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剖宫产与母乳喂养

如果你进行了剖宫产，无论是计划之中的还是计划外的，都可以母乳喂养自己的宝宝。

重要的是要知道，分娩阵痛和剖宫产手术期间的干预措施会影响早期的母乳喂养。如果你知道这些影响可能是什么，就能早做准备。

你可能在产后初期需要更多的支持来让母乳喂养有一个良好的开端。但没关系，你可以参阅为母乳喂养做准备了解更多信息。

尽快频繁地母乳喂养

许多母亲剖宫产后立即在手术室或恢复室进行母乳喂养。你越早抱着宝宝做肌肤接触并母乳喂养，就越会让你们双双获益。

如果你和宝宝分开了，孩子的父亲、你的伴侣或其他家庭成员也可以抱着孩子，直到你自己能抱为止。

分娩后即刻哺乳可以刺激你的身体产生大量的乳汁。这种产奶量的激增通常发生在产后几天内。然而，在剖宫产后它往往会延迟，原因可能包括:

分娩过程中用的强效药物，如硬膜外麻醉
手术给身体带来的生理压力
第一口奶延迟
产后初期哺乳次数较少
婴儿嗜睡

初乳营养丰富，在你的奶水下来前提供了宝宝所需的一切。

产奶量通常在产后第3~4天之间急剧增加，但也可能早在第2天、迟至第6天增加。剖宫产后产奶量在第5或第6天才会增加。

如果你担心的话，就在喂奶后挤出一些初乳，把它用杯子、勺子、眼药水滴管或注射器喂给宝宝（参阅杯喂）

额外多挤初乳将激发你的身体更快地产奶，宝宝就有更多的奶水吃了。如果你在孕晚期的最后几周挤初乳并存放在冷冻室里，可以把解冻的初乳喂给宝宝(参阅在产前挤出初乳 )。

分娩期间给你用的药物可能会让宝宝特别困倦。这些药物要花一周或更长时间才能从宝宝体内排出。所以，产后初期宝宝可能没法很清醒地吃奶。如果是这样，就用手挤奶，然后用杯子、勺子、眼药水滴管或注射器喂给他。

尽量避免使用奶瓶。它们会让宝宝含乳更困难。当宝宝变得更清醒后，你可以把他放在胸前直接哺乳。欲了解更多信息，请参阅建立奶量。

静脉注射的药物增加了你的体液量，这会导致产后初期乳房过度肿胀(充盈)，可能让宝宝更难含乳。你可能需要先挤出一些乳汁再给宝宝喂奶。欲了解更多信息，请参阅涨奶该怎么办？

正常的体重下降

大多数婴儿会在出生后的前几天体重下降。直到你的产奶量增加后，宝宝的体重才会增长。之后你就可以期待宝宝每天体重增加大约20~35克了。

如果你在临近分娩前的两小时内输了液，宝宝体内也就有了这些额外的液体。随着宝宝尿出这些多余的液体，体重好像减轻了很多。这些多余的液体会在产后头24小时内被宝宝的身体排出。因此建议在婴儿出生24小时后再称体重。这时的体重可以作为宝宝的起始体重。

婴儿体重下降的幅度通常可以达到出生体重的7%之多。对于一些婴儿来说，体重下降8%到10%可能没什么问题。不过建议由医疗保健人员观察过母亲和婴儿后评估母乳喂养的效果。

如果宝宝体重下降过多，可能就需要暂时补充喂养。这是短期的，直到你的身体产生大量的乳汁，宝宝也吃得很好了，就不用再补充了。欲了解更多信息，请参阅如何知道婴儿是否吃到了足够的母乳。点击“阅读原文”可查看英文版《补充喂养的同时如何保护母乳喂养》

找到一个舒适的姿势

图|国际母乳会中国图片库

对于剖宫产后的母亲来说，半躺式和后躺式哺乳通常更舒服。这些姿势也有助于激活宝宝天生的哺乳反射。

其它可选择的姿势有橄榄球式、摇篮式和交叉摇篮式。如果宝宝含乳很好，侧卧喂的姿势哺乳会很舒服。用枕头或折好的毯子保护好手术伤口对你很有帮助。宝宝踢到伤口处会生疼。

可以寻求帮助来找到一个对你和宝宝都舒服的姿势。欲了解更多信息，请参阅哺乳中最容易忽视的要点（上）：哺乳姿势和哺乳中最容易忽视的要点（下）：含乳姿势。

身体需要时间来恢复

计划之中的剖宫产往往比计划外的剖宫产恢复得更快。做计划外的剖宫产手术时，你的身体已经进入分娩状态，所以手术往往会很快。不管是计划好的还是计划外的，剖宫产都是个大手术。你可能需要用止痛药，这不会影响母乳喂养。

做剖宫产手术的母亲往往需要比超出预想中更多的时间来愈合伤口和恢复身体。产后最初几周你可能发现很难四处走动、起床、坐下、走楼梯，有时甚至咳嗽或大笑都很难。试着尽量多休息。定点进食(特别是富含蛋白质的食物)，每次给宝宝哺乳时都要喝点水。

为自己打造一个哺乳“加油站”

在你经常哺乳的地方准备一些有用的东西会很有帮助。这些东西可以包括:一个喝水瓶、零食、尿布、清洁湿巾、毯子、你的手机、充电线、电视遥控器、阅读材料等。这会帮助你减少起身和躺（坐）下的次数。

如果你住在两层楼的房子里，就会希望两层都各有一个哺乳“加油站”。当坐下来哺乳时，你所需的所有东西就都在手边了。这就省得你每次需要换尿布时还得爬楼梯！

接受朋友和家人的帮助

让其他人尽可能多做些照顾宝宝的其它事情和家务事。这样你可以把精力集中在身体恢复和母乳喂养上。请参阅伴侣和支持者如何提供帮助里的一些建议和想法。

你洗澡或小憩的时候让信任的人照看宝宝，这能给你带来奇迹。婴儿喜欢被抱着，当他们不吃奶时，可以由其他人抱着。

对自己和宝宝要和善耐心

你需要花些时间才能从术后恢复，重新回到自己以往的状态。宝宝也需要时间从生产中恢复过来。你们两人都需要时间学习如何一起母乳喂养。花时间抱着宝宝做肌肤接触有助于让你和宝宝放松。

复杂的情感

如果你的剖宫产是计划外的，你可能会对自己的分娩经历感到内疚、愤怒或失望。有人可能会告诉你没关系的，因为你现在已经生下一个漂亮的宝宝了。这样的说法会让你觉得更糟。对自己的生产感到难过并不意味着你对孩子的到来不感恩，孩子的到来让你不快乐。你当然是既高兴又感动。

但是，期待的生产方式落空，让你感到难过、愤怒、羞耻或者悲伤等等，各种情绪要分出类来还是很难的。和别人谈谈你的经历会很有帮助。一个曾经做过计划外剖宫产的朋友、一位国际母乳会的哺乳辅导、一位哺乳顾问或治疗师都可以。

获取母乳喂养的帮助

如果你有母乳喂养方面的问题，或者你准备剖宫产，可以联系国际母乳会中国的哺乳辅导或者一位IBCLC (国际认证哺乳顾问)寻求支持。大多数难题都能通过充足的资讯和良好的信息和支持来克服。

Cesarean Birth (C-Section) and Breastfeeding

If you have a cesarean birth (C-Section), either planned or unplanned, you can breastfeed your baby. It’s important to know that interventions during your labour and the c-section can impact nursing in the early days. If you know what those impacts may be, you can be prepared. You may require more support in the early days to get breastfeeding off to a good start. But that’s okay. For more information see Preparing to Breastfeed.

Breastfeed as soon as possible and often
Many mothers and parents breastfeed in the operating or recovery room right after a cesarean birth. The sooner you can hold your baby skin-to-skin and breastfeed, the better for both of you. If you are separated from your baby, the baby’s father, your partner or another family member can hold the baby skin-to-skin until you are available.

Nursing soon after birth stimulates your body to produce a lot of milk. This increase in milk production usually occurs in a few days. However, it is often delayed following a cesarean birth. Causes of this delay may include:

strong medications received during labour, such as those given via an epidural.
the physical stress of surgery on your body.
a delay in the first feeding.
fewer feedings in the early days.
a sleepy baby.

Colostrum is very nutrient dense and provides everything your baby needs until your milk comes in.

Milk production usually increases dramatically between days three and four but this could happen as early as day two and as late as day six. After a cesarean birth this occurs closer to day five or six. If you are concerned, express some colostrum after a feeding. Offer it to your baby in a cup, spoon, eye dropper or syringe (see Cup Feeding). The extra removal of colostrum will encourage your body to make milk quicker. And your baby gets more to eat. If you expressed colostrum in the final weeks of pregnancy and stored it in the freezer, you can feed your thawed colostrum to your baby (see Prenatal Colostrum Expression).

Medications given to you during labour may make your baby extra sleepy. It may take up to a week or more before they are eliminated from your baby’s body. Your baby may not be alert enough to nurse well in the early days. If this is the case, hand express your milk and feed it to him with a cup, spoon, eye dropper or syringe. Avoid bottles, if possible. They can make it harder for your baby to latch. When your baby becomes more alert, you can put him to your breast. For more information see Establishing Your Milk Supply.

Medication given by IV increases the amount of fluid in your body. This can lead to increased breast engorgement (fullness) in the early days. It may make it harder for your baby to latch. You may need to express some milk before feeding your baby. For more information see Breast Engorgement.

Normal Weight Loss
Most babies lose weight in the first few days. Your baby will not begin gaining weight until after your milk production increases. After that, you can expect your baby to gain around 20 to 35 g/day. If you got IV fluids within the final two hours before the birth, your baby also got these extra fluids. As your baby pees out these extra fluids, it may seem like a large weight loss. This extra fluid is eliminated by your baby’s body in the first 24 hours. For this reason it is recommended that your baby’s weight be taken 24 hours after birth. This weight can be used as your baby’s starting weight. Babies often lose up to 7% of their birth weight. A weight loss of 8% to 10% may be fine for some babies. However, it is recommended that mother and baby be seen by a healthcare provider to evaluate the breastfeeding. If your baby is losing too much weight, you may need to temporarily supplement. This will be short-term until your body is producing lots of milk and your baby is drinking well. For more information see How to Know Your Baby is Getting Enough Milk .

Find a Comfortable Position
Laid-back and reclining positions are generally more comfortable for mothers following a cesarean birth. These positions are also helpful for activating your baby’s natural feeding reflexes. Other options are the football hold, cradle hold, and cross-cradle hold. If your baby is latching well, the side-lying position can be very comfortable. Protecting the surgical site with a pillow or folded blanket can be helpful. A kick at the incision site can be extremely painful. Ask for help to find a position that is comfortable for both you and your baby. For more information see Positioningand Latching.

Take Time To Heal
Recovery from a planned cesarean birth tends to be faster than recovery from an unplanned one. With an unplanned c-section your body has gone into labour and the surgery is often very fast. Both planned and unplanned cesarean births are major surgery. You will likely need to take pain medication. This should not interfere with breastfeeding.

Parents who have cesarean births often need more time to heal and recover than they expect. For the first few weeks you will likely find it difficult to move around, get up, sit down, use stairs and sometimes even cough or laugh. Try to get as much rest as possible. Eat regularly (particularly protein-rich foods) and drink water every time you nurse your baby.

Set Up a Nursing Station
It can be helpful to have useful items right where you are going to be nursing. These will likely include: a water bottle, snacks, diapers, diaper wipes, blankets, your phone, charging cords, TV remote, reading material, etc. This will help you reduce the number of times you need to get up and down. If you live in a two-story house, you will probably want to have a nursing station on both floors. Then when you sit down to nurse everything you need will be close at hand. This will save you from walking up all of those stairs every time you need to change a diaper!

Accept Help from Friends and Family
Allow others to do as many of the other baby and household tasks as possible. It allows you to focus your energy on healing and breastfeeding. See How Partners and Supporters Can Help for ideas. Have someone you trust watch your baby while you take a shower or have a short rest. This can do wonders for you. Babies like to be held. When they are not feeding, they can be held by others.

Be Kind and Patient with Yourself and Your Baby
It will take time for you to recover from surgery and feel like your old self again. It will also take time for your baby to recover from birth. And it will take both of you time to learn how to breastfeed together. Spending time holding your baby skin-to-skin can help both you and your baby relax.

Complicated Feelings
If your cesarean birth was unplanned, you might have feelings of guilt, anger, or disappointment about your birth experience. You may have people tell you that it doesn’t matter because you now have your beautiful baby. Those kinds of comments can make you feel even worse. Feeling sad about your birth does not mean that you are not happy and grateful to have your baby. Of course, you are. But it can be difficult to sort through all of the feelings of sadness, anger, shame or grief for the loss of the birth you hoped for. It can be very helpful to talk to someone about your experience. This may be a friend who also had an unplanned cesarean birth, a La Leche League Leader, or a counsellor or therapist.

Get Help with Breastfeeding
If you are having problems breastfeeding, or chestfeeding, or you are anticipating having a cesarean birth, contact a La Leche League China Leader or an IBCLC (International Board Certified Lactation Consultant) for support. Most issues can be overcome with good information and support.

参考文献:
Hobbs, A. J., Mannion, C. A., MacDonald, S. W., Brockway, M., & Tough, S. C. (2016).The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum.BMC Pregnancy & Childbirth.16:90.

La Leche League International. (2017, November). Breastfeeding After Cesarean Birth.

www.lllc.ca/sites/default/files/Cesarean%20Birth%20%28C-section%29%20and%20Breastfeeding.pdf