運用母嬰親善概念照護一位初產婦成功哺育母乳之護理經驗

A Nursing Care Experience of a Primipara Who Successfully Breastfed Based on Baby-Friendly Approach

本篇敘述初產婦學習純母乳哺餵與親子同室照護之現況，個案是胎盤早期剝離接受剖腹生產的初產婦，配偶擔心其身體復原及無育兒經驗而不支持純母乳哺餵與親子同室照顧嬰兒，這讓想純母乳哺餵與親子同室的個案備感挫敗與壓力，故引發筆者選擇個案的想法。護理期間2018年5月28日至2018年6月2日，採用Gordon十一項健康功能型態架構評估，發現護理問題有:急性疼痛∕與手術、產後的生理變化（宮縮、脹奶）有關、母乳哺餵增進的準備度∕與基本的哺乳知識及技巧有關、焦慮∕與缺乏育兒照顧技巧及支持系統有關等。藉由疼痛控制、傷口護理、使用B-R-E-A-S-T Feed母乳哺育觀察表評估與協助調整含乳、哺乳姿勢、透過哺乳飲食調養、結合中醫刮痧改善脹奶，使哺乳過程更為順暢，讓嬰兒順利獲得最珍貴的禮物-母乳；灌輸母嬰親善概念與知識、說明純哺餵母乳與親子同室的運作模式，增強照顧嬰兒之知識與技巧，減輕家庭成員的焦慮並提升其照顧能力。臨床照護中B-R-E-A-S-T Feed母乳哺育觀察表鮮少被常規使用，建議列入照護常規，可迅速評估產婦與嬰兒哺乳狀況，給予即時性協助，進而提升產婦哺乳技巧與信心，而願意持續哺乳。

This article describes the current status of a primipara learning exclusive breastfeeding and rooming-in care. The case is a primipara with placental abruption and underwent cesarean section delivery. Due to her physical recovery and lack of parenting experience, her spouse did not support exclusive breastfeeding and roomingin care. This participant was frustrated because she wished to adopt exclusive breastfeeding and rooming-in care. The author was motivated to study the case from May 28 to June 2, 2018. Gordon's Eleven Functional Health Patterns Assessment was performed, and the following nursing problems were found: acute pain related to surgery and postpartum physiological changes (uterine contraction and breast engorgement); improvement of readiness for breastfeeding related to basic breastfeeding knowledge and skills; anxiety related to the lack of parenting care skills and a support system, and so on. This participant was evaluated based on pain control, wound care, use of the B-R-E-A-S-T Feed breastfeeding observation scale. Instruction on the adjustment of latching and breastfeeding postures was provided. Breastfeeding dietary care in combination with TCM scraping therapy to alleviate breast engorgement was given, so the breastfeeding process became smoother. The baby was able to smoothly obtain breast milk, the most precious gift. The concept and knowledge of baby-friendliness were introduced to the parents and the operation mode of exclusive breastfeeding and rooming-in care was explained. Thus, the anxiety of family members was relieved, and their caring ability was enhanced. The B-R-E-A-S-T Feed breastfeeding observation scale is rarely used routinely in clinical care, so it is recommended to include it in the care routine. This will allow for the quick evaluation of the breastfeeding status of parents and infants and provide instant assistance, thus improving breastfeeding skills and confidence of parents as well as their willingness to breastfeed continuously.