衛生福利部國民健康署近年來致力推廣母嬰親善及母乳哺餵政策，促使國人對母乳哺育支持度回升。但因健保相關政策的落實，致使產婦住院天數遽減，協助產婦有效學習正確的母乳哺育知識與技能，並能評斷奶水足以供足孩子所需，相形重要。目前國內外針對周產期衛教指導與初產婦母乳哺餵持續度之相關性研究匱乏，因而引發研究者探討的動機。
本研究目的在瞭解孕期傳授初產婦母乳哺育相關衛教指導，是否能提升初產婦母乳哺餵認知與技能、是否可強化其母乳哺餵自我效能及提高初產婦產後一個月內純母乳餵食的比率，並探討初產婦純母乳餵食狀況對新生兒體重變化的影響性及初產婦純餵母乳誘發新生兒高膽紅素血症入院照光的比率。
本研究為實驗性研究設計，針對台南市某區域教學醫院孕期滿32週以上之初產婦進行收案，以亂數表隨機分配入實驗組與對照組。本研究共收置38名初產婦，實驗組與對照組各19名，實驗組的初產婦，依母乳先修班課程規劃分別於妊娠32至36週間，配合初產婦產檢時間教授母乳哺育相關認知與技巧；對照組則維持原常規時程及指導方式執行衛教。收案時填寫母乳哺育認知前測及母乳哺餵自我效能第一次評量；產後第二天進行母乳哺育認知後測、母乳哺餵自我效能第二次測量並進行母乳哺餵技能之評測；產後一個月進行母乳哺餵自我效能第三次評估。新生兒部分則在出生後三天內、出生一個月紀錄其體重變化，並追蹤於出生兩週內因高膽紅素血症入院照光治療的比率。本研究以描述性統計、獨立樣本t檢定、成對樣本t檢定、皮爾森積差相關、二因子混合設計變異數分析進行資料分析。
研究結果發現(1)參與母乳先修班之初產婦其母乳哺餵認知及技能皆顯著高於周產期衛教指導組的初產婦；(2)參與母乳先修班之初產婦的母乳哺餵自我效能得分在產後第二天及產後一個月皆顯著高於周產期衛教指導組；(3)母乳先修班組的產後一個月內純餵食母乳的比率，顯著高於周產期衛教指導組；(4)純母乳餵食與混合奶餵食的新生兒在出生一個月時體重無顯著差異；(5)新生兒高膽紅素入院治療的比率與產婦純餵食母乳無顯著相關性。
本研究之結果有助於建立本土資料，做為周產期衛教指導內容修訂之參考，並提供母嬰團隊擬定在職教育之參考依據。

Background: In recent years, Ministry of Health and Welfare committed to promote the policy of baby friendly hospital and breastfeeding. However, the length of hospital stay reduced due to budget of health insurance. Therefore, assist mothers to learn effectively correct knowledge and skills of breastfeeding, and provide sufficient breast milk to babies is very important. Recent studies of the relationship between perinatal education and breastfeeding duration is deficient, thus the author decided to focus on this topic.

Aim: There are three purposes of the study. First, is to explore the effect of health education on primiparas’ cognition and skills of breastfeeding and the rate of exclusive breastfeeding. Second purpose is to examine the effect of education program on self-efficacy of breastfeeding. Last, is to explore the effect of exclusive breastfeeding on neonates’ hospitalization rate of hyperbilirubinemia.

Method: This study is an experimental research design. Primiparas of pregnancy over 32 weeks were recruited from a local community teaching hospital in Tainan. Subjects were randomly assigned to experimental and control groups. Thirty eight primiparas were in the experimental group, and 19 primparas were in the control group. Subjects in the experimental group received a breastfeeding placement class to teach cognition and skills of breastfeeding. Subjects in the control group received ordinary routine health education. The placement class started from subjects between 32-36 weeks of gestation. Subjects of two groups received the pretest of cognition and self-efficacy of breastfeeding questionnaire on the day of recruitment and the second day after delivering babies as the posttest. Subjects received the third time of self-efficacy assessment one month postpartum. Newborns’ body weight changes were recorded during one -three days and one month after birth. Hospitalization rate for phototherapy due to hyperbilirubinemia within two weeks of birth was documented. In this study, we used descriptive statistics, independent samples t-test, paired samples t-test, Pearson's product-moment correlation, two-factor mixed design ANOVA to analyze data.

Results: (1) The knowledge and skill on breastfeeding of women received placement breastfeeding education were higher than those received ordinary health education. (2) The breastfeeding self-efficacy scores of women in the experiment group on the second day and month postpartum were significantly higher than those in the control group. (3) Pure breastfeeding rate during postnatal one month of experiment group was significantly higher that of the control group. (4) The neonates’ body weight was not different between the pure breastfeeding and infant formula and breast milk mixed feeding groups, one month after birth. (5)The hospitalization rate of neonatal hyperbilirubinemia with pure breastfeeding rate was not related.

Conclusion: The results of the study will help to establish local data, as the reference to amend perinatal education content, and provide a guide to develop in-service education for maternal and child care team.

Summary:The study is to explore the effect of health education on primiparas’ cognition and skills of breastfeeding and the rate of exclusive breastfeeding. Second purpose is to examine the effect of education program on self-efficacy of breastfeeding. Last, is to explore the effect of exclusive breastfeeding on neonates’ hospitalization rate of hyperbilirubinemia. Results: (1) The knowledge and skill on breastfeeding of women received placement breastfeeding education were higher than those received ordinary health education. (2) The breastfeeding self-efficacy scores of women in the experiment group on the second day and month postpartum were significantly higher than those in the control group. (3) Pure breastfeeding rate during postnatal one month of experiment group was significantly higher that of the control group. (4) The neonates’ body weight was not different between the pure breastfeeding and infant formula and breast milk mixed feeding groups, one month after birth. (5)The hospitalization rate of neonatal hyperbilirubinemia with pure breastfeeding rate was not related. The results of the study will help to establish local data, as the reference to amend perinatal education content, and provide a guide to develop in-service education for maternal and child care team.

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