Objective To analyze the different conditions of breastfeeding and implementations of maternal and infant health care services between the first and second fetal time of multiparas,in order to explore the methods to promote breastfeeding & maternal and infant health care conditions under the two-child policy.Methods From January to March 2017,using the method of multistage stratified sampling,11 cities of Zhejiang Province was divided into 3 layers by economic levels ranking from high to low.This study randomly selected one city every layer,2 districts in each selected city,and one community health service center in each selected district.In all selected community health service centers,healthy mothers who had registered in community health service centers with no organic diseases and had a second baby aging from 6 months to 3 years old without birth defects were selected.The self-administered questionnaire was used and it contained basis information of respondents,main family members who took care of babies and pregnancy assessment conditions.This study compared and analyzed the different feeding patterns within 6 months of the first and second fetal times,different exclusive breastfeeding duration,different weaning reasons,whether having experienced breastfeeding difficulties and the source of the most effective help,different participation rates of pregnancy schools and postpartum visit situations between the first and second fetal times.Results There were 41 multiparas in the economic development class Ⅰ,73 multiparas in the economic development class Ⅱ and 54 in the economic development class There were significant differences of pregnancy assessment rates before the second pregnancy among different gestational ages (x2 =7.816,P ＜ 0.01).The consistency in feeding patterns of different fetal times was poor (Kappa =0.292,P ＜ 0.01),while there were statistically significant differences of feeding patterns in two fetal times (W =24.997,P =0.035).Exclusive breastfeeding duration and the whole breastfeeding duration of the second fetal time were longer than the first fetal time (P ＜ 0.05).The consistency in breastfeeding difficulties of different fetal times was general (Kappa =0.499,P ＜ 0.01) with statistical differences (x2 =4.45,P =0.034).'Experienced relatives or friends' and'searching by myself'were the two most effective ways for help when meeting breastfeeding difficulties.The participation rates of pregnancy schools were about 50.0％ in two fetal times with general consistency (Kappa =0.502,P ＜ 0.01) and no significant difference was found (W =1.097,P =0.778).There were 81 (48.2％) multiparas required the educations and instructions about breastfeeding skills after the second delivery.The consistency in postpartum visit situations was general in two fetal times (Kappa =0.431,P ＜0.01) with statistically significant differences (W =18.964,P ＜ 0.01).Conclusion The exclusive breastfeeding rate is raised in the second fetal time and the whole breastfeeding duration of the second fetal time is longer than the first fetal time.The participation rates of pregnancy schools in two fetal times are lower than 50.0％.There are gaps of times and contents of postpartum visit between the implementation and national requirements.General practitioners could offer relevant guidance to the elderly residents who take care of babies within general practitioners contract system in order to promote the breastfeeding situation.%目的 分析二孩政策开放后,经产妇不同胎次母乳喂养及母婴保健情况,探索改善母乳喂养状况及母婴保健的方法.方法 于2017年1-3月,采用多阶段分层抽样方法,将浙江省11个地级市按照经济水平由高到低分为3层,每层随机抽取1个城市,每个城市抽取2个市辖区,每个市辖区抽取1个社区卫生服务中心.选取已在社区卫生服务中心登记、二胎无出生缺陷且年龄为6个月～3周岁,无器质性疾病的健康母亲进行调查.采取自拟问卷方式调查,内容包含调查对象基本信息、主要照顾孩子的亲人、妊娠前评估情况.比较并分析一胎和二胎6个月内喂养方式、(纯)母乳喂养持续时间、终止母乳喂养的原因、是否有过母乳喂养困难及最有效帮助的来源、一胎和二胎孕妇学校参与度及分娩后访视差别.结果 经济发展Ⅰ类、Ⅱ类和Ⅲ类地区分别有41名、73名和54名二孩母亲.不同二胎受孕年龄经产妇妊娠前生殖评估行为比较,差异有统计学意义(x2 =7.816,P＜0.01).不同胎次经产妇0～6月龄喂养方式一致性较差(Kappa=0.292,P＜0.01),喂养方式比较,差异有统计学意义(W=24.997,P=0.035).二胎纯母乳喂养持续时长、母乳喂养持续时长均长于一胎(P＜0.05).不同胎次母乳喂养困难经历情况一致性一般(Kappa=0.499,P＜0.01),母乳喂养困难经历情况比较,差异有统计学意义(x2=4.45,P=0.034).“有经验的亲人或朋友”“自己搜索解决办法”是不同胎次经历母乳喂养困难时最有效帮助的来源.不同胎次孕妇学校参与情况均约占50.0％,一致性一般(Kappa=0.502,P＜0.01),孕妇学校参与情况比较,差异无统计学意义(W=1.097,P=0.778).二胎分娩回家后,有81例(48.2％)母亲仍需要母乳喂养知识及技巧的教育指导.不同胎次产后访视情况一致性一般(Kappa =0.431,P＜0.01),产后访视情况比较,差异有统计学意义(W=18.964,P＜0.01).结论 二胎时纯母乳喂养率较一胎时提高,二胎(纯)母乳喂养持续时长比一胎时延长.两胎次孕妇学校参与度均不足50.0％.基层妇幼保健机构分娩后访视次数及内容与国家规范尚存差距.全科医生可为需照护孙辈的签约老年居民提供母乳喂养指导,以改善母乳喂养现状.
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