| Summary: | 碩士 === 國立臺北護理健康大學 === 護理助產研究所 === 105 === Background
Breast 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.
Methods
This 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.
Results
This 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.
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