母乳哺育技巧, 泌乳新知

輕撫按摩加冥想，母奶順且多

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本篇的泌乳新知由華人泌乳顧問協會會員林憶淳老師，協助整理國內、外文獻，與大家一同探討產後母親透過「促催產素輕撫按摩」與「乳房冥想」，降低產後焦慮並增加母乳量的議題。

今年四月GOLD18課程中，來自新加坡的WONG BOH BOI博士，在分享臨床幫助乳房腫脹的案例中，提出一套自我發展的乳房按摩方式，開啟學界與臨床對於運用按摩幫助婦女產後哺乳的新視野。

輕撫按摩加冥想,母奶順且多

撰文整理:林憶淳 老師

Morhenn V., Beavin L. E., Zak P. J.於2012年的研究指出按摩可以增加催產素的分泌並降低促腎上腺皮質激素(ACTH)分泌;近幾年生產教育逐漸受重視,其中輕撫按摩減痛法就是透過輕柔的身體按摩刺激催產素分泌,來增加生產母親對疼痛的耐受度以及身體的放鬆。但截至目前為止,鮮少人將此類方法運用於產後泌乳期的母親。
台灣2013年劉蕙蜜等研究者於助產雜誌中的文章「泌乳期產後婦女乳房問題之照護探討」,透過背部放鬆按摩、乳房輕撫等方式協助產後母親度過產後泌乳腫脹期的不適;也有多組研究者針對中醫理論中乳房四周穴位按摩舒緩腫脹不適、刺激泌乳;臨床上也會指導哺乳母親的家人透過背、肩頸的按摩來幫助緩解哺乳初期乳房不適、刺激催產素反射。
2017年刊載於Journal of Maternal and Child Health的文獻,透過嚴謹的隨機對照實驗研究,並且運用量表與統計學考驗,更證實結合”全身性”的「促催產素輕撫按摩」與「乳房冥想」確實能夠降低產後母親的產後焦慮值、增加泌乳量。

協會小叮嚀:
1. 按摩於臨床運用廣泛,包括世界衛生組織教材中建議的背部按摩,以及近年少數研究提出的乳房按摩,全身性的撫觸對哺乳母親的幫助也有其重要性。
2. 冥想除了放鬆,更在於鼓勵人們認識自己的身體、理解身體所釋放出的訊息、進而增加對身體的自信;乳房冥想在哺乳期的意義,是哺乳母親增加母育信心的方式之一。
3. 哺乳即生活,有健康平衡的身心,重視嬰幼兒需求之虞,亦需重視哺乳母親的需求。才有快樂哺乳的母親。「促催產素輕撫按摩」與「乳房冥想」具有增加奶量的效果,唯有在需要的時候提供給媽媽建議,並不鼓勵常規性執行。

有效結合「促催產素輕撫按摩」與「乳房冥想」於產後母親之乳汁分泌

背景:
印尼和國外產後憂鬱症發病率相當高,產後母親經歷的壓力會抑制乳汁分泌而造成母乳哺育提早結束。「乳房冥想」放鬆與「促催產素輕撫按摩」組合治療一直是可能降低促腎上腺皮質激素(ACTH)分泌率的方法,並且可能有助於賀爾蒙和泌乳激素分泌,從而使泌乳變得順暢。
本研究旨在分析有效結合「促催產素輕撫按摩」與「乳房冥想」後是否減少產後母親的焦慮並增加泌乳量。

取樣與方法:
1. 本研究為隨機對照試驗(RCT)設計的分析性研究。
2. 在當地中央綜合醫院進行為期一個半月的研究。
3. 於 200 位產後母親中取樣 60 位作為研究對象,隨機分配為實驗組(n1 = 30)與對照組(n2 = 30)。
4. 實驗組將接受「促催產素輕撫按摩」與「乳房冥想」。
5. 依變項為焦慮和母乳量。自變項為「促催產素輕撫按摩」與「乳房冥想」。
6. 使用 STAI 量表測量焦慮。(State-Trait Anxiety Inventory,40 題自評李克特 4 點量表)
7. 泌乳與乳汁收集歷程透過問題檢核表紀錄。
8. 母乳量則透過有刻度的杯餵杯測量紀錄。
9. 兩組母親之間的母乳量使用 Mann-Whitney 考驗。(曼-惠特尼檢驗。曼-惠特尼 U 考驗是一種無母
數統計(nonparametric statistics)考驗,可使用於兩個獨立樣本且資料樣本是屬於次序變數時。)
結果:
1. 實驗組(中位數= 24.00; SD = 4.45)焦慮量表結果表現較好,焦慮分數低於對照組(中位數= 34.00;
SD = 6.93),兩組之間的差異有統計學意義(p <0.001)。
2. 實驗組(中位數= 9.00; SD = 1.66)和對照組(中位數= 8.00; SD = 1.56)之間泌乳與乳汁收集歷程的差異接近顯著(p <0.145)。
3. 此外,實驗組(中位數= 10.00; SD = 10.36)和對照組(中位數= 4.50; SD = 4.21)之間的母乳量差異有統計學意義(p <0.001)。

結論:
「促催產素輕撫按摩」與「乳房冥想」之組合治療,可以有效減少產後母親的焦慮並增加母乳量。

Optimizing the Combination of Oxytocin Massage and Hypnobreastfeeding for Breast Milk Production among Post-Partum Mothers

Lutfiana Puspita Sari1), Harsono Salimo2), Uki Retno Budihastuti3)

1)Masters Program in Public Health, Sebelas Maret University, Surakarta
2)Department of Maternal and Child Health, Dr. Moewardi Hospital, Surakarta
3)Department of Obstetric and Gynecology, Dr. Moewardi Hospital, Surakarta

ABSTRACT

Background: The incidence of post-partum blues both in Indonesia and abroad has been quite high; the stress that post-partum mothers experience will inhibit breast milk production and, as a result breastfeeding process should be stopped earlier. Hypnobreastfeeding relaxation and oxytocin massage have been a combination of therapy that might decrease the rate of Adenocorticotropic Hormon (ACTH) and that might assist hormone and prolactin secrection in
order that breast milk production becomes fluent. This study then aimed at analyzing the optimization of the combination of oxytocin massage and hypnobreastfeeding in order to decrease anxiety and to improve breast milk production among post-partum mothers.

Subjects and Method: This was an analytic experimental study with Randomized Control Trial (RCT) design. This study was conducted at Dr. Suradji Tirtonegoro Central General Hospital, Klaten, from January 25th, 2017 until March 9th, 2017. The population in this study was 200 post- partum mothers. A sample of 60 post-partum mothers was selected for this study and allocated into the intervention group (n1= 30) and the control group (n2= 30). The intervention group would be treated by the combination of oxytocin massage and hypnobreastfeeding. The dependent variables were anxiety and breast milk production. The independent variables were oxytocin massage and hypnobreastfeeding. The anxiety was measured by STAI scale. The breast milk production process was measured by checklist questionnaire. The breast milk production amount was measured by milking cups. The breast milk production between the two groups was tested by Mann-Whitney.

Results: The anxiety scale in the intervention group was better and lower than that of the control group.
The differences in terms of anxiety scale between the intervention group (median= 24.00; SD= 4.45) and the control group (median= 34.00; SD= 6.93) were statistically significant (p<0.001). Then, the differences in terms of breast milk production process between the inter- vention group (median= 9.00; SD= 1.66) and the control group (median= 8.00; SD= 1.56) were nearly significant (p<0.145). Furthermore, the differences in terms of breast milk production amount between the intervention group (median= 10.00; SD= 10.36) and the control group (median= 4.50; SD= 4.21) were statistically significant (p<0.001).

Conclusion: Combination of oxytocin massage and hypnobreastfeeding can effectively decreasing anxiety and increasing breast milk production for post-partum mothers.

Keywords: oxytocin massage, hypnobreastfeeding, breast milk production, post-partum

Correspondence:
Lutfiana Puspita Sari. Masters Program in Public Health, Sebelas Maret University, Surakarta. Email:
bidanlutfiana@gmail.com. Mobile: +6282221522374.