玥玥的小窝

如果奶水不足，你能做些什么？

    在孩子出生之前，Lindsay Miller 就做好了母乳的打算。儿子出生后，这个初为人母的妈妈因为自己迅速地给儿子吃上了母乳而特别激动。但是在刚出生的几天，儿子总是哭，以至于她总觉得哪里出现了问题。

    “在跟几个妈妈和医院里的护士打了几次电话之后，我意识到了是他不能从我这里得到足够的奶水。”她说，“我们给了他一瓶配方奶粉，他都喝干净了。”

    尽管这个挫败的芝加哥妈妈还是决定继续母乳，但是“在咨询了哺乳顾问之后，我坚持看着钟表每30分钟就用吸奶器吸奶或者喂一次奶以及用了所有我可能采取的方法和补救措施，坚持了数周，可是我每天的产奶量依然只有3-5盎司。”她说。

    十周以后，Miller的奶水已经减少到不足2盎司了，她下了好大的决心停止母乳。“我曾想着，我至少要像书中建议的那样母乳12个月。”她说，“可是我却连12周都没有坚持到，我觉得太失败了。”

    Miller的故事很常见。越来越多的女性选择母乳，也因此奶水不足的问题被有效地关注着，而且关注度在持续增加。那些像Miller一样希望顺利母乳的女人们，当母乳没有那么顺利的时候，就会觉得很失败。

    “当你想要母乳，却不能母乳或者不能完全依靠母乳的时候，是会很有挫败感的。”儿科医生Marianne Neifert说，她是母乳喂养协会的共创者，《伟大的期望：母乳喂养指南》的作者，“女人们总是会觉得是自己的错。”

    一项关于产后三周成功母乳的评估研究发现，大约15%的产妇都经历过奶水不足-----即使在给予密切关注和支持的情况下。所以，这还是很值得注意。“如果可能的话，预防奶水不足比发现奶水不足时再补救要容易的多。”

常见的原因

    管理问题，被Neifert认为是造成奶水不足最有可能的，也是很容易解决的问题。通常在开始的时候奶水很多，而后慢慢减少。

   “最常见的情况是有奶水，但是奶水没有被很好地排出，”她说，“如果奶水经常不被充分地排出来的话，在第一周的后期她就会出现问题了。”即使供给很好，奶水的产量后来也会减少，如果妈妈长期不排空自己的乳房（比如工作时不能定时吸出奶水）。不能完全排空的原因包括：

不能充分哺乳：

如果宝宝不能有效地和乳房对接，将不会刺激乳房出奶并吸空乳房。

早产儿：早产儿在吃母乳时通常不能有效地将全部奶水吸出，因为他们很容易疲劳，而且吃奶技巧不成熟。

妈妈的生活习惯：“许多产妇想制定喂奶时间表，并在夜间延长喂奶时间，这会造成供需不平衡。”Nancy Hurst说，她是博士，注册护士，休斯顿德州儿童医院的女性服务主管。她说：“如果乳房不能够很好地排空----经常性地----产妇的产奶能力会受到影响。

妈妈的乳房容量：“产妇的乳房容量和乳房的大小没有关系，但是却和她的功能性腺体组织有关系。” Hurst说。一些产妇拥有更大的储备奶水的能力，那么她们的宝宝两餐奶之间的间隔可能就比较长，而且也不会影响到奶水的量；有较小“容量”的产妇，如果她们经常不排空乳房就可能会影响奶水的产量。

罕见但是很顽固的原因

    大约4%的产妇有奶水不足的短期原因，而这些原因更难解决，这包括：乳腺和激素等的药物问题。“在乳房手术之前，乳腺组织不足和甲状腺或者其他激素组织紊乱都是常见的原因。”Neifert说，“产妇在喂奶的时候会比较困难，比如非常严重的出血，同样会有问题。”所以，有严重传染病或者高血压等的产妇同样会出现奶水不足的问题。

如果奶水不足，你该怎么办？

造成奶水不足的其他原因：

环境污染：产妇的生活环境可能会影响奶水的产量。2006年的一项研究发现，一个出生并生长在墨西哥有农药污染的农业山谷里的产妇出现乳腺组织不足的发生率要比同一地区山顶上的人要高。“我们看到越来越多的女性出现问题，可能是有环境污染引起的。”Diana West说，她是《如何产奶更多的哺乳妈妈指南》（《The Breastfeeding Mother’s Guide to Making More Milk》）的作者，“全球的哺乳顾问都反应不能提供充足奶水的产妇越来越多了。”

潜在的生育问题：“人们没有办法时会采取人工干预的方式来受孕，导致宝宝出生后产妇没有完善的生育系统，”West说，“例如，许多多囊卵巢综合症（多囊卵巢综合症可能会引起生产问题）的女人的产奶功能会出现问题。”

什么时候会出现问题

    如果你怀疑自己的奶水不足，一定要及时咨询哺乳顾问。她会为你确认危险的因素，评估您的宝宝在母乳的期间的各个阶段能吃多少奶水，并为你提供一个吸奶器吸奶的方案来增加奶水的排出量。采取方法无定论，一定要因人而异。

    即便如此，许多哺乳顾问仍是遵循一定的标准流程。首先，增加奶水的排出量。通常会是喂养和吸奶器吸出两种方法相结合。

    其次，哺乳顾问可能会建议您服用中药，比如葫芦巴，辣木，山羊豆，芦笋草等来帮助增加你奶水的产量。也有些顾问可能同时建议你服用处方药，比如多潘立酮。West说：“多潘立酮已被证明是可以哺乳妈妈可以长期服用的很高安全性的药物（要在我们的指导下用药），而且这种药全世界都在用，能够有效且安全地增加奶水的产量。

    专家们还表示，用对了方法，你应该能够增加奶水的产量-----特别是如果你能及早发现问题的话。“几乎所有的人都可能产出更多的奶水”West说，“如果仅仅能维持宝宝吃饱是远远不够的，所以你可能仍然需要给予补充，但是这也没关系。当你知道你可以做些什么，并且看到自己半满的乳房时还是应该庆祝的。

Common causes
Management problems, which Neifert says are the most likely and treatable causes of low milk supply, often involve having an abundant supply at the outset that then dwindles.

“The most common scenario is that the milk comes in but doesn't get well drained,” she says. “If milk isn’t removed from a woman’s breasts frequently and effectively, she’s already behind the eight ball by the end of the first week.” Even with a well-established supply, milk production can decrease later if a mother goes long intervals without draining her breasts (such as not pumping regularly during the work day). reasons for incomplete drainage include:

• An ineffective latch If a baby doesn’t have a good “docking” with the breast, he may not be able to stimulate and drain the breast effectively. 

• A premature baby Preemies can be particularly ineffective at removing enough milk when breastfeeding because they tire easily and have immature feeding skills.

• A mom’s lifestyle “Many women want to schedule feedings and stretch out the nighttime interval, which throws a wrench in the supply-and- demand of breastfeeding,” says Nancy Hurst, Ph.d., R.N., I.B.C.L.C., director of women’s support services at Texas Children’s Hospital in Houston. “If the breasts aren’t well emptied early on—and often—a woman can really take a hit in terms of her potential ability to produce milk.”

• A mom’s breast capacity “A woman’s storage capacity isn’t related to her breast size, but to the amount of functional glandular tissue she has,” Hurst says. Some women have greater milk-storage capacity, and their babies may be able to go longer between feedings without affecting the volume of milk; women with smaller “containers” may suffer in terms of supply if their breasts aren’t emptied more often.

Rare but stubborn causes
Approximately 4 percent of women have primary causes of low milk supply that are more difficult to treat, including such medical issues as breast and hormonal problems. “Previous breast surgeries, insufficient mammary tissue and thyroid or other hormonal disorders are some of the more common causes,” Neifert says. “A woman who has difficulties during delivery, such as very heavy bleeding, can also have problems.” So may a woman with a severe infection or high blood pressure.

What you can do if you’re not producing enough breast milk.

Other causes of low milk supply:

• Environmental toxin A woman’s surroundings may affect her milk supply. A small study conducted in 2006 found that daughters of women who grew up in a pesticide-contaminated agricultural valley of Mexico had a much higher incidence of insufficient mammary tissue than those living on a hilltop in the same area.“We’re seeing a dramatic increase in the number of women who have primary problems, possibly because of environmental contaminants,” says Diana West, I.B.C.L.C., a co-author of The Breastfeeding Mother’s Guide to Making More Milk (McGraw-hill). “Lactation consultants around the world are reporting increases in the numbers of women who can’t produce full milk supplies.”

• Underlying fertility problems “Interventions are allowing people to get pregnant when they wouldn’t otherwise, causing babies to be born to women who might not have fully functional reproductive systems,” West says. “For example, many women with PCoS [polycystic ovary syndrome, a condition that can cause ovulation problems] have less functional milk-making tissue.”

When you have a problem
If you suspect you have low milk supply, see a lactation consultant as soon as possible. She can identify risk factors, evaluate how much your infant drinks during a breastfeeding session and start you on a pumping regimen to improve milk drainage. there’s no blanket fix; treatment must be individualized.

That said, many lactation consultants follow a typical course of action. The first step is to increase milk removal, which often involves a combination of nursing and pumping.

Next, a lactation consultant might recommend herbs, such as fenugreek, malunggay, goat’s rue or shatavari, to help boost your supply. Some might also recommend prescription medications, such as domperidone. Says West, “Domperidone has been shown to be highly safe for long- term use at the levels we recommend for nursing mothers and is used throughout the world to effectively and safely increase milk production.”

Experts say that with the right approach, you should be able to boost your milk supply—especially if you catch the problem early. “Almost everyone can make more milk,” West says. “It may not be enough to sustain your baby, so you might still need to supplement, but that’s OK. You need to celebrate what you can do and see your breasts as being half full.”