改编自《母乳喂养的准备：孕妇手册 》
http://store.llli.org/public/profile/797
作者：特里莎·皮特曼
翻译:于莉宛 审核：Daisy，Missy
大多数妈妈们认为母乳喂养是她们“自己”要做的事情。妈妈们明白什么时间需要再次哺乳，她们会把宝宝抱到胸前，把乳头放进宝宝嘴里，她们清楚宝宝是否含乳良好，同时也会准确把握大概什么时间宝宝已经吃得差不多了而结束喂奶。
但事实上，你的宝宝对母乳喂养的了解比大部分人所知道的都多。像其他的哺乳动物宝宝一样，他天生就具备会吃母乳的本能与技巧。（如果你见过猫妈妈与刚出生的小猫，或是小牛犊与母牛，就会知道，它们很显然会本能地寻找食物。我们的宝宝们也是一样。）
妈妈们当然也天生就具备会喂母乳的能力，并且能够跟她们的宝宝配合得非常好。人类的宝宝不像其他哺乳动物的初生幼崽在体格上那样健壮有力（比如小牛犊在出生几小时后就可以走和跑－而人类的宝宝至少在出生后一年左右是不会走路的。这是很大的差异！），所以他们需要来自妈妈更多的帮助。母牛在给小牛喂奶时仍然只需要站着不动就可以，而人类的妈妈需要做的会比这多一些，但可能没有你想像的那么多。
抱着宝宝
如果有人递给你一个烦躁不安的宝宝，你会怎么做？大部分女人会不假思索地把宝宝竖着抱起靠在胸部或肩膀上，让宝宝的肚子紧贴着她们的胸部，一只手搂在宝宝的肩后，一只手在宝宝的屁股下。这种自然而然的安抚动作同样也是宝宝开始吃奶的最佳起点。
通常的情形是宝宝会首先在你胸前依偎一小会儿，然后他们才会竖起头部，或者向下滑一点。有时父母认为这是因为宝宝的颈部肌肉还不是十分强壮，或者认为这是宝宝的一种随机的动作，但研究者经过大量的观察证明这是宝宝的故意行为。这种行为好似宝宝调整自己找准方位的一种方式：“嗯，我挨着妈妈的身体啦，让我四处看看自己在哪——是的，她的头在这，那么里面有妈妈的奶的好东西应该还要往下一点，一边一个。”
而且，事实上，如果你的宝宝饿了的话，接下来他会朝一侧或另一侧移动，小脑袋朝着妈妈的乳房。有些宝宝在做这个动作时会很大力气——他们似乎是侧着把自己甩了出去。也有些宝宝会朝一侧扭动或摆动。
有些专家认为，当我们抱起正在哭闹的新生儿，用一种我们能想到的哺乳姿势抱着（把宝宝整个身体水平地横抱在我们肚子前，头部贴着乳房），这样做实际上是很容易让宝宝感觉混乱的。新生儿本能的期望被直立抱着，在这个得到安抚的位置，他随后会以自己的方式去找到妈妈的乳房。（当然，一些月龄稍大，吃奶更有经验的宝宝则不太在意这些，一旦他们掌握了母乳喂养，他们对马上被抱到吃奶的位置一点也不介意了。）
衔乳
近年来，宝宝如何在乳房含乳受到广泛关注。护士、哺乳顾问和一些人运用多种不同的技巧来帮助妈妈们把宝宝抱在合适的位置，贴着妈妈乳房。
如今，大部分母乳喂养专家都鼓励妈妈们以“半躺式哺乳法”来开始母乳喂养。这是宝宝充分展示技巧和能力的理想做法，为实现母乳喂养带来良好开端。在本书中有更多的关于半躺式哺乳法的详细内容，但最基本要做的是：
妈妈处于一个舒适放松的半躺式的位置。
把宝宝肚子朝下放在妈妈的胸前。
让宝宝自己找到妈妈的乳头开始含乳吃奶。根据宝宝的实际需要或多或少地给他以辅助。
当让宝宝在这种位置吃奶时，他向下移动到乳头，很自然地可以有良好、深入的含乳，乳头在宝宝嘴里。（而采用其他位置哺乳时，妈妈是直立坐着，宝宝要向上伸脖子去找到乳头，并且如此哺乳时宝宝更容易只含到妈妈的乳头而不是乳房。）
你不需要永远都用这种半躺式哺乳法，但在哺乳最开始的时期，它是理想的方式。它使你感到舒适和放松，宝宝可以很好地衔乳，你和宝宝一起让母乳喂养持续。
什么时候喂奶最合适
宝宝并不知道妈妈的乳房是怎样生产母乳的，但他非常清楚如何建立良好的奶量，如何调整奶量以满足自己的需求，如何在他的需求随着时间变化时改变母乳中的脂肪含量和其他营养成分。你要做的就是跟随宝宝的引导。
配方奶和母乳的一个显著差异就是，配方奶的成份一直都是相同的（当然，除非是配方奶生产商发现了一种更便宜的原料油脂并把它添加到配方奶中，这只是举例说明），而人类的乳汁成份随着每次哺乳而不同。比如，有时母乳里会多出某种特定的抗体或脂肪。母乳在傍晚或夜间时会产生一种可以帮助宝宝放松并有助于睡眠的成份。如果妈妈吃过大蒜或者有其他调料的食物，这些味道也会通过母乳传递给宝宝。我们不总是明白这些变化的目的，但显然大部分对于宝宝是非常重要的。
宝宝变换着吃奶模式来保证他所吃到的奶可以满足他的需求。假设宝宝正处于大脑的快速生长期，他需要母乳中更多脂肪来帮他发育脑细胞，频繁的短暂地吃奶会帮助他获得更高脂肪含量的母乳。或者比如，当天气很热的时候，你的宝宝体内需要更多的水份，他就会将两次吃奶的间隔时间拉长一点点，吃奶的时候也会很快地从一边换到另一边，这样的话他就可以获得一些低脂肪的母乳来解渴。
也许四周有病毒传播。你和你的宝宝都暴露在这个环境当中。当你的宝宝开始有一点不舒服时，他更频繁的吃奶，从你的母乳中尽可能多的获取抗体和免疫因子，以帮助减轻疾病对他的影响。
作为一位新手哺乳妈妈，可能会有很多次你想知道，“为什么我的宝宝今天吃奶这么频繁？”或者“哦，宝宝今天下午吃奶的频度明显比平时少，是什么原因？”这些问题通常都没有明显的答案。相信你的宝宝知道自己在做什么。他在调整母乳的成分及奶量以满足他不断变化的需求。而你所要做的就是及时识别出宝宝给的提示，他要吃时就喂奶。
现在你可以了解到为什么妈妈们会把这种时而发生的吃奶频率变化看成问题了，她们假设自己产奶不足，不够宝宝吃而给宝宝添加其他代乳品。没错，这时宝宝是能够吃饱了，但乳房没有得到需要产更多奶的信号，充盈的时间便会变慢，结果是降低产奶量。当宝宝再次回来吃奶的时候就会因为吸不到足够的奶而产生挫败感，因为其实宝宝是想通过频繁吃奶刺激乳房提高产奶量的，而不是降低产量。宝宝试图更加频繁地吃奶。妈妈就会更加确信一定是自己的奶量产生了问题（一定是奶量不够宝宝没吃饱，否则为什么她的宝宝会这么频繁地一个劲儿地想吃奶？），然后再继续增多给宝宝代乳制品的添加量。妈妈的产奶量下降的更多了。很快，妈妈的担心真的变成了事实，她真的没有足够的奶量来满足宝宝的需要了。如果她让宝宝展示自己提升奶量的能力，她本该奶量更多的。
宝宝并不是偷懒、固执、无能，也不是在拒绝你
有时候，当妈妈们在母乳喂养方面遇到了一些困难时，便会有护士、助产士、朋友、家人或者其他帮助和照顾她们母子的人对她们说，她们的宝宝太懒了，或是很固执，或是不愿意努力尝试。一些妈妈会感觉她们的宝宝在排斥她们，认为宝宝拒绝在乳房吃奶是因为不喜欢吃乳房，或者是不想去吸妈妈的奶，最糟糕的是，妈妈们有时还会误解为是宝宝不喜欢她们的妈妈！
所有这些都是不是真的！
如果你把乳房贴近宝宝而宝宝没有吃上奶，并不是因为他固执或是懒惰或是在生你的气，或是他有什么地方不对劲儿。他只是一个小宝宝。吃母乳是他天生的本性。母乳喂养对人类的生存是如此重要，因此这件事不可能被归类到只有“听话的勤快的”宝宝才会做。
“不吃母乳”的宝宝没法在母乳喂养。这不是宝宝不想吃，他是想吃母乳的。（或者他愿意吃奶如果宝宝能用成人的思维思考。他会想要母乳带给他的所有好处——与妈妈在一起的亲密感和舒适感，增加抗体和免疫力。但是他并不懂得这些。他只知道身体里的每个细胞都在告诉他去找妈妈的乳房吃奶。）那么，宝宝为什么做不到呢？有很多可能的原因：
产程中的药物使用可能会影响到宝宝寻找妈妈乳房的能力，影响到宝宝的含乳，以及影响到宝宝吮吸和吞咽的协调性。母乳喂养，这件从某些角度来看很简单的事情，需要宝宝具备一些复杂的能力。
宝宝有一些负面的经历，使得他想要保护自己。或许是在出生时宝宝在被清理呼吸道和口腔时巨大的吸力给他造成了创伤，于是他一直避免自己再度张开嘴。又或者是在宝宝刚刚出生的时候他被带到妈妈胸前吃奶的位置，有人把他的头部推向妈妈的乳房，而他的头部可能在产程中有过疼痛的经历，这让他误以为那种可怕的经历又要开始，所以他也会害怕，会产生抗拒。
宝宝意识到有些事的不同。可能宝宝出生后的第一、二次喂奶都是使用奶瓶来喂的。他是个聪明的小家伙：他很快明白了在他饥饿时一直在努力寻找的食物来源自那个硬硬的塑料东西里。现在你再给他提供一个有着小小的柔软乳头的软软的温暖的乳房，他感觉很好，但他却不会知道妈妈乳房同样可以提供美味的食物给他。
还会有一些生理原因会造成宝宝母乳喂养困难。一些宝宝在吃奶时不能很有效地活动舌头（舌系带短）；还有一些宝宝可能由于生产而疼痛或僵硬。这些宝宝需要更多的帮助和耐心来解决这些问题，从而使他们能够成功地母乳喂养。你的宝宝，他从一出生就认识并爱妈妈。当你跟他说话时，即使周围充斥着多种繁杂的声音，他会朝你声音的方向转头。在乳垫上挤一点点你的母乳，他马上会把他的小脑袋转向有你乳汁的方向，而不会去找有其他妈妈乳汁的乳垫。是的，他想要到妈妈这吃奶。帮助你进行母乳喂养的人的最重要的工作就是让你和宝宝的母乳喂养成为可能，而不是批评宝宝或者给宝宝贴标签。宝宝一直是在尽力做到最好，你也是一样。
我第一次在国际母乳会的聚会上听到这样一句话“相信你的宝宝，相信你自己”。这句话当时给了我莫大的鼓励，并且直到现在它仍然是一句好建议。是的，在整个母乳喂养过程中会有时候你需要更多的帮助和支持，但你和你的宝宝对母乳喂养都已经所知甚多。
特里莎•皮特曼成为国际母乳会哺乳辅导近34年，撰写过许多关于母乳喂养及其他育儿话题的书籍和杂志文章。她是《母乳喂养的女性艺术》一书第八版的合著者，经常在各种会议上发言。她是四个成年子女（都是母乳喂养长大的）的妈妈，同时又是6个母乳喂养孩子的祖母。特里莎将她所出版本书的部分收益作为款项捐赠给了加拿大国际母乳会。
What Your Baby Knows About Breastfeeding
Most mothers imagine breastfeeding is something they do. They figure out when it’s time to feed again, they bring the baby to the breast, they put the nipple in baby’s mouth, they make sure the latch is good, and unlatch the baby when the feeding is done.
The truth is, your baby knows a lot more than most people think about breastfeeding. He’s born with the instincts and skills to make breastfeeding work, just like other baby mammals are. (If you’ve ever seen a cat with newborn kittens or a baby calf with its mother, you’ll know that they are clearly hardwired to find food. Our babies are too.)
Of course, mothers also have built-in skills for breastfeeding, and those mesh nicely with the baby’s. Human babies aren’t as physically strong and capable as some others (that baby calf can walk and run within hours of birth—your baby won’t be walking for year or so. That’s a big difference!), so they need more help from their mothers. Mama cow just has to stand still while her baby latches on; you may need to do a bit more than that! But maybe not as much as you think.
Holding Your Baby
If someone hands you a fussy baby, what do you do? Most women, without even thinking about it, will hold the baby vertically against their chests or shoulders, with baby’s tummy against their chest, one hand behind baby’s shoulders and the other behind his bottom. This natural position for soothing is also the perfect spot for the baby to begin feeding.
What typically happens is that the baby will first snuggle into your chest a little, and then will lift up his head, or even throw his head back. Sometimes parents think this is because the baby’s neck muscles aren’t very strong, or imagine it’s just a random movement, but researchers who have observed many babies tell us that it’s deliberate. It seems to be part of the way the baby orients himself: “Hmm, I am in contact with my mother’s body, let’s look around and see where I am—yup, there is her head, so those nice things with the milk in them should be a little lower, one on either side.”
And, in fact, if your baby is hungry, what he’ll do next is move to one side or the other, heading towards the breast. Some babies do this very vigorously—they practically throw themselves sideways. Others squirm or wiggle to one side.
Some experts feel that when we pick up a crying newborn and hold him in what we think of as a breastfeeding position (horizontally across our tummies, head toward the breast) that we are actually confusing the baby. His instinctive expectations are to be held vertically, in that soothing position, so that he can find his own way to the breast. (Of course, an older, more experienced baby is less concerned—once they’ve mastered breastfeeding, they don’t mind at all being moved into breastfeeding position right away.)
Latching On
In recent years, a lot of attention has been paid to how babies latch on to the breast. Nurses, lactation consultants, and others have used a variety of techniques to help mothers get their babies properly positioned and attached to the breast.
Today, most breastfeeding experts encourage mothers to start with what some call “laid-back breastfeeding.” It’s ideal for letting the baby show off his skills and abilities, and for getting breastfeeding off to a good start. There’s more detailed information about this in the book, but basically here’s what you do:
• Get in a comfortable, semi-reclining position.
• Put the baby, tummy-down, on your chest.
• Let the baby find the breast and latch on. Help a little or a lot, as needed.
When the baby latches on in this position, he is coming down onto the nipple from above, and will naturally get a good, deep latch, with the nipple well back in his mouth. (In other positions, with the mother sitting upright, the baby is reaching up to the nipple, and it’s easier to just latch on to the nipple, not the breast.)
You don’t have to use this position forever, but during the early days, it’s ideal. It’s comfortable and restful for you, your baby will latch on well, and you’re working together to get breastfeeding going.
When to Feed
Your baby doesn’t know the mechanics of milk production and how the breast functions, but he knows exactly how to establish a good milk supply, how to adjust the milk supply to meet his needs, and how to change the fat content and other components of the milk as his needs change over time. All you have to do is follow his lead.
One of the significant differences between formula and human milk is that formula is always the same (unless, of course, the manufacturer finds a cheaper type of oil to add to it, for example), while human milk changes at every feeding. Sometimes it has more of a certain type of antibody, for example, or more fat. Milk produced in the evening or night has components that help to relax the baby and encourage sleep. If the mother has eaten garlic or foods with other flavors, those flavors come through in the milk. We don’t always understand the purpose of all these changes, but many of them are clearly important for the baby.
The baby varies his feeding patterns to make sure the milk he gets is meeting his needs. Let’s say he’s going through a period of rapid brain growth, when he needs more of the fats in the milk to build brain cells. Frequent, short feedings will bring him more of the high-fat milk. Or let’s say it’s a hot day and your baby needs more liquids. He may go a bit longer between feedings, and then want to switch quickly from one breast to the other, so he gets more of the lower fat milk to quench his thirst.
Maybe there is a virus going around. You and your baby have both been exposed to it. As your baby starts to feel a bit ill, he nurses more often to maximize the antibodies and immune factors he will get from your milk to reduce the impact of the illness.
As a new nursing mother, there may be many times that you wonder, “Why is my baby nursing so often today?” or “Hmm, what’s causing him to nurse less often this afternoon than usual?” Often there is no obvious answer. Trust that your baby knows what he’s doing. He’s adjusting the components of your milk and your milk production to meet his everchanging needs. All you have to do is recognize his cues and feed him when he asks.
You can see why it’s a problem when mothers react to these frequency days—as sometimes happens—by assuming they are no longer making enough milk for their baby and giving him a supplement instead. Now he’ll be full, true, but instead of getting signals to make MORE milk, the breasts will fill up more slowly and respond by making LESS milk. The baby gets more frustrated when he goes back to the breast because he was trying to increase milk supply, not decrease it. He tries to nurse even more often. The mother is more convinced than ever that something is wrong with her milk supply (why else would her baby be nursing all the time?), and increases the supplement. Her milk production drops even more. And soon her concern becomes reality, and she doesn’t have enough milk to satisfy her baby. She would have, though, if she’d let her baby demonstrate his skill at increasing milk production.
Your Baby Is Not Lazy, Stubborn,Incompetent, or Rejecting You
Sometimes mothers who are having some difficulties breastfeeding are told—by nurses, midwives, friends, family, and others who are helping or supporting them—that their babies are lazy, or stubborn, or not trying. Sometimes mothers feel that their babies are rejecting them, that they refuse to take the breast because they don’t like it, or don’t want to breastfeed, or, worst of all, that they don’t like their mothers.
NONE OF THESE THINGS ARE TRUE!If you offer your baby the breast and he doesn’t latch on, it’s not because he’s stubborn or lazy or mad at you. Or because there’s something wrong with him. He’s a baby. He is hardwired to breastfeed; breastfeeding is so important to the survival of the human species that it couldn’t possibly be relegated to something only “compliant and hard-working” babies do.
A baby who “won’t” breastfeed can’t breastfeed. It’s not that he doesn’t want to, he does. (Or he would if he was able to think that way. He’d want all the good things that breastfeeding offers—the closeness and comfort, the optimal development, the antibodies and immune support. But he doesn’t know about those things. All he knows is that every cell in his body tells him to find the breast and get milk.)So why can’t he? Well, there are many possible reasons:
• Medications given in labor may be affecting his ability to find the breast, latch on, and coordinate sucking and swallowing. Breastfeeding, while simple in some ways, requires some complex abilities on the baby’s part.
• He’s had some negative experiences and is trying to protect himself. Perhaps he had deep suctioning of his mouth and airways at birth and found that traumatizing—so he’s avoiding opening his mouth at all. Or perhaps the first few times he was held in a breastfeeding position, someone pushed his (possibly sore from the birth) head into the breast, and he’s afraid that will happen again.
• He’s learned something different. Maybe his first feeding or two was given via bottle. He’s a smart kid: he quickly figured out that food comes from those firm plastic things, and that’s what he’s looking for when he’s hungry. Now you offer him a soft, warm breast with a smaller, softer nipple. He thinks it’s nice, but has no idea that this could also be a food source.
• There are some physical issues making breastfeeding hard for him. Some babies can’t move their tongues effectively (tongue-tied); others have some pain or stiffness due to the birth. They need some help and patience to resolve these problems, so they can breastfeed successfully.
Your baby, right from the start, knows and loves you. Talk to him, even in a room with a dozen other voices, and he’ll turn toward the sound of your voice. Express a little of your milk onto a breast pad, and he’ll turn his head towards it rather than a breast pad with some other woman’s milk on it. Yes, he does want to breastfeed. The job of people who are helping you with breastfeeding is to make it possible—not to criticize him or label him. He really is doing the best he can, and so are you.
One of the phrases I heard at my first La Leche League meeting was “trust your baby, trust yourself.” It helped me a lot then, and it is still a good piece of advice today. Yes, there will be times when you need extra help and support, but you and your baby both already know a lot about making breastfeeding work.
Teresa Pitman has been a La Leche League Leader for nearly 34 years and has written many magazine articles and books about breastfeeding and other parenting topics. She’s one of the co-authors of The Womanly Art of Breastfeeding, 8th Edition, and frequently speaks at conferences. She’s the mother of four grown children (who were all breastfed) and the grandmother of six (also all breastfed). Teresa is donating a portion of any proceeds she receives from the new book to La Leche League Canada.