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不必迷信母乳喂養

The Ideal and the Real of Breast-Feeding
不必迷信母乳喂養

Concern is mounting that the "breast is best" dogma is creating undeserved guilt and serious hardships for a growing number of new mothers, many of whom work full time and cannot afford, professionally or financially, the prolonged maternity leaves needed to breast-feed their infants for the time now recommended.

越來越多人擔心,“母乳最好”的訓條會為越來越多的新媽媽帶來不必要的負罪感與煎熬,很多新媽媽需要從事全職工作,工作與家庭財務的壓力決定了她們無法獲得較長的產假,因此不可能按如今推薦的母乳喂養時間來哺育寶寶。

Forty-three years ago, when my twin sons were born, the pressure to breast-feed exclusively for six months was not as strong as it is today. I nonetheless felt I had let them - and myself - down when this proved impossible. I had looked forward to feeding only breast milk for the six months of maternity leave my job allowed. But nature had a different plan.

43年前,在我的一對雙胞胎兒子出生時,全母乳喂養(指只喂養嬰兒母乳,不搭配配方奶和輔食等的喂養方式——譯注)整整六個月的壓力還不像現在這么大??墒窃谖野l現無法達到這個要求時,還是感覺辜負了寶寶和我自己。我的工作允許休六個月的產假,所以我的本意是在他們出生的這六個月里進行全母乳喂養,但大自然另有安排。
 

At seven months pregnant, I learned I was carrying twins, and my doctor ordered me to stop working to avert an early delivery. The boys, born at 6 pounds 12 ounces each, were delivered by emergency Caesarean, after which I developed a life-threatening womb infection. Sustained by an IV drip for eight days, I was isolated from the babies and pumped breast milk while they suckled formula.

在懷孕七個月時,我得知自己懷的是雙胞胎,醫生要求我停止工作,避免早產。經過緊急剖腹產,我生下了兩個寶寶,每個都重6磅12盎司(合3.06公斤),但在此之后我出現了危及生命的宮腔感染,輸了八天液,沒法實現母嬰同室,在他們喝著配方奶時,我只能用吸奶器把母乳吸出來。

When we finally left the hospital, each boy was downing four ounces of formula every four hours, and I was producing less than half that in breast milk. My doctors gave contradictory advice.

出院時,兩個男寶寶每四個小時要喂四盎司(合113克)配方奶,而我吸出的母乳還不到這個量的一半。我的醫生們對此給出了截然相反的建議。

Obstetrician: Just nurse them and your milk will come in. If you give them bottles, they won't bother to nurse.

產科醫生說:你只要堅持喂母乳,奶總歸是夠的。假如你老是喂他們配方奶,他們就不會費勁吸你的奶了。

Pediatrician: Forget about nursing. Give them formula, or they will be hungry and crying every two hours. They'll lose weight, and you and they will be miserable.

兒科醫生說:別管母乳了。喂他們配方奶,否則他們會餓得每兩個小時大哭一次。他們會變瘦的,這樣寶寶跟你都會很不好受。

After a good cry myself, I decided to meld the advice: Nurse the babies first, and top off each feeding with formula. The boys gradually reduced their dependence on formula. But then I had to return to work, an hour's commute from home, to an office without on-site day care or any place to express milk.

我痛哭一場,決定中和兩方建議:每次我先喂母乳,不夠的時候再添奶粉。兩個寶寶逐漸不再那么依賴配方奶了。但很快我就得重返職場,路上要花一個小時,而且辦公室既沒有日托所,也沒有可以關起門來吸奶的地方。

An Insurmountable Gap

無法逾越的鴻溝
 
Many more women now work full time, most in places that cannot accommodate a nursing mother. Few can afford an extended unpaid maternity leave. As Alissa Quart noted recently in a lively essay in The New York Times, "The Milk Wars," many new mothers are finding it difficult, if not impossible, to feed their babies nothing but breast milk for six months.

現在做全職工作的女性越來越多,而且大部分工作場所都不利于媽媽哺乳。沒有多少人能承受超期無薪產假帶來的負擔。艾麗薩·夸特(Alissa Quart)近來在《紐約時報》上發表了一篇非常生動的隨筆,標題是《母乳戰爭》(The Milk Wars),在文中她指出,大量新媽媽都發現在寶寶六個月前除了母乳,其他什么都不喂,這是件極困難的事情,甚至可以說是不可能完成的任務。

Health officials have likened the failure to breast-feed to the risk of smoking during pregnancy, adding to the distress and guilt suffered by these women.

而衛生部門的官員則把未能母乳喂養給嬰兒帶來的危害,與懷孕期間吸煙的危害相提并論,令這部分女性的苦惱與負罪感又加深了一層。

But as a recent study in Scotland showed, the gap between what is ideal and what is real is insurmountable for many families. The authors, who conducted 220 face-to-face interviews, mostly with pregnant women, new mothers and their partners, concluded that more realistic, achievable goals should be set, particularly in countries like the United States and Britain, which have struggled and thus far failed to meet targets for breast-feeding.

最近在蘇格蘭進行的一項研究顯示,對于很多家庭來說,母乳喂養的理想與現實之間,存在著一條無法逾越的鴻溝。作者進行了220次面對面的訪談,大部分對象為孕婦、新媽媽以及她們的伴侶,結論是在需要設定一個更現實、更易于實驗的母乳喂養目標,在像美國和英國這類國家尤其如此,這些國家的婦女雖然幾經艱辛掙扎,仍然很難達到母乳喂養的目標。

Hanna Rosin, mother of three breast-fed babies, wrote in The Atlantic in 2009 that breast-feeding involves "a serious time commitment that pretty much guarantees that you will not work in any meaningful way. When people say that breast-feeding is 'free,' it's only free if a woman's time is worth nothing."

漢納·羅辛(Hanna Rosin)母乳喂養了三個孩子,2009年她在《大西洋月刊》(The Atlantic)雜志撰文稱,母乳喂養需要“犧牲大量時間,你幾無可能以任何有意義的方式工作。人們說母乳喂養是‘免費’的,而事實上母乳免費的前提是,人們把母乳媽媽付出的時間看作分文不值。”

The Scottish researchers, whose study was published in March in the journal BMJ Open, concluded that there is "a clash between overt or covert infant feeding idealism and the reality experienced." Some families, they found, "perceive that the only solution that will restore family well-being is to stop breast-feeding or introduce solids."

蘇格蘭的這項研究報告發表在《英國醫學雜志(網絡版)》(BMJ Open)的三月號上,研究者的結論是“在公開或隱秘的嬰兒喂哺的理想與現實之間,存在著沖突”。他們發現其中一些受訪家庭“認為,只有停止母乳喂養,或者讓嬰兒開始吃固體食品,這才可能讓全家人重拾幸福”。

Even mothers who planned to devote themselves to breast-feeding often struggled with the time it took away from getting back to their pre-pregnancy lives, including sleep, exercise, friendships, couple time, attention to other children, even housework.

即使是拿定主意想要母乳喂養的媽媽們,也往往會因為無法恢復孕前的正常生活而感到糾結,因為母乳喂養可能會占用各種時間,包括睡眠、健身、交友、與丈夫共處,照顧別的孩子,以及做家務的時間。

There may be little net benefit to breast-feeding if it results in distressed mothers or marital or family discord. As one woman in the Scottish study said, "It all seems to be, 'Don't ever do anything that would interfere with breast-feeding' ... But it just doesn't fit in with the rest of your life, and I think people just give up because it's too difficult."

如果堅持喂母乳可能會導致母親郁郁寡歡,或者家庭不和,這么做或許就得不償失了。蘇格蘭這項研究的一位被訪者說,“看起來,‘你不能做任何對母乳喂養不利的事情’……但它真的跟你生活中的其他事情都格格不入,我覺得人們放棄母乳喂養,原因在于它真的是太辛苦了。”

In some cases of exclusive breast-feeding, the women's partners or other children felt left out of baby care and the bond that comes from feeding a new baby. Another woman in the study said of her partner, "I think he's really delighted that the baby will finally take a bottle from him; that's their time to sit and chill. I think he feels more connected as well, just being able to do that."

也有些時候,母乳媽媽的伴侶或其他孩子會感覺自己因此沒法參與照顧家中的這個新生命,也無法體會到哺育小寶寶的幸福感。參與研究的另一位女性這樣形容自己的伴侶,“寶寶終于能喝他遞過來的奶瓶,我想他真的非常幸福;他們父子二人總算能坐在一起好好享受一下了。我覺得,光是參與喂奶,他就能感覺到與寶寶更加親密。”

The authors concluded, "Six months exclusive breast-feeding is considered unrealistic and unachievable by many families, and promoting this is perceived as setting parents up to fail."

作者總結道,“在很多家庭看來,六個月全母乳喂養是不現實并且無法實現的,鼓吹這個目標,就等于是宣判家長不合格。”

They recommended that rather than dictate how babies are fed, health professionals should have open-ended discussions with families to see how well a particular feeding regimen would fit into family life.

該研究的作者建議,衛生部門的從業者不應武斷決定嬰兒的喂養方式,而應坐下來與人們探討,從而判斷出某種特定的喂養方式是否能適應現代的家庭生活。

Uncertain Evidence

不明確的證據

Some mothers in the Scottish study resented the "propaganda" promoting breast-feeding, calling the message that "breast is best" overdone and questioning the strength of evidence that exclusive breast-feeding for six months reduces a baby's risk of developing allergies, asthma, eczema, ear infections, obesity, diabetes, heart disease, sudden infant death and diminished intelligence, as well as protecting mothers from breast cancer.

參與蘇格蘭這項研究的一些母親表示,她們很討厭母乳喂養的“宣傳攻勢”,認為“母乳最好”言過其實,表示全母乳六個月帶來的種種裨益證據不足,此前人們稱,這樣喂養可以減少嬰兒患過敏、哮喘、濕疹、耳道感染、超重、糖尿病、心臟病、嬰兒猝死和智力下降的危險,并能減少母親罹患乳腺癌的機率。

Although there is some evidence supporting such claims, no randomized, controlled trials - the gold standard of scientific research - have proved that breast-fed babies fare better, at least in industrialized countries.

盡管有一些證據證明上述主張,但目前還沒有隨機對照實驗——而這是科學實驗的金科玉律——能夠證明,母乳喂養的嬰兒確實生存率更高,至少在工業化國家這一點并不準確。

Babies who are exclusively breast-fed for six months typically come from families that differ in a variety of ways from those weaned early or fed formula from the outset. (Of course, breast-fed babies do fare better in less developed areas, where formula may be prepared with contaminated water or poverty prompts mothers to skimp on its use.)

通常來說,給嬰兒進行了六個月全母乳喂養的家庭,在諸多方面與早早斷奶或者一開始就喂配方奶的家庭存在各種不同。(在欠發達地區,母乳喂養的寶寶生存率確實更高,這可能是因為沖調配方奶的水不干凈,或者是因為迫于經濟壓力,母親沒有給寶寶喂足量奶粉。)

As for the antibodies that protect babies early in life, most are acquired not through breast-feeding but via the placenta during pregnancy. The main exceptions are antibodies against gastrointestinal infections (vomiting and diarrhea); these antibodies are transferred to a baby's gut through breast milk but not formula.

至于保護小嬰兒的抗體,大部分并不是通過母乳,而是經由胎盤獲取的。其中一個最主要的例外是一種能避免嬰兒發生胃腸道感染(嘔吐和腹瀉)的抗體,這種抗體只能通過母乳傳遞給嬰兒,配方奶里沒有。

Based on her review of the medical evidence, Ms. Rosin, in her Atlantic article, wrote, "It shows that breast-feeding is probably, maybe, a little better, but it is far from the stampede of evidence" that has been promoted in the popular literature.

羅辛在回顧了各種醫療證據后,在《大西洋月刊》的這篇文章中寫道:“數據表明母乳喂養可能、或許是稍好一點點的喂養方式,但是并不存在充分證據”,證明它擁有大眾媒體所宣揚的種種好處。

"Over all," she concluded, "breast is probably best, but not so much better that formula deserves the label of 'public health menace,' alongside smoking."

她總結道:“總的來說,母乳也許是最好的,但它的好處還不足以讓配方奶淪落到跟吸煙一樣的境地,被人打上‘公共衛生公敵’的標簽。”

Perhaps it is time for more realistic, less polarizing messages about breast-feeding.

或許,是時候在母乳喂養這件事情上,傳遞出更理性、不偏激的信息了。
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