Strengthening and weakening factors for breastfeeding from the perspective of the nursing mother and her family

Abstract

Objective: To describe the strengthening and weakening factors for breastfeeding. Method: This is a descriptive multiple case qualitative study, conducted in Curitiba, Parana, with members of 17 families with children between 6 and 12 months old, through semi-structured interview and construction of genograms, analyzed by the strategy of cross case synthesis. Results: 28 people participated in the study. Strengthening factors for breastfeeding were: the desire to breastfeed; child with facility for breastfeeding; mother with time available to the child; previous breastfeeding experience and family history of breastfeeding; the support and encouragement to breastfeed. Weakening factors were: negative expectations; the myth of weak milk; child’s disease; maternal illness; negative experiences of the mother; the absence of family history of breastfeeding; lack of a support network. Conclusion: Breastfeeding is a family and social phenomenon. Therefore, practices that go beyond the mother-baby dyad are necessary. The care process should include the social and subjective dimension, strengthening the support network of nursing mothers, in order to obtain more satisfactory professional practices that promote breastfeeding.

Determinants of the offer of breast milk complements for newborns

“…The administrative nature, the level of complexity and the ratio of the number of professionals per bed did not in uence the offer of the complement. These ndings differ from those obtained by studies in the United Kingdom, whose lack of personnel, perception of the importance of support and professional education were associated with the offer of the complement with infant formulas [12]. However, sociocultural and biological maternal factors were protective (age) and predictors (parity and type of delivery) for such an outcome.…”

“…In this study, we found a high prevalence of complement offer, which corroborates the ndings of studies conducted in other countries and in Brazilian cities [2,14,15,19]. Although the WHO recommends skin-toskin contact at birth, breastfeeding in the rst hour of life and "Do not give the newborn baby any food or drink other than breast milk, unless such procedure has a medical indication", most NB received the complement in the rst hours and days after birth.…”

“…Conversely, the prevalence of this offer increased by 1.37 times for NB of primiparous mothers, being consistent with the pertinent literature. This vulnerability can be justi ed by the absence of previous breastfeeding [16,21], inadequate milk perception, pain, breast milk problems [22] and cesarean section. The latter was associated to a 20% increase in the complement prevalence, corroborating the ndings in the pertinent literature [17].…”

“…In maternity wards, the offer of complements to EB is a frequent practice for low-risk neonates, even if they do not have justi able reasons through BFHI, with an approximate prevalence of 75% [10], varying among countries [11][12][13][14][15]. In Brazil, studies show a prevalence between 16% and 63.5% in different regions [7], being associated with the intrinsic conditions to NB (immediate absence of skin-to-skin contact and breastfeeding in the rst hour of life, the use of a paci er, di culty in latching and sucking, hypoglycemia and infection) and to the mother (age, previous experience of breastfeeding, obesity and gestational diabetes), as well as the absence of professional guidance in the prenatal and puerperium, besides the nonaccreditation of the maternity ward in BFHI are also associated with the indiscriminate offer of the complement [10,11,[13][14][15][16][17].…”

“…Another worrying factor has been the increased offer of milk formulas due to the shortage of pasteurized breast milk in human milk banks (HMB). This practice, in turn, has been related to the increased risk of intestinal dysbiosis, infections and allergy to the cow's milk protein in NB [14,18]. It is known that breast milk is rich in essential amino acids, growth factors, immunoglobulins, probiotics, among other essential substances for neonatal development.…”