eight times per day. Factors significantly related to the onset of lactation included duration of second stage of labor (p< .05), initial breastfeeding (p< .01), and immediate skin to skin contact after birth (p< .05). In addition, the exclusive breastfeeding rate was higher for those who adopted vaginal birth (p< .01), rooming-in (p< .01), and did not use formula (p< .01). The exclusive breastfeeding rate, perception of milk production, and intervention made no significant difference in the onset of lactation. However, the intervention group has a higher self-efficacy of breastfeeding score than the comparisons. And, the self-efficacy of breastfeeding scores have gradually increased with the days after birth (p< .01). In terms of the interaction effects of the intervention and time, the score of the self-efficacy of the breastfeeding of the two groups makes a significant difference on the fourth and fifth days after birth (p< .05). Antenatal breast expression can facilitate with the puerpera’s confidence of breastfeeding. Conclusion and application Parity, birth mode, duration of the second stage of labor, initial breastfeeding time, immediate skin to skin contact after birth, rooming-in, formula feeding, and frequency of suckling per day are the important factors related to the onset of lactation, maternal milk supply perception, and exclusive breastfeeding rate. According to the study result, under the circumstances of the current birth practices, antenatal breast expression makes no significant influence on the onset of lactation, exclusive breastfeeding rate, and perception of milk supply. However, the intervention increases the maternal self-confidence of breastfeeding. The skill of hand expression needs to be practiced. If colostrum can be expressed in the antenatal period, it may supply the need of the newborn for the first three days. The women need to stimulate and maintain lactation soon after birth to cope with the problems of lactation and breastfeeding resulting from too much medical intervention. Accordingly, antenatal breast expression turns out to be a good option. We expect the maternity care providers to understand the related knowledge and skills of antenatal breast expression, and to practically help and teach the skills of antenatal hand expression. In this way, they can facilitate with the woman’s confidence in breastfeeding, increase the duration of breastfeeding and the exclusive breastfeeding rate