Orientação da mulher e a duração da amamentação: um estudo de métodos mistos
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Data
2025-06-30
Autores
Minarini, Greyce Pollyne Santos Silva
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Universidade Federal do Espírito Santo
Resumo
Introduction: Breastfeeding guidance provided in both primary and specialized health services can influence maternal decisions to initiate, maintain, and prolong breastfeeding. The use of mixed methods is recommended to investigate this subjective practice, influenced by individual and social factors, and to allow for comparisons between biological, psychological, cultural, socioeconomic, and demographic aspects that affect its duration. This approach broadens the understanding of breastfeeding as a lived and relational experience, involving multiple determinants that interact over time. General Objective: To examine the correlation between the guidance received by postpartum women during prenatal, delivery, and postpartum care and the duration of total breastfeeding in the first three months of life. Specific Objectives: To describe postpartum women's perceptions of the breastfeeding guidance received during prenatal, delivery, and postpartum care. To analyze the association of sociodemographic and clinical variables with the type and duration of breastfeeding. Method: The study adopted a convergent mixed-methods approach. In the qualitative phase, a descriptive and exploratory study was designed, with individual interviews guided by a semi-structured script aimed at understanding perceptions and experiences related to breastfeeding. In the quantitative phase, a longitudinal study was conducted, administering a sociodemographic and clinical questionnaire, in addition to using the Interactive Breastfeeding Scale to measure objective aspects of the practice. The study was conducted at the Women's Health Unit of the Espírito Santo University Hospital, Brazil. The population consisted of postpartum women admitted to rooming-in care and discharged after May 2024. The R Interface for Multidimensional Analysis of Texts and Questionnaires (Iramuteq) software, version 7.2, was used for the qualitative analysis, guided by the theoretical framework of the Interactive Theory of Breastfeeding. For the quantitative data analysis, descriptive statistics were applied, including measures of central tendency (mean) and measures of dispersion (standard deviation) for continuous variables, as well as relative and absolute frequencies for categorical variables. After analyzing the data from the quantitative and qualitative stages individually, the data were integrated using the concomitant incorporation strategy. Results: A total of 296 postpartum women were interviewed. Most of the postpartum women included in the study were between 15 and 35 years old (82%), lived with a partner (70%), and had 12 years of education or more (70%). Approximately 63% were primiparous, and 26% were multiparous. Most had more than six prenatal care appointments (85%), and the most common mode of birth was cesarean section (72%), with a predominance of late preterm infants (57%). Regarding the type of feeding, 57% practiced exclusive breastfeeding (EBF), 34% mixed breastfeeding, and 9% exclusive formula. Higher rates of exclusive breastfeeding (EBF) were associated with several factors, such as: a greater number of prenatal care visits (p = 0.010), greater milk production (p = 0.015), vaginal delivery (p = 0.058), absence of formula use in the first 48 hours of life (p < 0.001), absence of breastfeeding difficulties (p = 0.030), and non-use of pacifiers (p < 0.001). The practice of skin-to-skin contact and professional support during childbirth also favored EBF. There was a progressive reduction in breastfeeding difficulties and in the use of formula and pacifiers over time. Although social support was not statistically significant, it was more frequent among mothers who maintained exclusive breastfeeding. The integration of quantitative and qualitative data revealed that, despite statistical associations, the lack of breastfeeding guidance during prenatal care and the mode of delivery limited breastfeeding practices, highlighting the importance of considering maternal experience when evaluating breastfeeding care. Final Considerations: The results demonstrate that multiple factors influence the practice of exclusive breastfeeding, including clinical, care-related, and contextual aspects. Although most women had access to prenatal care and institutionalized birth, the lack of adequate breastfeeding guidance and limitations in immediate support after birth reveal gaps in care. The integration of quantitative and qualitative data demonstrates that considering maternal experience is essential to improving care practices and promoting breastfeeding equitably and effectively.
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Amamentação , Centros de saúde materno-Infantil , Métodos Mistos