Fatores associados à amamentação na primeira hora de vida

Abstract

OBJECTIVE:To identify factors associated with breastfeeding in the fi rst hour of life (Step 4 of the Baby-Friendly Hospital Initiative). METHODS:A cross-sectional study was conducted with a representative sample of mothers who gave birth in maternity wards in the city of Rio de Janeiro, Southeastern Brazil, between 1999 and. Newborns or mothers with restriction to breastfeeding were excluded, resulting in a sample of 8,397 pairs. A random effect -at maternity hospital level -Poisson model was employed in a hierarchical approach with three levels: distal, intermediate and proximal for characteristics of the mother, of the newborn, and of prenatal and hospital assistance. RESULTS:Only 16% of the mothers breastfed in the fi rst hour of life. Breastfeeding in this period was less prevalent among neonates with immediate intercurrences after birth (PR = 0.47; CI99% 0.15;0.80); among mothers who did not have contact with their newborns in the delivery room (PR = 0.62; CI99% 0.29;0.95); among mothers submitted to cesarean section delivery (PR = 0.48; CI99% 0.24;0.72); and among mothers who gave birth at private maternity hospitals (PR = 0.06; CI99% 0.01;0.19) or at maternity hospitals contracted out to National Health System (SUS) (PR = 0.16; CI99% 0.01;0.30). The context effect of maternity wards was statistically signifi cant. CONCLUSIONS:At an individual level, breastfeeding within one hour after birth was constrained by inappropriate practices in private or SUS-contracted maternity hospitals. The group effect of maternity hospitals and the absence of individual maternal-related factors that explain the outcome suggest that mothers have little or no autonomy to breastfeed their babies within the fi rst hour of life, and depend on the institutional practices that prevail at the maternity hospitals.

Fatores ligados aos serviços de saúde determinam o aleitamento materno na primeira hora de vida no Distrito Federal, Brasil, 2011

“…Boccolini et al 20 observed this same trend in Rio de Janeiro. Cesarean section influences the postponement of the first breastfeeding 40,41 due to several factors, including those related to anesthesia and the surgical procedure itself 20 .…”

“…Boccolini et al 20 observed this same trend in Rio de Janeiro. Cesarean section influences the postponement of the first breastfeeding 40,41 due to several factors, including those related to anesthesia and the surgical procedure itself 20 . The prevalence of cesarean delivery in this study was high (61.5%), and also higher than that observed in Brazil (55.4%) 41 , which indicates the need to review the current professional practice that elects caesarean section as a routine procedure, since Brazil accounted for 15% of the unnecessary cesareans occurred globally in 2008 42 .…”

“…The orientation on breastfeeding by health professionals soon after birth increased the chance of women to breastfeed in the first hour of life 17 . Boccolini et al 20 found that mothers have limited or no power to make decisions about breastfeeding their children in the first hour of life, and shall be subject to the practices and actions of the professionals involved in the delivery, as well as to the institutional procedures in place in maternity wards. Inadequate hospital procedures in healthy newborns, such as aspiration of air and gastric tract immediately after birth 5 and providing food before breastfeeding 9 have also been identified in the literature as factors that may interfere in the early breastfeeding, which reinforces the importance of the WHO's recommendation that mother and baby should not be separated in the delivery room, except if there is a medical reason to justify such action 1 .…”

“…Few studies have investigated the factors associated with breastfeeding within one hour of birth in the Brazilian population 15,[18][19][20][21][22] and none of them were conducted in the Midwest region. This study aimed at investigating the prevalence of breastfeeding in the first hour of life, as well as the factors that interfered in this practice in the Federal District, the country capital, in 2011.…”

Práticas educativas segundo os “Dez passos para o sucesso do aleitamento materno” em um Banco de Leite Humano

“…O contato pele a pele e a amamentação na sala de parto podem sofrer ainda a influência das normas e rotinas dos serviços de saúde, do investimento em capacitações e da tradição institucional 14 , os quais podem caracterizar a sistemática das maternidades do interior do estado onde a Iniciativa Hospital Amigo da Criança ainda não atingiu ampla divulgação e/ou implementação.…”