Breastfeeding maintenance of very low weight premature babies : experience of mothers

The objectives of this study were to comprehend the breastfeeding process from reports of mothers of premature babies and identify factors facilitating or complicating this process. A descriptive qualitative study regarding the family centered care. We conducted 12 interviews with mothers of six months premature babies of chronological age and we submitted data to content analysis. Four categories emerged: The previous breastfeeding experience in the process of breastfeeding the premature baby; Emotional context versus the breastfeeding process; The ability to manage breastfeeding the premature baby and, Successes and failures. We concluded that family and professional support, adequate management and the welcoming of individualized services in the prematurity context were majorly responsible for the breastfeeding success, being even able to surpass the previous maternal desire. Breastfeeding accompaniment after discharge is indispensable for its success with premature babies. Descriptors: Breast Feeding; Weaning; Infant, Premature; Neonatal Nursing. RESUMO Os objetivos deste estudo foram compreender o processo de amamentação a partir do relato das mães de prematuros e identificar fatores que facilitaram ou dificultaram esse processo. Estudo descritivo, de abordagem qualitativa à luz do cuidado centrado na família. Foram realizadas 12 entrevistas com mães de prematuros com seis meses de idade cronológica e os dados foram submetidos à análise de conteúdo. Emergiram quatro categorias: A experiência prévia em aleitamento materno no processo de amamentar um prematuro; Contexto emocional versus processo de amamentação; O domínio do manejo da amamentação do prematuro e Sucessos e fracassos. Conclui-se que no contexto da prematuridade, o apoio familiar e profissional, o manejo adequado e o acolhimento do serviço de maneira individualizada foram reconhecidos como grandes responsáveis pelo sucesso da amamentação, podendo até mesmo sobrepor o desejo materno prévio. O acompanhamento da amamentação após a alta é imprescindível para o seu sucesso nos prematuros. Descritores: Aleitamento Materno; Desmame; Prematuro; Enfermagem Neonatal. Ciaciare BC, Migoto MT, Balaminut T, Tacla MTGM, Souza SNDH, Rossetto EG. Rev. Eletr. Enf. [Internet]. 2015 jul/set;17(3). Available from: http://dx.doi. org/10.5216/ree.v17i3. 27548. 2 INTRODUCTION The World Health Organization (WHO) preconizes that all newborn (NB) should be exclusively breastfed until their six month of life and complement it only after this period. Premature babies need exclusive breastfeeding (EB) even more, an important ally in the reduction of neonatal morbidity and mortality . However, a integrative review about the prevalence/duration of breastfeeding among very low weight (VLW) premature babies, found unsatisfactory results in different studies and places, that came from peculiar difficulties in breastfeeding this population at risk. The prevalence vary from 19,5% to 76% EB at discharge, considering different levels of prematurity. High rates of weaning were found on the first days after discharge, with decreases of more than 50% of weaning at the first ambulatory return. Increase of breastfeeding rates is related to specific intervention efficacy as the kangaroo method, oral stimulation, advice, support strategies, accompaniment and follow-up. Low rates of breastfeeding in premature babies can be explained by the major challenge of breastfeeding them due to their physiological and neurological immaturity, difficulty of suction-swallowing-breathing coordination and prolonged hospitalization, besides all feelings of maternal failure and emotional stress that could decrease lactation. In addition, during the baby hospitalization, mothers face difficulties with the early extraction and lactation maintenance due to cesarean fatigue; anxiety and stress due to premature delivery; worries with the child’s health, finances; separation from the child; distance from their homes to the neonatal unit; lack of privacy; return to work; changes in social life. Considering diverse difficulties to establish breastfeeding of premature babies, the project “A support network to the premature family” (5) was proposed, based on family centered care, to include the family in the care and on decisions, encourage and facilitate the family support and the support network, recognize the family’s strengths and individualities, within others. The project activities are developed since the premature birth, during the hospitalization process and follow-up until one year of life, breastfeeding support and stimuli are one of the main goals. Resident nurses in neonatology and teachers attend families with the support of a multi-disciplinary team. A study was conducted with 54 binomial mother/baby who were attended by the project, through the family records and interviews with the mothers. The dependent variable was the type of feeding at discharge. At the third and sixth month after birth, the EB prevalence was 50% between VLW premature babies at discharge and only 11% did not receive maternal milk (MM). At the third and sixth month of life the EB prevalence decreased to 34% of children, considering that at the third month 35,8% did not receive MM and at six months, this weaning prevalence increased to 51%. The growing weaning rates of premature babies despite the professional practice centered in the family and the major challenges for mothers to breastfeed their premature child, motivated the development of this research. Our aim was to comprehend the breastfeeding process from reports of mothers with premature babies; and to identify factors facilitating or complicating this process. The comprehension of the breastfeeding process in this integral support context to families, from the maternal perspective, can contribute to this practice