O contato e a amamentação precoces no contexto de um hospital amigo da criança

Abstract

The Baby-Friendly Hospitals should follow the criteria described as "Ten steps to successful breastfeeding (BF)". Among those, we highlight the fourth step, which establishes that the baby should be placed in skin-to-skin contact with his mother immediately after birth, and BF should be encouraged. Thus, this study had the purpose to analyze the experiences and the meanings of an early contact and breastfeeding of the puerperae admitted at a Baby-Friendly Hospital (BFH), as well as the factors involved in such practices. It is a descriptive, exploratory study, with qualitative approach, that was developed at the University Hospital of Maringá. Participated in the research 16 women who were admitted to give birth in that institution and that were capable of breastfeeding and establish an early contact with their babies soon after birth. Data was collected from November 2011 to January 2012, through the non-participant systematic observation of the childbirths, annotations on field diary, and semistructured interview with the women after delivery. For the treatment of the data, the analysis of content, thematic modality proposed by Bardin, was applied. From the results, four categories emerged: living the experience of giving birth in the presence/absence of a companion; building the knowledge on the early contact and breastfeeding; accomplishing the early contact and breastfeeding experience; establishing the relationship of assistance on the childbirth, and of the working process with the fourth step. Thus, the companion's presence in the moment of childbirth, in spite of this practice being experienced by few participants, it was a positive factor on the fulfillment of the fourth step. It was observed that despite the presence of a partner in the delivery was chosen by few participants, it represented a positive factor on the fourth step effectiveness The puerperae were quite receptive to the accomplishment of the fourth step, though, they showed little knowledge in relation to that practice. In some moments they seemed surprised and unprepared. For the participants, the moment of the early contact and BF was full of emotions, sometimes difficult to describe. The necessary time for the beginning of the contact was related to the priority given to the routine care and to the Cesarean section, which interfered negatively in the early contact and breastfeeding when it postponed that first encounter. The study revealed the fourth step was not fully developed as having preconized by the Baby-Friendly Hospital Initiative (BFHI). However, intermediate practices towards meeting the ends were noticed, such as the contact between mother and child still within the period described as "sensitive". The assistance given on the childbirth and the working process showed to be decisive in the characterization of the assistance, facilitating the visualization of the main barriers and roads to be taken for the development and effectiveness of the fourth step. Finally, we can affirm that we have a long road to travel, with many challenges to be conquered, considering that for the consolidation of the fourth step it is necessary to go beyond the techniques, once there is the involvement of several factors, such as the patients' sociocultural background, the professionals, the institutions and the society. Thus, efforts should be made by the health professionals, especially by the nurses, in the sense of the accomplishment of a sensitive and integrated assistance, the one that takes into account all the singularity the moment conveys.