Ana Lúcia de Lourenzi Bonilha

Uso de mamadeira no primeiro mês de vida: determinantes e influência na técnica de amamentação

OBJETIVO: Analisar a incidencia e os determinantes do uso de mamadeira no primeiro mes de vida e possiveis efeitos dessa pratica na tecnica de amamentacao. METODOS: Estudo transversal aninhado em uma coorte contemporânea de Porto Alegre, RS, de junho a novembro de 2003. Durante um mes foram acompanhados 211 pares de mae e crianca. A influencia do uso de mamadeira sobre a tecnica de amamentacao foi avaliada comparando-se as frequencias de cinco itens desfavoraveis ao posicionamento mae/crianca e tres itens desfavoraveis a pega da crianca; e as medias do numero de itens desfavoraveis entre as duplas que iniciaram o uso mamadeira no primeiro mes e as que nao o fizeram. A regressao logistica estimou o grau de associacao das variaveis com os desfechos, utilizando modelo hierarquizado. RESULTADOS: Aos sete dias, 21,3% das criancas usavam mamadeira e, aos 30 dias, 46,9%. Coabitacao com a avo materna esteve associada com uso de mamadeira tanto aos sete quanto aos 30 dias. Tambem estiveram associados ao uso de mamadeira aos sete dias: a mae ser adolescente e trauma mamilar na maternidade. Os outros dois fatores associados ao uso de mamadeira aos 30 dias foram trauma mamilar aos sete dias e uso de chupeta aos sete dias. Nao houve associacao entre tecnica de amamentacao ensinada na maternidade e uso de mamadeira, mas aos 30 dias, criancas que usavam mamadeira apresentaram tecnica menos adequada as que sugavam so no peito. CONCLUSOES: Os resultados mostram que a mamadeira foi bastante utilizada no primeiro mes de vida, principalmente: em criancas com maes adolescentes e com trauma mamilar, cujas avos maternas estavam presentes no domicilio e que faziam uso de chupeta. Alem dos efeitos negativos ja conhecidos, a mamadeira pode influenciar negativamente a tecnica de amamentacao.

Effect of Intervention to Improve Breastfeeding Technique on the Frequency of Exclusive Breastfeeding and Lactation-Related Problems

This randomized clinical trial compared frequencies of exclusive breastfeeding and lactationrelated problems during the first 30 days among 74 mothers who received a 30-minute counseling session on breastfeeding technique in the maternity ward, and 137 controls. The frequency of exclusive breastfeeding among mothers who had received intervention was similar to controls by 7 days (79.7% vs 82.5%, respectively) and 30 days (60.8% vs 53.3%). There was no difference between groups in the frequency of sore nipples at 7 and 30 days, in breast engorgement and mastitis, and in the quality of breastfeeding technique at 30 days. Therefore, a single intervention at maternity was not sufficient to improve breastfeeding technique, increase exclusive breastfeeding rates, and reduce the incidence of breastfeeding problems during the first month.

A participação do pai como acompanhante da mulher no parto

Se trata de un estudio de caso, de caracter cualitativo, con el objetivo de conocer la participacion del padre como acompanante de la mujer durante el parto. Participaron del estudio veinticuatro padres que estuvieron presentes durante el trabajo de parto y en el parto de sus companeras, en el Hospital de Clinicas de Porto Alegre-RS. Las informaciones, colectadas por medio de observacion participante y entrevista semi-estructurada, se examinaron a traves del analisis de contenido tematico. El tema encontrado: la experiencia de ser acompanante, se refiere a la presencia y el significado de la experiencia de vivir el nacimiento del hijo. Los hallazgos del estudio revelaron que los padres entienden que estar presente, dar carino y usar palabras de apoyo hacen parte del rol de ser acompanante en ese momento. Los padres creen que la experiencia de vivir el nacimiento del su hijo, independiente del numero de nacimientos ya acompanados por ellos, es una experiencia unica, un momento inexplicable.The objective of this qualitative case study was to determine paternal participation as a companion to women during delivery. There were 24 fathers present during the labor and delivery processes accompanying their wives at the Porto Alegre, RS, Brazil, Clinical Hospital (Hospital de Clinicas). Information was obtained through participative observation and semi-structured interviews and was then submitted to content analysis (thematic type). The theme found was the experience of being a companion which regards the presence and the meaning of living the childs birth. The findings of this study showed that the fathers involved understood that being present, caring, and saying supportive words is part of their role as a companion during this moment. The fathers believe that the experience of living their childs birth, independent from the number of births which they may have already been experienced, is a unique event and an inexplicable moment.

Influência da técnica de amamentação nas freqüências de aleitamento materno exclusivo e lesões mamilares no primeiro mês de lactação

OBJETIVO: Investigar a influencia da tecnica de amamentacao nas frequencias de aleitamento materno exclusivo e de lesoes mamilares no primeiro mes de lactacao. METODOS: Foram pesquisados parâmetros desfavoraveis a amamentacao (cinco relacionados ao posicionamento mae/bebe e tres a pega do bebe) em 211 maes/bebes na maternidade e, aos 30 dias, no domicilio. Foram comparadas as frequencias desses parâmetros entre as duplas com e sem amamentacao exclusiva aos 7 e 30 dias, e entre as maes com e sem lesoes mamilares na maternidade. RESULTADOS: O numero de parâmetros desfavoraveis na maternidade foi semelhante nas duplas com e sem amamentacao exclusiva aos 7 e 30 dias. Porem, aos 30 dias, foi, em media, menor nas duplas em amamentacao exclusiva, tanto no posicionamento (1,7±1,2 versus 2,2±1,1; p = 0,009) quanto na pega (1,0±0,6 versus 1,4±0,6; p < 0,001). O numero de parâmetros desfavoraveis de pega na maternidade foi semelhante entre as mulheres com e sem lesao mamilar, porem as mulheres sem essa complicacao apresentaram um numero maior de parâmetros desfavoraveis de posicionamento (2,0±1,4 versus 1,4±1,2; p = 0,04). CONCLUSOES: As frequencias de amamentacao exclusiva no primeiro mes e de lesoes mamilares nao foram influenciadas pela tecnica de amamentacao na maternidade, mas houve associacao entre melhor tecnica aos 30 dias e pratica da amamentacao exclusiva. Novos estudos poderao elucidar se uma melhora da tecnica ao longo do tempo seria responsavel pela manutencao da amamentacao exclusiva ou se a introducao de mamadeira exerceria efeito negativo na tecnica.

Práticas utilizadas pelas puérperas nos problemas mamários

Estudio calitativo del tipo ConvergenteAsistencial, objetivando conocer las practicas adoptadas por las puerperas para la resolucion de los problemas mamarios, en el domicilio, e intervenir para su resolucion. Fueron participantes catorze puerperas, que estaban amamantando y recibiendo atendimiento en un Centro de Atencion Integral a la Salud. Se utilizo encuesta semiestructurada, observacion participante y apuntes en diario de campo, analizadas segun propuesta de Trentini y Paim. Los temas fueron: Practicas utilizadas por las puerperas en los problemas mamarios; Repercusiones de los mismos en la desmama y la promocion del amamantamiento materno. La diversificacion de productos utilizados por las puerperas, la necesidad de los profesionales de salud conocieren las practicas utilizadas en las comunidades y se actualizaren en relacion al amamantamiento materno, para su promocion, fueron los hallados encontrados.This is a qualitative study, of Convergent-assistential type, with the objective of knowing the womens practices at post-birth for the resolution of nipple problems, at home, and intervene to its resolution. Fourteen women at post-birth who were in the breastfeeding period and attended at a Center of Integral Attention to Health were participants. It was used a semi-structured interview, participant observation and notes in field diary, analised according to Trentini and Paims proposal. The themes were the following: Practices used by the women with nipple problems; their repercussion and breastfeed ending and promotion of feeding. The diversification of products used by women at post-birth, the necessity of health professionals to know the practices used in the communities and be used in relation to breastfeeding, to its promotion, were the findings.

Capacitação participativa de pré-natalistas para a promoção do aleitamento materno

The commitment with the promotion and support of breastfeeding justified the training of professionals that give prenatal care in primary health. This is a exploratory, qualitative study, based on the assumptions of participant research. It aimed to identify the thematics about breastfeeding and report the actions and strategies proposed during the meetings. Data was registraded in a field diary and analysis was done according to the categorization of data. Discussion of findings showed the lack of professionals update and lack of standardization in their conducts. The research gave the opportunity to discuss the politics and programs that were implanted by the government management, searching for alternatives inside the context of the users and workers that are involved with prenatal care.The commitment with the promotion and support of breastfeeding justified the training of professionals that give prenatal care in primary health. This is a exploratory, qualitative study, based on the assumptions of participant research. It aimed to identify the thematics about breastfeeding and report the actions and strategies proposed during the meetings. Data was registraded in a field diary and analysis was done according to the categorization of data. Discussion of findings showed the lack of professionals update and lack of standardization in their conducts. The research gave the oportunity to discuss the politics and programms that were implanted by the government management, searching for alternatives inside the context of the users and workers that are involved with prenatal care. K

Conhecimento de puérperas sobre amamentação exclusiva

This is a descriptive study, with a qualitative approach, aimed to identify the knowledge of puerperal women on exclusive breastfeeding. Data were collected between September-October 2011, through semi-structured interview. Thirteen puerperal women, interned in a rooming unit of a public institution in the city of Caxias do Sul-RS, participated in the study. Data analysis was performed using thematic analysis. From the interpretation of information three categories emerged: the knowledge about exclusive breastfeeding, the breastfeeding process and the influences of received information. Even getting information from health professionals in the prenatal period, it is possible to understand that there is a need to improve communication and monitoring of mothers, as a continuity of professional care in the postpartum period, and also later, in the remote.This is a descriptive study, with a qualitative approach, aimed to identify the knowledge of puerperal women on exclusive breastfeeding. Data were collected between September-October 2011, through semi-structured interview. Thirteen puerperal women, interned in a rooming unit of a public institution in the city of Caxias do Sul-RS, participated in the study. Data analysis was performed using thematic analysis. From the interpretation of information three categories emerged: the knowledge about exclusive breastfeeding, the breastfeeding process and the influences of received information. Even getting information from health professionals in the prenatal period, it is possible to understand that there is a need to improve communication and monitoring of mothers, as a continuity of professional care in the postpartum period, and also later, in the remote.

The resignification of management processes in care procedures in nursing

This study had as goal to discuss some aspects about the management processes in the care production in nursing. It’s made up by a critic reflective analysis, which aims to reflect on the questioning that was brought from the reading of texts used in a doctor and master’s course. During the subject’s development it was possible to identify, through the analysis of the suggested bibliography, the drifting away visualized by the nurses between the management and the care. However it’s possible to conclude that this is due to, in great part to these professionals’ graduation, which lead to the distortion on the comprehension of these subjects about the care procedures.

Temporal evolution and spatial distribution of maternal death

OBJECTIVE To analyze the temporal evolution of maternal mortality and its spatial distribution. METHODS Ecological study with a sample made up of 845 maternal deaths in women between 10 and 49 years, registered from 1999 to 2008 in the state of Rio Grande do Sul, Southern Brazil. Data were obtained from Information System on Mortality of Ministry of Health. The maternal mortality ratio and the specific maternal mortality ratio were calculated from records, and analyzed by the Poisson regression model. In the spatial distribution, three maps of the state were built with the rates in the geographical macro-regions, in 1999, 2003, and 2008. RESULTS There was an increase of 2.0% in the period of ten years (95%CI 1.00;1.04; p = 0.01), with no significant change in the magnitude of the maternal mortality ratio. The Serra macro-region presented the highest maternal mortality ratio (1.15, 95%CI 1.08;1.21; p < 0.001). Most deaths in Rio Grande do Sul were of white women over 40 years, with a lower level of education. The time of delivery/abortion and postpartum are times of increased maternal risk, with a greater negative impact of direct causes such as hypertension and bleeding. CONCLUSIONS The lack of improvement in maternal mortality ratio indicates that public policies had no impact on women’s reproductive and maternal health. It is needed to qualify the attention to women’s health, especially in the prenatal period, seeking to identify and prevent risk factors, as a strategy of reducing maternal death.

Father participation as a companion to delivering women

Se trata de un estudio de caso, de caracter cualitativo, con el objetivo de conocer la participacion del padre como acompanante de la mujer durante el parto. Participaron del estudio veinticuatro padres que estuvieron presentes durante el trabajo de parto y en el parto de sus companeras, en el Hospital de Clinicas de Porto Alegre-RS. Las informaciones, colectadas por medio de observacion participante y entrevista semi-estructurada, se examinaron a traves del analisis de contenido tematico. El tema encontrado: la experiencia de ser acompanante, se refiere a la presencia y el significado de la experiencia de vivir el nacimiento del hijo. Los hallazgos del estudio revelaron que los padres entienden que estar presente, dar carino y usar palabras de apoyo hacen parte del rol de ser acompanante en ese momento. Los padres creen que la experiencia de vivir el nacimiento del su hijo, independiente del numero de nacimientos ya acompanados por ellos, es una experiencia unica, un momento inexplicable.The objective of this qualitative case study was to determine paternal participation as a companion to women during delivery. There were 24 fathers present during the labor and delivery processes accompanying their wives at the Porto Alegre, RS, Brazil, Clinical Hospital (Hospital de Clinicas). Information was obtained through participative observation and semi-structured interviews and was then submitted to content analysis (thematic type). The theme found was the experience of being a companion which regards the presence and the meaning of living the childs birth. The findings of this study showed that the fathers involved understood that being present, caring, and saying supportive words is part of their role as a companion during this moment. The fathers believe that the experience of living their childs birth, independent from the number of births which they may have already been experienced, is a unique event and an inexplicable moment.