Fatores associados à autoeficácia para amamentação e desmame de mães de bebês prematuros
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2018-05-03
Autores
Emílio, Danielle Marinho Viegas
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Universidade Estadual Paulista (Unesp)
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Introdução: O aleitamento materno, além das propriedades nutritivas e imunológicas, propicia momentos essenciais de interação mãe-bebê. Quando o recém-nascido, especialmente o prematuro, é separado da mãe devido à sua internação em uma Unidade Neonatal, diversos fatores podem prejudicar o início do aleitamento materno e sua duração. Pesquisas com crianças nascidas a termo mostram que dentre vários fatores, a percepção de autoeficácia materna está associada com maior tempo de amamentação exclusiva e desmame mais tardio; entretanto, pouco se sabe sobre o papel da autoeficácia em mães de prematuros. Objetivos: Avaliar a percepção de autoeficácia em mães de prematuros durante a internação e após a alta e sua associação com a manutenção do aleitamento materno e desmame. Método: Trata-se de um estudo longitudinal, com 47 mães de prematuros cujos dados sociodemográficos e clínicos foram obtidos a partir de entrevista realizada até o terceiro dia após o nascimento e dos prontuários médicos do bebê. Entre três e sete dias após início da amamentação foram aplicados dois questionários para avaliação de autoeficácia: a) com relação aos cuidados (Perceived Maternal Parenting Self-Efficacy – PMP); b) com relação à amamentação (Brastfeeding Self-Efficacy Scale – Short-Form – BSE - SF). No primeiro retorno após a alta hospitalar do bebê, o BSES – SF foi reaplicado, e 60 dias após o nascimento foi verificado no prontuário, ou por contato telefônico se os bebês continuavam sendo amamentados. Resultados: A mediana da idade gestacional foi de 32 semanas e o tempo médio de internação foi de 20 dias. Na alta 85% dos prematuros estavam em aleitamento materno exclusivo, e até 60 dias após o nascimento 31,7% continuaram em aleitamento materno exclusivo. Nenhuma mãe pontuou para baixa autoeficácia, e altos índices de autoeficácia foram predominantes em mães com maior idade, multíparas e cujo recém-nascido teve melhor vitalidade ao nascer. A autoeficácia não se associou com tempo de amamentação, mas nascer pequeno para a idade gestacional foi fator de proteção e maior idade materna foi fator de risco para o desmame. Conclusão: A alta autoeficácia na amamentação não se associou com risco de desmame. As taxas de aleitamento materno foram elevadas na alta hospitalar mas caíram drasticamente 60 dias após o nascimento, o que sinaliza para a necessidade de retornos mais frequentes aos serviços de saúde após a alta para continuar encorajando o aleitamento materno, dando orientações técnicas ajustadas às necessidades individuais de cada mãe, visando aumentar seu empoderamento, sua percepção de autoeficácia e confiança em sua capacidade de amamentar.
Introduction: Breastfeeding propitiates not only nutritional and immunological advantages, but also essential moments of mother-baby interaction. According to the literature, when a newborn, especially if premature, is separated from the mother to be admitted into a Neonatal Unit, several factors can impair breastfeeding and its duration. Research with infants born at full-term shows that among several factors maternal perception of self-efficacy is associated with exclusively breastfeeding for a longer period and weaning at a later date. However, little is known about the role of self-efficacy in mothers of premature babies. Objectives: Evaluating the perception of self-efficacy in mothers of premature babies during hospitalization and after discharge and its association to breastfeeding and weaning. Methodology: A longitudinal study with 47 mothers of premature babies whose sociodemographic and clinical data were obtained through an on-site interview conducted up to three days after birth and from the baby’s medical charts. From three to seven days after they first started breastfeeding, two questionnaires were used to evaluate self-efficacy: a) the - Perceived Maternal Parenting Self-Efficacy (PMP-E); and b) the Breastfeeding Self-Efficacy Scale – Short-Form (BSES-SF). On the first consultation after discharge the BSES-SF questionnaire was applied once more and and 60 days after birth medical charts were consulted or by phone contact to check whether the mother was still breastfeeding. Results: Average gestational age was 32 weeks at birth and the children were admitted for an average of 20 days. 85.1% of the children were discharged on exclusive breastfeeding and up to 60 days after birth 31.7% continued on exclusive breastfeeding. No mother had a low score on self-efficacy and high levels of self-efficacy were predominant in older mothers who had given birth before and whose children had higher Apgar scores. No mother scored for low self-efficacy, and high self-efficacy rates were predominant in older mothers, multiparous, and whose newborn had better vitality at birth.Self-efficacy was not associated with breastfeeding time but being small for gestational age appeared as a protective factor and having an older mother a risk factor for weaning. Conclusion: The high self-efficacy in breastfeeding was not associated with risk of weaning. Breastfeeding rates were high at hospital discharge but dropped dramatically 60 days after birth, signaling the need for more frequent returns to post-discharge health services to continue encouraging breastfeeding, providing technical guidance tailored to individual needs of each mother, in order to increase their empowerment, their perception of self-efficacy and confidence in their ability to breastfeed.
Introduction: Breastfeeding propitiates not only nutritional and immunological advantages, but also essential moments of mother-baby interaction. According to the literature, when a newborn, especially if premature, is separated from the mother to be admitted into a Neonatal Unit, several factors can impair breastfeeding and its duration. Research with infants born at full-term shows that among several factors maternal perception of self-efficacy is associated with exclusively breastfeeding for a longer period and weaning at a later date. However, little is known about the role of self-efficacy in mothers of premature babies. Objectives: Evaluating the perception of self-efficacy in mothers of premature babies during hospitalization and after discharge and its association to breastfeeding and weaning. Methodology: A longitudinal study with 47 mothers of premature babies whose sociodemographic and clinical data were obtained through an on-site interview conducted up to three days after birth and from the baby’s medical charts. From three to seven days after they first started breastfeeding, two questionnaires were used to evaluate self-efficacy: a) the - Perceived Maternal Parenting Self-Efficacy (PMP-E); and b) the Breastfeeding Self-Efficacy Scale – Short-Form (BSES-SF). On the first consultation after discharge the BSES-SF questionnaire was applied once more and and 60 days after birth medical charts were consulted or by phone contact to check whether the mother was still breastfeeding. Results: Average gestational age was 32 weeks at birth and the children were admitted for an average of 20 days. 85.1% of the children were discharged on exclusive breastfeeding and up to 60 days after birth 31.7% continued on exclusive breastfeeding. No mother had a low score on self-efficacy and high levels of self-efficacy were predominant in older mothers who had given birth before and whose children had higher Apgar scores. No mother scored for low self-efficacy, and high self-efficacy rates were predominant in older mothers, multiparous, and whose newborn had better vitality at birth.Self-efficacy was not associated with breastfeeding time but being small for gestational age appeared as a protective factor and having an older mother a risk factor for weaning. Conclusion: The high self-efficacy in breastfeeding was not associated with risk of weaning. Breastfeeding rates were high at hospital discharge but dropped dramatically 60 days after birth, signaling the need for more frequent returns to post-discharge health services to continue encouraging breastfeeding, providing technical guidance tailored to individual needs of each mother, in order to increase their empowerment, their perception of self-efficacy and confidence in their ability to breastfeed.
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Palavras-chave
Amamentação, Prematuridade, Autoeficácia, Breastfeeding, Prematurity, Self-efficacy