Antenatal breast examination for promoting breastfeeding

 

Abstract

Background

The rationale for antenatal breast examination has included the need to determine whether any problems with breastfeeding could be anticipated, using the time during examination as an opportunity for the healthcare provider to introduce and discuss the importance of breastfeeding, and for the detection of breast cancer during pregnancy. Despite these purported benefits of antenatal breast examination, whether there is evidence that it should be recommended for all pregnant women remains unclear.

Objectives

To determine the effect of antenatal breast examination(s) on the initiation of breastfeeding.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2008).

Selection criteria

All randomised controlled trials of the effects of antenatal breast examination, with a concurrent comparison group.

Data collection and analysis

Two review authors independently assessed trial quality and extracted data.

Main results

We identified no randomised controlled trials.

Authors' conclusions

Ideally, policies that govern the care of pregnant women should be evidence based. There is no doubt that breastfeeding is beneficial for both mother and infant. However, there is no evidence to support the notion that antenatal breast examinations are effective in promoting breastfeeding, nor any evidence on other potential effects of antenatal breast examination, such as the detection of breast anomalies or satisfaction with care.

 

Plain language summary

Breast examination during pregnancy for promoting breastfeeding

The rationale for breast examination during pregnancy is to determine whether any problems with breastfeeding can be anticipated and to use the opportunity for the healthcare provider and pregnant woman to discuss breastfeeding. Examination by a healthcare provider is recommended in some countries. Breast examination can also be performed by the pregnant woman herself. Furthermore, breast examination during pregnancy has been recommended as a screening method for breast cancer, although no evidence has been found to support breast examination by a doctor, nurse or the woman as a primary screening technique for breast cancer. A woman’s breasts are often tender and swollen during pregnancy. This makes examination difficult and potentially compounds a woman's feelings of discomfort or vulnerability. Some women may find a clinical breast examination during pregnancy intrusive, and identification of flat or inverted nipples may actually act as a deterrent to breastfeeding. No randomised controlled trials were identified to guide a decision on whether antenatal breast examination promotes breastfeeding. Ideally, policies that govern the care of pregnant women should be evidence based and impact on any disease outcomes.

 

摘要

背景

產前進行乳房檢查以促進哺乳

產前乳房檢查的理論基礎，包括(1)需要確定是否可能發生任何哺餵母乳的問題、(2)讓醫護人員利用檢查時機，介紹及討論母乳哺育的重要性，(3)同時也可以在懷孕期間檢查有無乳癌。儘管醫學界聲稱產前乳房檢查具有上述的優點，但是仍需要釐清是否有證據，建議所有孕婦都接受乳房檢查。

目標

本篇回顧的目的是確定產前乳房檢查的對開始哺乳的效果。

搜尋策略

我們搜尋了Cochrane Pregnancy and Childbirth Group's Trials Register (2008年3月)資料庫。

選擇標準

所有調查產前乳房檢查之效果的隨機對照試驗，包含同時比對的對照組。

資料收集與分析

2位進行回顧的作者獨立評估試驗的品質及摘錄數據。

主要結論

我們並未發現任何一篇相關的隨機對照試驗。

作者結論

理論上，與孕婦照護有關的管理政策，應該以證據為依據。無疑的，哺乳對於母親和嬰兒都是有利的。然而，目前還沒有證據可支持產前乳房檢查能有效地促進哺乳的概念，也沒有證據支持產前乳房檢查具有其他潛在的效果，例如檢查乳房異常或是讓孕婦對於照護感到滿意。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

懷孕期間進行乳房檢查的理論基礎，是為了確定是否可能發生任何哺乳問題，以及讓醫護人員及孕婦利用這個機會討論母乳哺育。某些國家建議由健康照顧人員進行檢查。孕婦本身也可以進行乳房自我檢查。 此外，醫學界已建議利用懷孕期間的乳房檢查作為乳癌的檢查方法，雖然並未發現證據，可以支持由醫生、護士或女性本身進行乳房檢查，作為乳癌的主要篩檢技術。女性乳房在懷孕期間經常較敏感且腫脹。這會造成檢查困難，而且可能造成造成女性不舒服或易受傷的感覺。有些女性覺得，在懷孕期間進行臨床上的乳房檢查是受到侵擾的，而且辨別出乳頭平坦或乳頭凹陷，可能會遏止母親以母乳哺育。我們沒有發現任何隨機對照試驗，可確認產前乳房檢查能否促進哺餵母乳。理論上，與孕婦照護有關的管理政策，應該以證據為依據，而且會對於任何的疾病結果造成影響。