READING ROOM(ENGLISH N CHINESE)

看孩子，别看钟时间
作者：小巫

某天在朋友家书架子上发现一本上个世纪七十年代出版的《赤脚医生手册》，页面已经发黄，这在今天可是希奇物品。翻到生孩子那一章，看到章末有关母乳喂养写着这样寥寥几句话：“新生儿出生24小时后开始喂母乳，每4小时喂一次，两次喂养中间可以喂糖水。”

看见这样的过时信息，不禁哑然失笑。不过，就平时经常听到的有关母乳喂养的问题而言，其实在21世纪的今天，还是有不少人糊涂地信守着这种陈旧观念，就是给孩子喂奶要按时按点喂。总有人问我，“我应该多长时间喂一次？每次要喂多久？”

“看孩子，别看钟”(watch the baby' not the clock)，这是国际母乳会的一句著名格言，就是说，母乳要按需喂养，而不是按时喂养。

“母乳喂养不是一场数学演算，”西尔斯医生在《育婴手册》里说。“小宝宝们和有哺乳经验的妈妈们可都没有写过任何严格的规则。”

那这样的传统观念是从哪里来的呢？其实是把喂奶粉的经验套用在母乳上了。但是母乳喂养迥异于奶粉喂养，其中包括以下这几个原因：

- 婴儿出生伊始的头几个星期里，母婴之间要建立起恰如其分的喂养方式，婴儿要以频繁的吸吮来刺激母亲的乳汁分泌。宝宝吃的越频繁，乳汁分泌量越旺盛。而且在大约三个星期和六个星期左右，婴儿会经历“猛长期”，需要的养料比平常多，也会通过频繁吸吮来提高母乳的分泌量。这是大自然安排好的供需关系，因此母亲要在婴儿需要时喂奶。

- 每一个婴儿都有其天生的独特性格，首先就表现在吃奶方式上。有的婴儿吃的又快又猛，吃饱后可以等待两三个小时再吃下一顿。有的孩子却吃得温柔缓慢，一顿奶要吃上半个小时甚至一个小时，有时还会吃着吃着就睡着了，过一会儿醒来又要吃。而且大多数婴儿在吃饱肚子后还会在奶头上耽搁一阵，获得娱乐性吸吮。新生儿的胃口也随时有所变化，有时吃的多，有时需要的少。每一位妈妈的乳汁都是为自己宝宝的独特性而设计的，根据宝宝不同的需要情况，每一次喂奶时，乳汁的分泌量、浓度和成分都有所调节。因此哺乳的妈妈要按照自己孩子的需要来喂奶。但是奶粉却千篇一律，其中含有数倍于母乳的蛋白质、脂肪和矿物质，新生儿不成熟的消化系统无法完全承受。由于无法根据个性安排奶粉量，人工喂养就需要人为地制造一个固定的时间表，以防过饱或消化不良。

- 母乳较奶粉更容易消化和吸收，母乳喂养的宝宝需要喂食的次数也自然多一些。 作为新手妈妈，最好做好思想准备，你的宝宝在最初几个星期里，基本上要平均每两个小时吃一次奶，或者是在24小时阶段内吃10到12次奶。一般三个月之后，乳汁分泌量达到孩子的要求，在按需喂养的基础上，母婴之间建立起令双方满意的喂养关系，孩子也会接受频繁吃奶之外的安抚方式。至于多长时间喂一次、每次喂多久这样的疑问就不会再出现了。

其实就象一位母亲的著名言论所说的那样，“成功地分泌乳汁是每一位女人女性气质的自然表现，她不需要计算给孩子喂奶的次数，就象她不需要计算亲吻孩子的次数一样。”

原载《妈咪佳人》2002年2期 本篇文章来源于 准妈妈网 原文链接：http://www.zhunmama.cn/fmqh/mrwy/7923.html

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10 Ways to Prevent and Overcome Breastfeeding Difficulties

by Lyla Wolfenstein, B.S., IBCLC, RLC

Take a prenatal breastfeeding class. Often, expectant parents fully intend to breastfeed, but figure that it is a natural process and they shouldn't need a class to learn how. Breastfeeding is natural and normal, but there can be obstacles to overcome along the way, while baby and mother learn this new skill. By informing yourself ahead of time about how to prevent and overcome breastfeeding difficulties, you can significantly increase the likelihood that any difficulties you do encounter will be minor and short-lived.

Take a childbirth education class, plan for a natural birth, if possible, and use a labor doula to help you achieve the birth you desire. Many babies breastfeed just fine after an epidural or narcotic, but for many it does not start out so smoothly. If you do get an epidural or a narcotic during your labor, you can still breastfeed, but you may need to have more patience with your baby as he or she overcomes the effects of the drug(s) and learns to breastfeed. Getting skilled help can often speed the resolution of any breastfeeding problems that do arise after a medicated (or any) birth.
Statistics show that the use of a labor doula to assist with pain management and to provide support and encouragement throughout labor and delivery reduces the length of labor by 25 per cent, the use of pain medication by 30 per cent, the use of forceps by 40 per cent, the C-section rate by 50 per cent, the use of Pitocin by 40 per cent, and the use of epidural anesthesia by 60 per cent. Since all of the above-mentioned interventions can impact the initiation of breastfeeding, it makes sense that the use of a labor doula can positively affect breastfeeding outcome.

Attend a few La Leche League meetings before the birth of your baby. La Leche League is a great place to learn more about the normal course of breastfeeding and hear from other mothers who have had a variety of experiences with labor, birth and breastfeeding, as well as to form friendships that may persist beyond your baby's infancy and help break the isolation of new motherhood. At La Leche League Meetings, you will also be able to speak with and get phone numbers of local accredited La Leche League Leaders who you can call on for support if you encounter any difficulties with the normal course of breastfeeding.
No matter how you plan to give birth (medicated, unmedicated, home, hospital, etc.) be prepared for the possibility that your birth might go differently than desired - and plan ahead accordingly! Even if you plan a natural birth, things could take a different turn, and it can help tremendously to gather information ahead of time about how to prevent and overcome breastfeeding difficulties that might arise from a medicated birth, even if you don't plan on using medications. And if you plan on using an epidural, or know you will be having a c-section, it is all the more important to inform yourself beforehand of how to avoid or overcome breastfeeding difficulties within the context of your birth reality.

Plan on breastfeeding, don't plan on "trying" to breastfeed. In my article What's Your Breastfeeding Intelligence Quotient: Getting the Facts Straight -Debunking the Myths about Breastfeeding, I discussed the common misconception that formula is a close second choice after breastfeeding. The following snippet, taken from that article, will help illuminate the points made afterward, under this item.

From "What's Your Breastfeeding Intelligence Quotient?" by Lyla Wolfenstein:
While formula is commonly assumed to be the second-choice infant food after breastfeeding, the World Health Organization (WHO) actually states: "The second choice is the mother's own milk expressed and given to the infant in some way.The third choice is the milk of another human mother. The fourth and last choice is artificial baby milk (infant formula)�
Even one bottle of formula alters the infant gut flora for at least a month - rendering it no different from an adult's or older child's (eating other foods) gut profile. Just one bottle of formula can set the stage for future allergies, food sensitivities, diabetes mellitus, and a host of other conditions and diseases. While this does not mean that any baby given formula will develop a medical condition, do we really want to risk it with our babies? Of course, in some cases, supplementation is needed, and if the first three options on the WHO's list are not available, formula is preferable to cow's milk for a newborn. Feeding the baby is definitely preferable to not feeding the baby, if the baby needs food! But the scientific facts point toward it being well worth the effort to avoid early supplementation with artificial baby milk if at all possible - and it often is possible, with proper information and timely intervention.

Breastfeeding is the biological norm for human infants. If we woke up one morning, and couldn't breathe easily, not one of us would say "Oh well, I guess unassisted breathing didn't work out for me, I will have to use an oxygen tank from now on!" Now of course there are situations which require the use of oxygen, but every one of us would attempt everything possible to fix our breathing problem before resigning ourselves to an oxygen tank! This may seem an absurd comparison, but if we truly view breastfeeding as the norm, and artificial infant feeding as almost never necessary and a distant 4th in order of preference, then the analogy makes sense.
When mothers are prepared with accurate information, are supported by family, friends, and/or professionals, and seek out competent assistance if problems do occur, it is rare that breastfeeding doesn't work out. And if it does happen to be one of those rare situations where a mother truly cannot make enough milk, or a baby truly cannot breastfeed, then that is comparable to the medical situation that truly warrants the prolonged use of oxygen, and in those situations, she can be grateful to have options for artificial feeding, even while she is saddened she missed out on breastfeeding.

If problems arise - get help immediately! As with many health-related situations, breastfeeding difficulties can become more complicated over time, so early intervention by a skilled professional (look for an International Board Certified Lactation Consultant) can make a huge difference in how quickly and easily problems can be overcome. It can be helpful to prepare yourself before the birth of your baby with the name and number of the person with whom you have chosen to consult.

If you decide not to breastfeed, or to discontinue breastfeeding, inform yourself fully of the risks of artificial feeding, and the realities of breastfeeding. Then and only then, can you make a truly informed decision. We all have the right to weigh the realities of any choice with which we are presented and make an informed decision. The problem that occurs too frequently with regard to breastfeeding is that, out of fear of "making mothers feel guilty" about not breastfeeding, "experts" deprive parents of the information needed to make an informed choice. This is patently ridiculous, as guilt is used frequently to further other causes, such as car seat use, not smoking while pregnant, putting baby on their back to sleep to prevent SIDS (formula feeding is a risk factor for SIDS, but that is not often mentioned), and many other issues not only pertaining to parenting.

If you do choose to quit breastfeeding, and your baby has trouble with infant formula or you have a change of heart, keep in mind that it is often possible to go back to breastfeeding, even if your milk supply has dropped. Finally, if you are leaning toward not breastfeeding at all, consider just breastfeeding for the first few days, so that your baby can have the advantages of your colostrum, which is rich in immune factors and vitally important in many ways. Who knows - you may find breastfeeding is easier than you imagined and decide to continue a bit longer!
Get support! Many of us giving birth in the past decade were not breastfed as babies, or not for long, and our mothers likely didn't receive the support and information that could have helped them breastfeed. As a result, some grandparents today are extremely supportive of their daughters or daughters-in-law breastfeeding, but others are not. They may feel guilt or remorse that they were not able to provide what we are now telling them is the best for babies. Or perhaps they simply do not understand how much more information we have now about infant nutrition, bonding, and child development, and they feel uncomfortable with how different parenting "looks" compared to when they were young parents.

If your family is not supportive, if you don't have friends with babies or friends who breastfeed, or even if you have supportive family and friends but feel isolated by new motherhood, it can be tremendously helpful to surround yourself with other breastfeeding moms who are encountering similar experiences and can support each other. So consider joining a support group, playgroup, or mom's group, or forming one of your own! Once you reach out, you'll be surprised how many moms are feeling just as isolated as you are!

Love your baby, cherish your time with your baby, and don't rush your baby to the next step before he is ready - enjoy your new adventure! It sounds cliche, but its true - you will soon look back amazed at how the months and years have flown, and what seemed like insurmountable problems when your baby was 3 weeks, 3 months, or even 3 years old, will seem like blips on a radar screen before you know it. Your baby will eventually sleep more, sleep alone, eat solid foods, crawl, walk, talk, learn to use a toilet, and wean from the breast, whether you push those things on him or not, and it is a lot less anxiety-provoking for both you and your baby to follow your baby's lead than it is to push and hope baby is ready. The more "present" you can be with your baby through those early stages, the sweeter the memories of those fleeting months will be when you reflect in years to come.

Trust your instincts, follow your heart. Probably the most important of all the suggestions you will receive, this really needs no elaboration. Our instincts are there, we just have to recognize them and listen to our hearts. Each mother has the power to know what is right for her baby and her family, but many other voices sometimes crowd out the most important voice of all - the one inside that is guided by maternal instinct.

Written by Lyla Wolfenstein, B.S., IBCLC, RLC