A voz materna e o bebê prematuro: questões sobre a comunicação no ambiente hospitalar
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2018-02-26
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Universidade Estadual Paulista (Unesp)
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Há evidências na literatura de que a permanência dos prematuros em incubadora, com o propósito de garantir sua sobrevida, pode gerar um impacto negativo para o vínculo mãe/filho. Na maioria das vezes a criança está sedada e as mães impossibilitadas do contato tátil e de oferecer cuidados. Há vários estudos de como as mães vivenciam essa situação, mas poucos centram-se no papel da voz materna que, nessas condições, é uma via disponível para o estabelecimento do vínculo com o bebê, fundamental para sua constituição subjetiva. Este estudo teve por objetivo analisar o conteúdo da fala e a voz das mães frente a seu parto e a seu filho prematuro, pacientes de incubadora. Os médicos responsáveis pelo pelos leitos das crianças da pesquisa também foram entrevistados com o intuito de avaliar seu papel na forma como a mãe subjetiva a criança neste contexto. Em até sete dias após a internação da criança na Unidade de Terapia Intensiva neonatal (UTIN), foi realizada uma primeira entrevista, aberta, com mães de prematuros que permaneciam na incubadora. Uma segunda entrevista ocorreu após a alta da incubadora. Os médicos responsáveis pelo leito da criança também foram entrevistados, afim de encontrar possíveis relações do discurso médico com o discurso materno. Observou-se, também, como e o que as mães diziam aos bebês e seus comportamentos quando elas falavam com eles. Os dados foram analisados qualitativamente, à luz da teoria psicanalítica. A característica mais presente nos relatos foi a necessidade de reconstruir a história do nascimento prematuro, de forma minuciosa. Frente à perplexidade da situação, as mães tentavam encadear os acontecimentos, recordando detalhes, organizando sua história e tentando preencher com palavras e números o vazio e a angústia do não-saber. Ao “falar a criança”, as características físicas se sobrepunham a outras peculiaridades subjetivas, denotando dificuldade de simbolização diante do real do corpo da criança. Foi frequente recorrer a termos técnicos e ao uso de significantes que evidenciavam sua condição de fragilidade. Todas as mães relataram “falar com a criança” desde a gestação. Apesar do contato ser mediado por aparelhos e do toque estar praticamente excluído, as mães permaneciam próximas à incubadora, apostavam na importância de sua presença, falando em manhês com seus filhos, falas carregadas de afeto. Para elas, os comportamentos das crianças, assim como as mudanças cardíacas e respiratórias observadas nos aparelhos de monitoração, tinham um propósito e eram interpretados como reação à sua presença e à sua voz. As respostas as alimentavam narcisicamente, retroalimentando um diálogo e devolvendo o lugar roubado pelo nascimento prematuro. Na segunda entrevista, na Unidade de Cuidados Especiais (UCE), a voz e o discurso denotavam que as mães estavam mais tranquilas; as crianças eram incluídas nas entrevistas e nos planos de um futuro próximo. Estar mais longe dos riscos, possivelmente, permitiu algumas elaborações e enunciações caladas pelo trauma da prematuridade. Ter a criança nos braços foi apontado como mágico, apesar de algumas referirem insegurança, sem a proteção da incubadora. Os médicos, sempre presentes na cena de cuidado do recém-nascido prematuro, tinham a preocupação em transmitir o maior número de informações possível, contudo observou-se grande empenho em informar e dificuldade para lidar com questões subjetivas, que a condição da UTIN exigia. Na UCE a equipe incentivava as mães a assumir os cuidados, contudo cuidar não era fácil, apesar de trazer a sensação de ser mais mãe. Os dados apontam para a importância que as mães dão à sua voz no estabelecimento e manutenção do vínculo da díade, mesmo quando separadas da criança pela incubadora, durante um período fundamental da constituição do sujeito. Apesar do ambiente da UTIN não ter sido projetado para favorecer a maternagem, tanto pela formação de pessoal como organização do serviço e isso possa trazer consequências para constituição da subjetividade dos bebês, observou-se um esforço das mães de pressupor ali um sujeito, para além da prematuridade e manter o vínculo com os filhos prematuros, quando ainda permaneciam na incubadora.
There is evidence in the literature of the negative impact that keeping premature babies in incubators - to ensure they will survive - can cause to mother-child bonding. Most of the times, the child is sedated and the mother cannot offer tactile contact or care. There are many studies on how mothers manage this situation, but only a few focus on the mother’s voice, that is, in these conditions, an available way to bonding with the baby, which is essential to their subjective constitution. The present study’s aim was to understand mothers’ perception of premature delivery, their role during the child’s stay in the incubator and their interaction with the babies. In up to seven days after the internment in the Neonatal Intensive Care Unit (NICU), an open interview with mothers of newborns in incubators was held. A second interview took place after the discharge from the incubator. The doctors responsible for each crib were also interviewed in an attempt to find possible correlations between the medical and the maternal speech. It was also observed what mothers told their babies, how they did it and their behavior while talking to them. A qualitative analysis of data was done according to the psychoanalysis theory. The need to rebuild minutely the premature newborn story was the most common feature in the mothers’ report. Facing the perplexity of the situation, mothers tried to connect moments by recalling details, organizing their story and trying to fill up the emptiness and the not-knowing anguish with words and numbers. When talking about the child, physical characteristics superposed other subjective peculiarities, making it difficult to symbolize before the child’s real body. Searching for technical terms and significants that made their fragile condition evident was recurrent. All mothers said that they talked to the child since pregnancy. Although contact is mediated by equipment and touch is basically inexistent, moms kept close to the incubator once they believed their presence was important, talking to their children in mommy talks full of care. For them, the child’s behavior, as well as cardiac or respiratory changes seen in the monitoring, had a purpose and was interpreted as reaction to her presence and her voice. Answers fed them in a narcissist way, empowering some dialogues and giving back the place that was stolen by the premature birth. In the second interview, at the Special Care Unit (SCU), voice and speech showed mothers were more at ease; children were part of the interviews and of near future plans. Being further away from the risks possibly allowed elaboration and enunciation concealed by the trauma of prematurity. Having their children in their arms was pointed out as something magical, although some mothers referred to insecurity without the incubator’s protection. Doctors, always around in the premature newborn scenario, worried about offering as much information as possible, but, despite of the engagement in informing, there was difficulty in dealing with subjective matters, which was an NICU condition. At the SCU, the team encouraged mothers to take over, but taking care was not easy, despite the feeling of being more mom. Data suggest mothers value their voice in stablishing and maintaining the dyad bonding, even when they are apart from the child in the incubator during a critical period for the subject constitution. Although the environment at the NICU was not designed to favor maternity, both because of staff educational background and lack of service organization - and this can pose consequences to the constitution of babies’ subjectivity, the mothers’ effort to presuppose a subject, beyond prematurity was noted, and an effort to keep the bonding to the premature children when they were kept in the incubator.
There is evidence in the literature of the negative impact that keeping premature babies in incubators - to ensure they will survive - can cause to mother-child bonding. Most of the times, the child is sedated and the mother cannot offer tactile contact or care. There are many studies on how mothers manage this situation, but only a few focus on the mother’s voice, that is, in these conditions, an available way to bonding with the baby, which is essential to their subjective constitution. The present study’s aim was to understand mothers’ perception of premature delivery, their role during the child’s stay in the incubator and their interaction with the babies. In up to seven days after the internment in the Neonatal Intensive Care Unit (NICU), an open interview with mothers of newborns in incubators was held. A second interview took place after the discharge from the incubator. The doctors responsible for each crib were also interviewed in an attempt to find possible correlations between the medical and the maternal speech. It was also observed what mothers told their babies, how they did it and their behavior while talking to them. A qualitative analysis of data was done according to the psychoanalysis theory. The need to rebuild minutely the premature newborn story was the most common feature in the mothers’ report. Facing the perplexity of the situation, mothers tried to connect moments by recalling details, organizing their story and trying to fill up the emptiness and the not-knowing anguish with words and numbers. When talking about the child, physical characteristics superposed other subjective peculiarities, making it difficult to symbolize before the child’s real body. Searching for technical terms and significants that made their fragile condition evident was recurrent. All mothers said that they talked to the child since pregnancy. Although contact is mediated by equipment and touch is basically inexistent, moms kept close to the incubator once they believed their presence was important, talking to their children in mommy talks full of care. For them, the child’s behavior, as well as cardiac or respiratory changes seen in the monitoring, had a purpose and was interpreted as reaction to her presence and her voice. Answers fed them in a narcissist way, empowering some dialogues and giving back the place that was stolen by the premature birth. In the second interview, at the Special Care Unit (SCU), voice and speech showed mothers were more at ease; children were part of the interviews and of near future plans. Being further away from the risks possibly allowed elaboration and enunciation concealed by the trauma of prematurity. Having their children in their arms was pointed out as something magical, although some mothers referred to insecurity without the incubator’s protection. Doctors, always around in the premature newborn scenario, worried about offering as much information as possible, but, despite of the engagement in informing, there was difficulty in dealing with subjective matters, which was an NICU condition. At the SCU, the team encouraged mothers to take over, but taking care was not easy, despite the feeling of being more mom. Data suggest mothers value their voice in stablishing and maintaining the dyad bonding, even when they are apart from the child in the incubator during a critical period for the subject constitution. Although the environment at the NICU was not designed to favor maternity, both because of staff educational background and lack of service organization - and this can pose consequences to the constitution of babies’ subjectivity, the mothers’ effort to presuppose a subject, beyond prematurity was noted, and an effort to keep the bonding to the premature children when they were kept in the incubator.
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voz materna, vínculo, prematuro, psicanálise, premature, mother's voice, bonding, psychanalysis