产后恢复与哺乳 · 生完孩子身体在做什么

参考文献 · 22

1. American College of Obstetricians and Gynecologists (Ogunyemi, D.). (2022). 3 conditions to watch for after childbirth (patient education; last updated January 2022, last reviewed February 2026). Postpartum preeclampsia most often happens within a few days after delivery but can occur up to 6 weeks later; call the doctor right away for blood pressure of 140 systolic or 90 diastolic or higher, vision changes, a headache that won't go away, shortness of breath, swelling of the face or hands, upper-right belly pain, nausea or vomiting. Postpartum hemorrhage is bleeding much heavier than usual, soaking through two pads an hour for more than 1 to 2 hours; it usually happens within 24 hours but can occur up to 12 weeks later; the most common cause is uterine atony, when the uterine muscles do not contract normally so blood vessels do not tighten after delivery; signs include large clots, pale or clammy skin, feeling faint or dizzy, confusion and a rapid heart rate. Endometritis usually happens 2 to 10 days after delivery (up to 6 weeks): fever and chills, abdominal pain, foul-smelling discharge. If you cannot reach your ob-gyn or need immediate care, call 911 or go to the hospital. www.acog.org/womens-health/experts-and-stories/the-latest/3-conditions-to-watch-for-after-childbirth
2. Visness, C. M., Kennedy, K. I., & Ramos, R. (1997). The duration and character of postpartum bleeding among breast-feeding women. Obstetrics & Gynecology, 89(2), 159-163. Prospective cohort of 477 experienced breast-feeding women in Manila who kept a bleeding diary. The median duration of lochia was 27 days and did not vary by age, parity, infant sex or weight, breast-feeding frequency or supplementation. More than one-fourth had a bleeding episode separated from the lochia by at least 4 bleeding-free days and beginning by postpartum day 56. Lochia lasted substantially longer than the conventional 2 weeks, and bleeding often stopped and started again. Return of menses is rare among fully breast-feeding women in the first 8 weeks postpartum. 10.1016/S0029-7844(96)00482-6
3. NHS. (2024). Your body after the birth (page last reviewed 25 April 2024). Bleeding (lochia) is quite heavy at first; it may be redder and heavier when you breastfeed because breastfeeding makes the womb contract, with cramps like period pains; it carries on for a few weeks, gradually turns brownish and stops. Tell your midwife if you are losing blood in large clots. Leaking a bit of pee when you laugh, cough or move suddenly is quite common after having a baby; pelvic floor exercises can help, and tell the GP at your postnatal check if they are not helping. On the third or fourth day the breasts may feel tight and tender as they start to produce milk. www.nhs.uk/pregnancy/labour-and-birth/your-body
4. Pang, W. W., & Hartmann, P. E. (2007). Initiation of human lactation: secretory differentiation and secretory activation. Journal of Mammary Gland Biology and Neoplasia, 12(4), 211-221. Review. Lactation starts in two stages: secretory differentiation in pregnancy, when mammary epithelial cells become lactocytes able to make milk constituents such as lactose (requiring a lactogenic hormone complex of estrogen, progesterone, prolactin and metabolic hormones), and secretory activation, the onset of copious milk secretion. The withdrawal of progesterone triggers secretory activation, but prolactin, insulin and cortisol must also be present. Milk ejection is the expulsion of milk already secreted; milk secretion is a separate, continuous process. 10.1007/s10911-007-9054-4
5. Bloch, M., Schmidt, P. J., Danaceau, M., Murphy, J., Nieman, L., & Rubinow, D. R. (2000). Effects of gonadal steroids in women with a history of postpartum depression. The American Journal of Psychiatry, 157(6), 924-930. Experimental simulation in 16 euthymic women (8 with and 8 without a history of postpartum depression): hypogonadism induced with leuprolide, supraphysiologic estradiol and progesterone added back for 8 weeks, then both withdrawn under double-blind conditions. Five of the eight women with a history of postpartum depression (62.5%) and none of the comparison group developed significant mood symptoms during withdrawal. The authors read this as direct evidence that estrogen and progesterone are involved in postpartum depression in a subgroup of women who are differentially sensitive to them. Very small study. 10.1176/appi.ajp.157.6.924
6. Centers for Disease Control and Prevention. (2024). Urgent maternal warning signs (Hear Her campaign; last updated May 15, 2024). Be aware of urgent maternal warning signs during pregnancy and in the year after delivery, and seek medical care immediately for: a headache that won't go away or gets worse; dizziness or fainting; changes in vision; fever of 100.4°F or higher; extreme swelling of the hands or face; thoughts about harming yourself or your baby; trouble breathing; chest pain or fast-beating heart; severe nausea and throwing up; severe belly pain that doesn't go away; vaginal bleeding or discharge after pregnancy; severe swelling, redness or pain of a leg or arm. Tell providers if you were pregnant within the last year. www.cdc.gov/hearher/maternal-warning-signs/index.html
7. Royal College of Obstetricians and Gynaecologists. (2015). Reducing the risk of venous thrombosis in pregnancy and after birth (patient information, August 2015). Pregnancy increases the risk of deep vein thrombosis, with the highest risk being just after the baby is born; venous thrombosis is still uncommon in pregnancy or in the first 6 weeks after birth, occurring in only 1-2 in 1000 women. Risk is higher with immobility, dehydration, a very long labour (more than 24 hours), a caesarean section, losing a lot of blood after the birth or a blood transfusion. Stay as active as you can and keep hydrated by drinking normal amounts of fluids. Sudden unexplained difficulty in breathing, tightness in the chest or chest pain, coughing up blood, or feeling very unwell or collapsing may mean a pulmonary embolism: seek help immediately. www.rcog.org.uk/for-the-public/browse-our-patient-information/reducing-the-risk-of-venous-thrombosis-in-pregnancy-and-after-birth
8. Uvnäs Moberg, K., Ekström-Bergström, A., Buckley, S., Massarotti, C., Pajalic, Z., Luegmair, K., Kotlowska, A., Lengler, L., Olza, I., Grylka-Baeschlin, S., Leahy-Warren, P., Hadjigeorgiu, E., Villarmea, S., & Dencker, A. (2020). Maternal plasma levels of oxytocin during breastfeeding: a systematic review. PLoS ONE, 15(8), e0235806. Systematic review of 29 exploratory studies (601 women). Breastfeeding induced an immediate, short-lasting (20 minutes) oxytocin release, pulsatile early postpartum. The number of oxytocin pulses in early breastfeeding was associated with greater milk yield and longer lactation and was reduced by stress. Breastfeeding-induced oxytocin release was associated with higher prolactin and lower ACTH and cortisol. All included studies were exploratory. 10.1371/journal.pone.0235806
9. Daly, S. E., Owens, R. A., & Hartmann, P. E. (1993). The short-term synthesis and infant-regulated removal of milk in lactating women. Experimental Physiology, 78(2), 209-220. Breast volume was measured before and after every feed over 24 h in seven mothers at home. Short-term milk synthesis rates varied markedly between breasts and between feeds, and for six of thirteen breasts were positively related to how far the breast had been emptied. Infants rarely emptied the breast (mean 76% of available milk removed), and the storage capacity of a breast was related to the demand for milk from that breast. Milk supply is linked to infant demand through local (autocrine) control in each breast. Small physiological study. 10.1113/expphysiol.1993.sp003681
10. Foong, S. C., et al. (2020). Oral galactagogues for increasing breast-milk production in mothers of non-hospitalised term infants. Cochrane Database of Systematic Reviews, CD011505.pub2. Evidence for fenugreek and other galactagogues is low to very-low certainty; effective, frequent milk removal is first-line. 10.1002/14651858.CD011505.pub2
11. Dror, D. K., & Allen, L. H. (2018). Overview of nutrients in human milk. Advances in Nutrition, 9(suppl_1), 278S-294S. Review of how each nutrient in milk varies with lactation stage, maternal intake, status and supplementation. Thiamin, riboflavin, vitamin B-6, vitamin B-12, choline and iodine concentrations in milk are associated with maternal intake, and milk fatty acid composition depends on the mother's intake and status. Milk iron is not associated with maternal intake and iron supplementation does not raise it; zinc is refractory to maternal status, intake and supplementation; milk folate is unrelated to maternal folate status or intake; neither maternal status nor calcium or vitamin D interventions have shown an effect on milk calcium (dietary calcium may matter only where habitual intake is low). In well-nourished women, vitamin A intake or supplementation has much less influence on milk. Breast milk supplies the exclusively breastfed infant with only about 15 IU/d of vitamin D activity. 10.1093/advances/nmy022
12. Brenna, J. T., Varamini, B., Jensen, R. G., Diersen-Schade, D. A., Boettcher, J. A., & Arterburn, L. M. (2007). Docosahexaenoic and arachidonic acid concentrations in human breast milk worldwide. The American Journal of Clinical Nutrition, 85(6), 1457-1464. Descriptive meta-analysis of 65 studies (2474 women). Mean breast-milk DHA was 0.32% of fatty acids by weight (range 0.06-1.4%), lower and more variable than arachidonic acid (0.47%, range 0.24-1.0%). The highest DHA concentrations were mainly in coastal populations and were associated with marine food consumption. 10.1093/ajcn/85.6.1457
13. Centers for Disease Control and Prevention. (2026). Maternal diet and breastfeeding (breastfeeding special circumstances; last updated August 25, 2026). An additional 330 to 400 kcal per day is recommended for well-nourished breastfeeding mothers. Guidelines recommend 290 mcg of iodine daily during lactation. A low to moderate caffeine intake is about 300 mg or less per day, about 2 to 3 cups of coffee; irritability, poor sleeping patterns, fussiness and jitteriness have been reported in infants, and preterm and younger newborns break caffeine down more slowly, so their mothers might consume even less. Most fish contain mercury that can pass to the infant through breast milk. Breastfed infants of women who eat no animal products may have very limited vitamin B12. Women generally do not need to limit or avoid specific foods while breastfeeding. www.cdc.gov/breastfeeding-special-circumstances/hcp/diet-micronutrients/maternal-diet.html
14. Wagner, C. L., Greer, F. R., American Academy of Pediatrics Section on Breastfeeding, & American Academy of Pediatrics Committee on Nutrition. (2008). Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics, 122(5), 1142-1152. Clinical report. Rickets from inadequate vitamin D intake and low sun exposure is still reported. Because natural dietary sources are limited and adequate sun exposure is hard to judge and may raise skin-cancer risk, all infants, including those exclusively breastfed, and all children and adolescents should have a minimum daily vitamin D intake beginning soon after birth. Breastfed and partially breastfed infants should be supplemented beginning in the first few days of life, continuing unless weaned to at least 1 L/day of vitamin D-fortified formula or whole milk; nonbreastfed infants taking less than 1000 mL/day of fortified formula or milk should also be supplemented (a stated dose; this site leaves the dose to the paediatrician). 10.1542/peds.2008-1862
15. Kovacs, C. S. (2017). The skeleton is a storehouse of mineral that is plundered during lactation and (fully?) replenished afterwards. Journal of Bone and Mineral Research, 32(4), 676-680. Perspective review. Women who breastfeed exclusively lose an average of 210 mg calcium in milk each day (twins or triplets double or triple it), and skeletal calcium released during lactation provides much of it. Lumbar spine BMD declines by a mean of 5% to 10% during 3 to 6 months of exclusive lactation; mostly cortical sites lose half that or nothing. Losses come from osteoclast-mediated resorption and osteocytic osteolysis. After weaning the skeleton is fully restored to its prior mineral content and strength in animals and humans, despite persistent microarchitectural changes; the factors driving recovery are unclear. In most studies a history of lactation does not increase, and may protect against, low BMD and fragility fractures. 10.1002/jbmr.3090
16. Kalkwarf, H. J., Specker, B. L., Bianchi, D. C., Ranz, J., & Ho, M. (1997). The effect of calcium supplementation on bone density during lactation and after weaning. The New England Journal of Medicine, 337(8), 523-528. Two randomized placebo-controlled trials of calcium in postpartum women (lactation study: 97 lactating and 99 nonlactating women from about 2 weeks postpartum; weaning study: 95 weaning and 92 nonlactating women). Lumbar spine bone density fell 4.2% in lactating women given calcium and 4.9% with placebo over 6 months, while it rose in nonlactating women. After weaning it increased 5.9% with calcium and 4.4% with placebo. Calcium had no effect on breast-milk calcium. Conclusion: calcium supplementation does not prevent bone loss during lactation and only slightly enhances the gain in bone density after weaning. 10.1056/NEJM199708213370803
17. Woodley, S. J., Lawrenson, P., Boyle, R., Cody, J. D., Mørkved, S., Kernohan, A., & Hay-Smith, E. J. C. (2020). Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews, 5, CD007471. 46 trials, 10,832 women, 21 countries; many trials at moderate to high risk of bias. Continent pregnant women doing antenatal PFMT probably have a lower risk of urinary incontinence in late pregnancy (62% less; RR 0.38; moderate quality) and slightly lower risk 3-6 months postpartum (29% less; RR 0.71; high quality). For postnatal women with persistent incontinence there is no evidence PFMT makes a difference at 6-12 months (RR 0.55, 95% CI 0.29-1.07; low quality), and the effect of PFMT started after delivery in a mixed population is uncertain (RR 0.88). Authors: early structured antenatal PFMT in continent women may prevent incontinence; a population approach to postnatal PFMT is not likely to reduce it; uncertainty surrounds PFMT as treatment in antenatal and postnatal women, in contrast with its more established effectiveness in mid-life women. 10.1002/14651858.CD007471.pub4
18. World Health Organization. (2022). WHO recommendations on maternal and newborn care for a positive postnatal experience. Geneva: WHO (ISBN 9789240045989). Rec. 7: starting routine pelvic floor muscle training after childbirth to prevent urinary and faecal incontinence is not recommended; women who leak small volumes of urine after childbirth should be advised of its potential benefits, and unsupervised home exercises may be beneficial and are unlikely to cause harm. Rec. 18: screening for postpartum depression and anxiety with a validated instrument (such as EPDS or PHQ-9), with diagnosis and management for women who screen positive, is recommended; every woman should be asked about emotional well-being at each contact. Rec. 19: psychosocial and/or psychological interventions to prevent postpartum depression and anxiety are recommended. Rec. 20 (context-specific, from a 2016 conditional recommendation on low-certainty evidence): oral iron, alone or with folic acid, may be given for 6-12 weeks after birth where gestational anaemia is a public-health concern, irrespective of lactation. Rec. 21: postpartum vitamin A supplementation is not recommended. iris.who.int/handle/10665/352658
19. Sperstad, J. B., Tennfjord, M. K., Hilde, G., Ellström-Engh, M., & Bø, K. (2016). Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. British Journal of Sports Medicine, 50(17), 1092-1096. Prospective cohort of 300 first-time pregnant women; DRA defined as a palpated separation of 2 or more fingerbreadths. Prevalence was 33.1%, 60.0%, 45.4% and 32.6% at gestation week 21 and 6 weeks, 6 months and 12 months postpartum. Women reporting heavy lifting 20 or more times a week were more likely to have DRA (OR 2.18). Women with and without DRA reported the same amount of lumbopelvic pain 12 months postpartum. 10.1136/bjsports-2016-096065
20. Montgomery-Downs, H. E., Insana, S. P., Clegg-Kraynok, M. M., & Mancini, L. M. (2010). Normative longitudinal maternal sleep: the first 4 postpartum months. American Journal of Obstetrics and Gynecology, 203(5), 465.e1-465.e7. Wrist actigraphy in 50 mothers over postpartum weeks 2-13 and 24 mothers over weeks 9-16. Nocturnal sleep time was 7.2 h and did not change across weeks 2-16, but sleep efficiency improved from 79.7% at week 2 to 90.2% at week 16 as fragmentation fell. Total sleep was higher than expected, but it was highly fragmented (similar to fragmenting sleep disorders) and inefficient. 10.1016/j.ajog.2010.06.057
21. NHS. (2026). Postnatal depression: overview (page last reviewed 18 March 2026). Feeling down, anxious or irritable for a few days after the birth is very common, sometimes called the baby blues, and usually goes away within 2 weeks. Postnatal depression can begin in pregnancy, soon after birth or up to a year after; symptoms include persistent low mood, lack of enjoyment and interest, trouble bonding with the baby, sleep problems, and thoughts of suicide or of harming yourself or your baby. Speak to a GP, midwife or health visitor if you think you might have it; fathers and partners can also have depression after having a baby. www.nhs.uk/mental-health/conditions/post-natal-depression/overview
22. NHS. (2023). Mastitis (page last reviewed 17 March 2023). Mastitis is when the breast becomes swollen, hot and painful; it is common in breastfeeding women because it can be caused by a build-up of milk. It usually affects one breast and comes on quickly: a hot, painful swollen area, a wedge-shaped lump, burning while breastfeeding, and flu-like symptoms such as aches, a high temperature and tiredness. Keep breastfeeding regularly, check the baby's attachment, use cold compresses and painkillers; see a GP if symptoms do not improve 12 to 24 hours after treating it at home, or 48 hours after starting antibiotics. www.nhs.uk/conditions/mastitis