Influência das práticas de incentivo e apoio à amamentação em maternidades na prevalência do aleitamento materno exclusivo no primeiro mês de vida do bebê

Apesar das evidências sobre o impacto positivo da amamentação exclusiva na saúde da criança e da mãe, sua prevalência é preocupante, pois mesmo sendo um poderoso comportamento de promoção de saúde ainda é pouco adotada. Diante desse cenário, fica evidente a necessidade de se intensificar esforços em prol da amamentação exclusiva e identificar estratégias para tal. Algumas práticas de incentivo à amamentação nas maternidades se associam ao aumento na duração da amamentação e existe uma relação dose-resposta entre o número de práticas às quais as duplas mãe-bebê são expostas e a duração da amamentação exclusiva. Porém, não há estudos que tenham avaliado o efeito de um conjunto de práticas pró-amamentação em maternidades nas prevalências de amamentação exclusiva. A ideia do presente estudo nasceu a partir do conhecimento desta lacuna, tendo como objetivo avaliar a associação entre o conjunto dessas práticas e a prevalência de amamentação exclusiva no primeiro mês de vida do bebê, levando em consideração a contribuição de cada uma das práticas nesse efeito. Trata-se de um estudo transversal envolvendo 287 mulheres que tiveram parto em duas maternidades em Porto Alegre, Brasil: uma pública, com certificação na Iniciativa Hospital Amigo da Criança, e outra privada, sem certificação nessa Iniciativa. Foram selecionadas aleatoriamente mulheres que tiveram recém-nascidos a termo, não gemelares e sem intercorrências neonatais. Após 30 dias do parto, elas foram entrevistadas em seus domicílios. As práticas avaliadas foram: contato pele a pele, amamentação na primeira hora de vida, alojamento conjunto ininterrupto, apoio profissional na amamentação, orientações sobre amamentação, incentivo à amamentação em livre demanda, não suplementação com fórmula infantil e não uso de chupeta Foi elaborada uma variável latente, que resume em uma única medida os resultados dessas práticas, denominada escore de práticas pró-amamentação, através do ajuste de um modelo da Teoria de Resposta ao Item (TRI), o Modelo Logístico de Dois Parâmetros, que permite que cada prática tenha seu parâmetro de discriminação e dificuldade estimados individualmente. A associação entre amamentação exclusiva aos 30 dias de vida e o escore de práticas pró-aleitamento foi verificada por meio de regressão de Poisson com variância robusta, sendo estimada razão de prevalência (RP) e seus respectivos intervalos de confiança (IC 95%). Como resultados, encontramos prevalência de amamentação exclusiva aos 30 dias de vida da criança de 61,7%. As práticas com maior capacidade de discriminação, ou seja, que mais contribuíram na estimativa do escore foram: apoio profissional para amamentar, orientações sobre amamentação e incentivo à livre demanda. Já as práticas mais difíceis foram: recém-nascido 9 colocado para mamar na 1ª hora de vida, incentivo à livre demanda e não uso de fórmula infantil. A análise multivariável estimou que a cada unidade (desvio padrão) de acréscimo no escore há um aumento de 20% na prevalência de amamentação exclusiva aos 30 dias de vida. Concluímos que a associação entre prevalência de amamentação exclusiva no primeiro mês de vida do bebê e o escore de práticas pró-amamentação nas maternidades aponta para a importância do conjunto dessas práticas para a melhoria dos indicadores de aleitamento materno.Despite the evidences on the positive impact of exclusive breastfeeding on the health of the child and mother, this prevalence is worrying, because, even being a powerful behavior of health promotion, is still little adopted. Given this scenario, it is evident the need of intensifying efforts to promote exclusive breastfeeding and identify its strategies. Some practices of incentive to breastfeeding in maternity hospitals are associated with increased duration of breastfeeding and there is a dose-response relationship between the number of practices to which mother-baby pairs are exposed and the duration of exclusive breastfeeding. However, there are no studies that have evaluated the effect of a set of practices of encouragement and support to breastfeeding in the prevalence of exclusive breastfeeding. The idea of this study was born from the knowledge of this lack, being its goal to evaluate the association between a set of pro-breastfeeding practices in maternity hospitals and the prevalence of exclusive breastfeeding in the first month of the baby’s life, taking into account the contribution of each of the practices to this effect. It’s a cross-sectional study involving 287 women who had delivered in two maternity hospitals in Porto Alegre, Brazil: one public, with certification in the Baby-Friendly Hospital Initiative, and another private, without certification in such Initiative. Women who had babies to term, non-twins and with no neonatal complications were randomly selected, and after 30 days of delivery, they were interviewed at home. The evaluated pro-breastfeeding practices were: skin-to-skin contact, breast-feeding in the first hour, rooming-in, professional support in breastfeeding, breastfeeding orientations, encouragement to feeding on demand, non-supplementation with infant formula and no pacifier. It was elaborated a latent variable, summarizing in a single measure the results of such practices called pro-breastfeeding practices score with the adjustment of a model of Item Response Theory (IRT), the Two-Parameter Logistic Model that allows that each practice has its discrimination and difficulty parameters individually estimated. It was used the Poisson regression with robust variance to verify the association between exclusive breastfeeding at 30 days of life and the score of practices of breastfeeding encouragement and support, being estimated the prevalence ratio (PR) and its respective confidence intervals (CI 95%). As results, it was found prevalence of 61.7% of exclusive breastfeeding at the 30 days of the child’s life. The practices with greater discrimination capacity, that is, which contributed the most in the score estimations, were: professional support for breastfeeding, breastfeeding orientation, and incentive to breastfeeding on demand. The most difficult ones were: suckling within the first hour of life, on-demand 11 incentive, and non-utilization of infant formula. The multivariate analysis estimated that at each unit (standard deviation) of increase in the score there is an increase of 20% in the prevalence of exclusive breastfeeding at 30 days. It was concluded that the association between prevalence of exclusive breastfeeding in the baby’s first month of life and the score of pro-breastfeeding practices in the maternity hospitals points to the importance of all these practices for the improvement of breastfeeding indicators

Association between maternal satisfaction with breastfeeding and postpartum depression symptoms

Background Due to the multiple health benefits of breastfeeding, it is essential to identify factors that may negatively interfere with this healthy practice. Among such factors are postpartum depression (PPD) and maternal satisfaction with breastfeeding. The objective of this study was to evaluate the association between maternal satisfaction with breastfeeding and symptoms of PPD in the first month after childbirth. Methods This cross-sectional study nested in a cohort study was conducted in Porto Alegre, Brazil, with 287 puerperal women selected at two maternity hospitals, one public and one private. Women were interviewed at their homes the week after the infant completed 30 days of life. A structured questionnaire was applied, as well as instruments to evaluate maternal satisfaction with breastfeeding (Maternal Breastfeeding Evaluation Scale) and to screen for PPD (Edinburgh Postnatal Depression Scale). The association between higher satisfaction with breastfeeding (outcome) and negative PPD screening test was assessed using Poisson regression with robust variance, adjusting for specific covariables. Adjusted prevalence ratios (aPR) and respective 95% confidence intervals (95%CI) were estimated. Results The prevalence of increased satisfaction with breastfeeding (defined as women with scores above the median) was 47% higher among women who screened negative for PPD when compared to those with a positive result (aPR 1.47; 95%CI 1.01–2.16). This result was adjusted for maternal age and skin color, cohabitation with the infant’s father, planned pregnancy, type of delivery, exclusive breastfeeding, and occurrence of breastfeeding problems. Conclusions The findings of this study showed an association between higher maternal satisfaction with breastfeeding and absence of PPD symptoms, reinforcing the importance of caring for the mental health of pregnant and puerperal women and paying attention to their satisfaction with breastfeeding.Telemedicin

Maternal satisfaction with breastfeeding in the first month postpartum and associated factors

Background:Breastfeeding success has been measured based on its duration, disregarding satisfaction with thematernal experience. Studies to investigate maternal satisfaction with breastfeeding are rare, especially in Brazil, andlittle is known about their determinants. The aim of this study was to measure the level of satisfaction withbreastfeeding in a group of women in the first month of their child’s life, and to identify factors associated withhigher maternal satisfaction.Methods:A cross-sectional study nested within a cohort was conducted with 287 women recruited at two (onepublic, one private) maternity services in the city of Porto Alegre, southern Brazil, from January to July 2016. Womenresiding in the municipality who had given birth to a healthy singleton born at term, were rooming in, and hadinitiated breastfeeding were randomly included. During the week after the child was 30 days old, women wereinterviewed at their homes to measure the level of maternal satisfaction with breastfeeding, using the MaternalBreastfeeding Evaluation Scale (MBFES), validated for use in the Brazilian population. Associations between maternalsatisfaction and explanatory variables were estimated using multivariate Poisson regression with robust variance ina four-level hierarchical approach. Satisfaction level was categorized using as cutoff point the median scoreobtained with the MBFES. Women with scores equal to or above the median were considered to have higher levelsof satisfaction, whereas those scoring below the median were considered to be less satisfied.Results:Maternal satisfaction with breastfeeding in the first month postpartum was high, with a median score of124 on MBFES, close to the maximum score (145 points). The prevalence of more elevated levels of satisfactionwith breastfeeding was higher among women with brown (pardo) and black skin color (prevalence ratio [PR] 1.33,95%CI 1.05;1.69), those who lived with the partner (PR 1.75, 95%CI 1.05;2.94), who planned to breastfeed for 12months or more (PR 1.48, 95%CI 1.02;2.17), and who did not report low milk supply (PR 1.47, 95%CI 1.03;2.10) orcracked nipples (PR 1.29, 95%CI 1.01;1.65).Conclusions:The factors associated with maternal satisfaction with breastfeeding in the first month postpartuminclude individual factors and maternal expectations, family constitution, as well as breastfeeding-related problems

Influência das práticas de incentivo e apoio à amamentação em maternidades na prevalência do aleitamento materno exclusivo no primeiro mês de vida do bebê

Apesar das evidências sobre o impacto positivo da amamentação exclusiva na saúde da criança e da mãe, sua prevalência é preocupante, pois mesmo sendo um poderoso comportamento de promoção de saúde ainda é pouco adotada. Diante desse cenário, fica evidente a necessidade de se intensificar esforços em prol da amamentação exclusiva e identificar estratégias para tal. Algumas práticas de incentivo à amamentação nas maternidades se associam ao aumento na duração da amamentação e existe uma relação dose-resposta entre o número de práticas às quais as duplas mãe-bebê são expostas e a duração da amamentação exclusiva. Porém, não há estudos que tenham avaliado o efeito de um conjunto de práticas pró-amamentação em maternidades nas prevalências de amamentação exclusiva. A ideia do presente estudo nasceu a partir do conhecimento desta lacuna, tendo como objetivo avaliar a associação entre o conjunto dessas práticas e a prevalência de amamentação exclusiva no primeiro mês de vida do bebê, levando em consideração a contribuição de cada uma das práticas nesse efeito. Trata-se de um estudo transversal envolvendo 287 mulheres que tiveram parto em duas maternidades em Porto Alegre, Brasil: uma pública, com certificação na Iniciativa Hospital Amigo da Criança, e outra privada, sem certificação nessa Iniciativa. Foram selecionadas aleatoriamente mulheres que tiveram recém-nascidos a termo, não gemelares e sem intercorrências neonatais. Após 30 dias do parto, elas foram entrevistadas em seus domicílios. As práticas avaliadas foram: contato pele a pele, amamentação na primeira hora de vida, alojamento conjunto ininterrupto, apoio profissional na amamentação, orientações sobre amamentação, incentivo à amamentação em livre demanda, não suplementação com fórmula infantil e não uso de chupeta Foi elaborada uma variável latente, que resume em uma única medida os resultados dessas práticas, denominada escore de práticas pró-amamentação, através do ajuste de um modelo da Teoria de Resposta ao Item (TRI), o Modelo Logístico de Dois Parâmetros, que permite que cada prática tenha seu parâmetro de discriminação e dificuldade estimados individualmente. A associação entre amamentação exclusiva aos 30 dias de vida e o escore de práticas pró-aleitamento foi verificada por meio de regressão de Poisson com variância robusta, sendo estimada razão de prevalência (RP) e seus respectivos intervalos de confiança (IC 95%). Como resultados, encontramos prevalência de amamentação exclusiva aos 30 dias de vida da criança de 61,7%. As práticas com maior capacidade de discriminação, ou seja, que mais contribuíram na estimativa do escore foram: apoio profissional para amamentar, orientações sobre amamentação e incentivo à livre demanda. Já as práticas mais difíceis foram: recém-nascido 9 colocado para mamar na 1ª hora de vida, incentivo à livre demanda e não uso de fórmula infantil. A análise multivariável estimou que a cada unidade (desvio padrão) de acréscimo no escore há um aumento de 20% na prevalência de amamentação exclusiva aos 30 dias de vida. Concluímos que a associação entre prevalência de amamentação exclusiva no primeiro mês de vida do bebê e o escore de práticas pró-amamentação nas maternidades aponta para a importância do conjunto dessas práticas para a melhoria dos indicadores de aleitamento materno.Despite the evidences on the positive impact of exclusive breastfeeding on the health of the child and mother, this prevalence is worrying, because, even being a powerful behavior of health promotion, is still little adopted. Given this scenario, it is evident the need of intensifying efforts to promote exclusive breastfeeding and identify its strategies. Some practices of incentive to breastfeeding in maternity hospitals are associated with increased duration of breastfeeding and there is a dose-response relationship between the number of practices to which mother-baby pairs are exposed and the duration of exclusive breastfeeding. However, there are no studies that have evaluated the effect of a set of practices of encouragement and support to breastfeeding in the prevalence of exclusive breastfeeding. The idea of this study was born from the knowledge of this lack, being its goal to evaluate the association between a set of pro-breastfeeding practices in maternity hospitals and the prevalence of exclusive breastfeeding in the first month of the baby’s life, taking into account the contribution of each of the practices to this effect. It’s a cross-sectional study involving 287 women who had delivered in two maternity hospitals in Porto Alegre, Brazil: one public, with certification in the Baby-Friendly Hospital Initiative, and another private, without certification in such Initiative. Women who had babies to term, non-twins and with no neonatal complications were randomly selected, and after 30 days of delivery, they were interviewed at home. The evaluated pro-breastfeeding practices were: skin-to-skin contact, breast-feeding in the first hour, rooming-in, professional support in breastfeeding, breastfeeding orientations, encouragement to feeding on demand, non-supplementation with infant formula and no pacifier. It was elaborated a latent variable, summarizing in a single measure the results of such practices called pro-breastfeeding practices score with the adjustment of a model of Item Response Theory (IRT), the Two-Parameter Logistic Model that allows that each practice has its discrimination and difficulty parameters individually estimated. It was used the Poisson regression with robust variance to verify the association between exclusive breastfeeding at 30 days of life and the score of practices of breastfeeding encouragement and support, being estimated the prevalence ratio (PR) and its respective confidence intervals (CI 95%). As results, it was found prevalence of 61.7% of exclusive breastfeeding at the 30 days of the child’s life. The practices with greater discrimination capacity, that is, which contributed the most in the score estimations, were: professional support for breastfeeding, breastfeeding orientation, and incentive to breastfeeding on demand. The most difficult ones were: suckling within the first hour of life, on-demand 11 incentive, and non-utilization of infant formula. The multivariate analysis estimated that at each unit (standard deviation) of increase in the score there is an increase of 20% in the prevalence of exclusive breastfeeding at 30 days. It was concluded that the association between prevalence of exclusive breastfeeding in the baby’s first month of life and the score of pro-breastfeeding practices in the maternity hospitals points to the importance of all these practices for the improvement of breastfeeding indicators