Emzirme Sorunlarına Kanıta Dayalı Yaklaşım

Emzirme sorunları doğum sonrası ilk bir ayda yaklaşık %70 sıklıkla yaygın görülmekte, emzirmenin erken sonlanması, postpartum depresyon gibi olumsuz sonuçlar doğurmaktadır. Annenin emzirme konusunda profesyonel destek alması ise sadece anne sütüyle emzirme başarısını arttırmaktadır. Bu yazının amacı sadece anne sütüyle beslenmenin önündeki en büyük engellerden, yaygın görülen emzirme sorunlarını kanıta dayalı olarak güncel araştırmalar eşliğinde tartışmaktır. Bebeğin memeye yerleşme sorunları ve ağrılı meme ucu emzirme ile ilgili kaygıların başında gelmektedir. Bu sorunların erken saptanmaması halinde sütte azalma ve bebekte yetersiz tartı alımı ile sonuçlanmaktadır. Son yıllarda yapılan ultrason çalışmaları emzirme konusunda yeni bilgiler ortaya koymaktadır. Başarılı emzirmede anne bebek ikilisinin erken ten tene teması, doğum sonrası 1-2 saatlik pencere döneminin kaçırılmayarak bebeğin primitif reflekslerinin harekete geçirilmesi, annenin güvenini kıran müdahaleci yaklaşımlar yerine, anneye özgüven kazandırılması, rahat bir emzirme için bedenen ve ruhen hazırlanması, uygun memede yerleşimle, sık emzirme önerilmektedir. Anne sütünü arttırmak için kullanılan bitkisel ürünlerde standardize doz olmaması, olası kirleticiler, alerjik potansiyelleri ve olası ilaç etkileşimleri nedeniyle kullanılması önerilmemektedir.

Anahtar Kelimeler:

emzirme, meme masajı

Evidence Based Approach to Breastfeeding Difficulties

Breastfeeding difficulties are common with a reported occurrence of approximately 70%, leading to adverse outcomes such as early cessation of breastfeeding and postpartum depression. Professional breastfeeding support is associated with a higher success of exclusive breastfeeding. The aim of this paper is to discuss the common breastfeeding difficulties, one of the biggest obstacles to exclusive breastfeeding, in light of evidence-based research. Poor latching and nipple pain are the main concerns about breastfeeding. Failure to diagnose these problems result in low milk supply and inadequate weight gain of the baby. Recent ultrasound studies reveal new information about breastfeeding. For a successful breastfeeding early skin to skin contact of the mother-infant dyad, stimulating the baby’s primitive reflexes without missing the postpartum 1-2-hour window period, giving self-confidence to the mother, instead of hands on interventional approaches, preparing the mother physically and mentally for a comfortable breastfeeding, frequent breastfeeding in an optimal position is recommended. Herbal products used to increase breast milk supply are not recommended due to the lack of standardized doses, possible pollutants, allergic potential and possible drug interactions

Keywords:

breastfeeding, breast massage,

PDF

___

1. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü. (2019). 2018 Türkiye Nüfus ve Sağlık Araştırması. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü, T.C. Cumhurbaşkanlığı Strateji ve Bütçe Başkanlığı ve TÜBİTAK, Ankara, Türkiye.
2. Brown A, Rance J, Bennett P. Understanding the relationship between breastfeeding and postnatal depression: the role of pain and physical difficulties. J Adv Nurs 2016; 72(2): 273-82.
3. Gianni ML, Bettinelli ME, Manfra P, Sorrentino G, Bezze E, Plevani L ve ark. Breastfeeding difficulties and risk for early breastfeeding cessation. Nutrients 2019; 11: 2266.
4. Eren T, Kural B, Yetim A, Boran P, Gökçay G. Kadın hekimlerin emzirme deneyimleri ve yasa değişikliğinin emzirme üzerindeki etkisi. Turk Pediatri Ars 2018; 53: 238-44
5. Kural B, Boran P. Sütüm Yetmiyor diyen anneye yaklaşım. Turkiye Klinikleri 2018; 14Ç 305-9.
6. Bunik M. The pediatrician’s role in encouraging exclusive breastfeeding. Pediatrics Rev 2017; 38: 353-68.
7. Nease EK, Narumanchi J, Nield OE, Niled LS. Breastfeeding concerns and their management: one year experience in a physician-run lactation clinic. Global Ped Health 2018; 5: 1-4.
8. Sowjanya SVNS, Venugopalan L. LATCH score as a predictor of exclusive breastfeeding at 6 weeks postpartum: a prospective cohort study. Breastfeeding Med 2018; 13:
9. Cato K, Sylven SM, Skalkidou A, Rubertsson C. Experience of the first breastfeeding session in association with the use of the hands-on approach by healthcare professionals: a population-based Swedish study. Breastfeed Med 2014; 9: 294-300.
10. Thompson R, Kruske S, Barclay L, Linden K, Gao Y, Kildea S. Potential predictors of nipple trauma from an in-home breastfeeding programme: a cross-sectional study. Women Birth 2016; 29: 336-44.
11. Douglas P, Geddes D. Practice-based interpretation of ultrasound studies leads the way to more clinical support and less pharmaceutical and surgical intervention for breastfeeding infants. Midwifery 2018; 58: 145-55.
12. Douglas P. Gestalt breastfeeding: helping mothers and infants optimize positional stability and intra-oral breast tissue volume for effective, pain free milk transfer. J Hum Lactation 2017; 33: 509-18
13. Colson SD. Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Hum Dev 2008; 84: 441-49.
14. Schafer R. Physiologic breastfeeding: a contemporary approach to breastfeeding initiation. J Midwifery and Women’s Health 2015: 546-53.
15. Moore ER, Bergman N, Anderson GC, Medley N. Early skin to skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev 2016; 11:CD003519.
16. Widström AM. Newborn behavior to locate the breast when skin to skin: a possible method for enabling early self-regulation. Acta Pediatrica 2011; 100: 79-85.
17.Genna CW, Barak D. Facilitating autonomous infant hand use during breastfeeding. Clinical Lactation 2010.
18. Girish M, Mujawar N, Gotmare P, Paul N, Punia S, Pandey P. Impact and feasibility of breast crawl in a tertiary care hospital. J Perinatology 2013; 33: 288-91.
19. Berens P, Eglash A, Malloy M ve ark. ABM Clinical protocol 26: persistent pain with breastfeeding. Breastfeeding Med 2016; 11:
20. Barrett ME. Raynaud Phenomenon of the nipple in breastfeeding mothers: an underdiagnosed cause of nipple pain. JAMA Dermatol 2013; 149(3): 300-306.
21. Jackson KT, Dennis CL. Lanolin for the treatment of nipple pain in breastfeeding women: a randomized controlled trial. Matern Child Nutr 2017; 13(3).
22. Berens P, Brodribb W ve ark. ABM Clinical protocol 20: engorgement, revised 2016. Breastfeeding Med 2016; 11:
23. Witt AM, Bolman M, Kredit S, Vanic A. Therapeutic breast massage in lactation for the management of engorgement, plugged ducts, and mastitis. J Hum Lact 2016; 32: 123-31.
24. Amir LH. ABM Clinical protocol 4: mastitits. Revised March 2014. Breastfeed Med 2014; 9: 239-43.
25. Boakes E, Woods A, Johnson N ve ark. Breast infection: a review of diagnosis and management practices. Eur J Breast Health 2018; 14: 136-43.
26. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü Çocuk ve Ergen Sağlığı Dairesi. Emzirme Danışmanlığı Uygulayıcı Kitabı 2018, Ankara. Yalçın SS ed. Başak Matbaacılık.
27. Kellams A, Harrel C, Omage S ve ark. ABM Clinical protocol 3. Supplementary feedings in the healthy term breastfed neonate, revised. Breastfeeding Med 2017; 12:
28.Brodribb W. ABM Clinical Protocol 9: Use of galactagogues in initiating or augmenting maternal milk production, second revision 2018. Breastfeeding Med 2018; 13: 307-14..
29. Academy of Breastfeeding Medicine Protocol 11. Guidelines for the evaluation and management of neonatal ankyloglossia and its complications in the breastfeeding dyad. https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/11-neonatal-ankyloglossia-protocol-english.pdf, erişim 9.9.2019.
30. O’Shea JE, Foster JP, O’Donnell CP, Breathnach D, Jacobs SE, Todd DA, Davis PG. Frenotomy for tongue-tie in newborn infants. Cochrane Database Syst Rev 2017; 11;3: CD011065. doi: 10.1002/14651858
31.Srinivasan A, Al Khoury A, Puzhko S, Dobrich C, Stern M, Mitnick H, Goldfarb L. Frenotomy in infants with tongue tie and breastfeeding problems. J Hum Lact 2019; 35: 706-12.