Tipo de nascimento e sua associação com a interação materno-filial

Santos Neto, Crystiane Hereny dos; Oliveira, Fábio Sagula; Gomes, Graciele Fernanda; Araujo Júnior, Edward; Nakamura, Mary Uchiyama; Souza, Eduardo de

doi:10.1055/s-0040-1712133

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Brasil

Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Original Article, Obstetrics • Rev Bras Ginecol Obstet. 42 (10) • Out 2020 • https://doi.org/10.1055/s-0040-1712133 copiar

Tipo de nascimento e sua associação com a interação materno-filial

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Objetivo

O objetivo do presente estudo foi avaliar a qualidade do vínculo mãe-filho em três contextos diferentes relacionados ao trabalho de parto, ou seja, parto vaginal, cesariana eletiva e cesariana intraparto.

Métodos

Estudo clínico observacional, transversal, realizado em duas cidades do estado de São Paulo, Brasil. A amostra do estudo foi composta por 81 recém-nascidos sem maiores complicações durante a gravidez e o parto, com idades entre 3 e 4 meses, e suas respectivas mães, com idades entre 20 e 35 anos, primíparas, residentes nas cidades de Palmital e Ourinhos, estado de São Paulo, Brasil. A avaliação da qualidade da interação materno-filial foi realizada por meio de análise de vídeo-imagem, utilizando o Protocolo de Observação da Interação Mãe-Bebê de 0 a 6 meses (POIMB 0-6).

Resultados

Mães que tiveram parto vaginal tiveram maior quantidade de contato visual ou tentativa de contato visual (p = 0,034), melhor resposta ao comportamento social da criança (p = 0,001) e maior sensibilidade (p = 0,007) que as demais. Os filhos também mostraram maior interação com elas, pois olhavam com mais frequência para o rosto da mãe (p < 0,008) e respondiam com mais frequência ao estímulo comunicativo da mãe (p < 0,001).

Conclusão

Considerando a ocorrência do parto vaginal, conclui-se que a interação entre a díade mãe-filho é quantitativamente maior e qualitativamente melhor quando comparada à cesariana intraparto ou eletiva.

Palavras-chave
cesariana; parto obstétrico; relações mãe-filho; parto vaginal

Variables		VD	ICS	ECS	Total
		(n = 26)	(n = 27)	(n = 28)	(n = 81)	p-value
Marital status	Stable union	19.2%;	18.5%;	10.7%;	16.0%;	0.443
	Married	53.8%;	59.3%;	78.6%;	64.2%;
	Single	23.1%;	22.2%;	10.7%;	18.5%;
	Widow	3.8%;	-	-	1.2%;
Schooling	Incomplete fundamental	-	7.4%;	-	2.5%;	0.091
	Complete fundamental	11.5%;	14.8%;	-	8.6%;
	Incomplete medium	7.7%;	11.1%;	-	6.2%;
	Medium complete	19.2%;	25.9%;	35.7%;	27.2%;
	Incomplete Higher	23.1%;	18.5%;	14.3%;	18.5%;
	Graduated	38.5%;	22.2%;	50.0%;	37.0%;
Maternal Age	Average	26.6	25.3	26.3	26.1	0.441
	Median	27.0	25.0	26.0	26.0
	Minimum	20	20	20	20
	Maximum	32	33	33	33
	Standard deviation	3.4	4.1	3.6	3.7
Gestational planning	Yes	19.2%;	29.6%;	21.4%;	23.5%;	0.639
	No	80.8%;	70.4%;	78.6%;	76.5%;
Family income (minimum wages)	Average	2.6	3.0	3.4	3.0	0.184
	Median	2.0	3.0	3.0	3,0
	Mínimum	1	1	1	1
	Maximum	5	5	7	7
	Standard deviation	1.2	1.1	1.6	1.3
Gestational age (weeks)	Average	39.4	39.7	38.7	39.3	< 0.001
	Median	40.0	40.0	39.0	39.0
	Minimum	38	38	38	38
	Maximum	42	42	40	42
	Standard deviation	2.2	1.1	0.7	1.5
Childbirth institution	Private	30.8%;	40.7%;	42.9%;	38.3%;	0.626
	Public	69.2%;	59.3%;	57.1%;	61.7%;
Breastfeeding	Absent	-	14.8%;	32.1%;	16.0%;	0.013
	Exclusive	69.2%;	55.6%;	35.7%;	53.1%;
	Not exclusive	30.8%;	29.6%;	32.1%;	30.9%;

Question^* * 2) Amount of visual contact or attempted eye contact from mother to child; 7) Mother's response to the child's social behavior; 10) Maternal sensitivity to the child; 11) Attention of the mother to the child.	Kappa/95%;CI	Observer		VD (n = 26)	ICS (n = 27)	ECS (n = 28)	p-value
2	0.91	1	Few	-	-		0.034
	0.78-1.04		Moderate	7.7%;	29.6%;	10.7%;
			Many	88.5%;	59.3%;	42.9%;
			Always	3.8%;	11.1%;	32.1%;
		2	Few	-	-	14.3%;	0.150
			Moderate	15.%;	29.6%;	10.7%;
			Many	80.%;	59.3%;	39.3%;
			Always	3.8%;	11.1%;	35.7%;
		3	Few	-	-	14.3%;	0.095
			Moderate	11.%;	29.6%;	10.7%;
			Many	84.%;	63.0%;	39.3%;
			Always	3.8%;	7.4%;	35.7%;
7	0.91		Few	-	-	14.3%;	0.001
	0.81-1.00	1	Moderate	11.5%;	18.5%;	10.7%;
			Many	34.6%;	33.3%;	28.6%;
			Always	53.8%;	48.1%;	50.0%;
		2	Few	-	-	10.7%;	0.005
			Moderate	11.%;	22.2%;	10.7%;
			Many	38.%;	33.3%;	28.6%;
			Always	50.%;	44.4%;	46.4%;
		3	Few	-	-	14.3%;	0.002
			Moderate	11.%;	18.5%;	10.7%;
			Many	42.%;	37.0%;	28,6%;
			Always	46.%;	44.4%;	50.0%;
10	0.86	1	Moderate	-	7.4%;	10.7%;	0.007
	0.73-0.99		Many	15.4%;	40.7%;	14.3%;
			Always	84.6%;	51.9%;	39.3%;
		2	Moderate	-	7.4%;	46.4%;	0.072
			Many	26.%;	40.7%;	14.3%;
			Always	73.%;	51.9%;	39.3%;
		3	Moderate	-	7.4%;	46.4%;	0.018
			Many	19.%;	40.7%;	10.7%;
			Always	80.%;	51.9%;	42.9%;
11	0.91	1	Moderate	19.2%;	37.0%;	46.4%;	0.104
	0.82-1.00		Many	34.6%;	44.4%;	28.6%;
			Always	46.2%;	18.5%;	32.1%;
		2	Moderate	11.%;	37.0%;	39.3%;	0.026
			Many	42.%;	48.1%;	28.6%;
			Always	46.%;	14.8%;	32.1%;
		3	Moderate	19.%;	37.0%;	39.3%;	0.082
			Many	30.%;	44.4%;	32.1%;
			Always	50.%;	18.5%;	28.6%;
						39.3%;

Question^* * 13) Number of times the child looks at the mother's face; 14) The child's responses to the mother's communicative stimulus; 15) Intensity with which the child responds positively to the attempt to establish communication; 16) to establish verbal and/or physical contact with the mother; 21) Quantity and quality of the interaction (communication, contact).	Kappa/95%;CI	Observer		VD (n = 26)		ICS (n = 27)		ECS (n = 28)		p-value
13	0.85	1	None	-	-	1	3.7%;	1	3.6%;	0.001
	0.77-0.93		Few	3	11.5%;	1	3.7%;	8	28.6%;
			Moderate	5	19.2%;	8	29.6%;	12	42.9%;
			Many	11	42.3%;	13	48.1%;	7	25.0%;
			Always	7	26.9%;	4	14.8%;	-	-
		2	None	-	-	1	3.7%;	1	3.6%;	0.001
			Few	3	11.5%;	2	7.4%;	8	28.6%;
			Moderate	5	19.2%;	9	33.3%;	12	42.9%;
			Many	12	46.2%;	12	44.4%;	7	25.0%;
			Always	6	23.1%;	3	11.1%;	-	-
		3	None	-	-	1	3.7%;	1	3.6%;	0.008
			Few	3	11.5%;	1	3.7%;	7	25.0%;
			Moderate	7	26.9%;	8	29.6%;	13	46.4%;
			Many	11	42.3%;	14	51.9%;	5	17.9%;
			Always	5	19.2%;	3	11.1%;	2	7.1%;
14	0.82	1	None	-	-	-	-	2	7.1%;	< 0.001
	0.72-0.91		Few	-	-	1	3.7%;	7	25.0%;
			Moderate	7	26.9%;	16	59.3%;	13	46.4%;
			Many	13	50.0%;	9	33.3%;	5	17.9%;
			Always	6	23.1%;	1	3.7%;	1	3.6%;
		2	None	-	-	-	-	2	7.1%;	< 0.001
			Few	-	-	2	7.4%;	7	25.0%;
			Moderate	7	26.9%;	15	55.6%;	12	42.9%;
			Many	12	46.2%;	9	33.3%;	6	21.4%;
			Always	7	26.9%;	1	3.7%;	1	3.6%;
		3	None	-	-	-	-	2	7.1%;	<0.001
			Few	-	-	1	3.7%;	7	25.0%;
			Moderate	7	26.9%;	15	55.6%;	11	39.3%;
			Many	13	50.0%;	10	37.0%;	7	25.0%;
			Always	6	23.1%;	1	3.7%;	1	3.6%;
15	0.84	1	Few	-	-	1	3.7%;	1	3.6%;	0.065
	0.72-0.96		Moderate	3	11.5%;	7	25.9%;	11	39.3%;
			Many	19	73.1%;	17	63.0%;	13	46.4%;
			Always	4	15.4%;	2	7.4%;	3	10.7%;
		2	Few	-	-	1	3.7%;	2	7.1%;	0.038
			Moderate	4	15.4%;	11	40.7%;	10	35.7%;
			Many	18	69.2%;	13	48.1%;	14	50.0%;
			Always	4	15.4%;	2	7.4%;	2	7.1%;
		3	Few	-	-	1	3.7%;	2	7.1%;	0.030
			Moderate	4	15.4%;	7	25.9%;	11	39.3%;
			Many	17	65.4%;	17	63.0%;	13	46.4%;
			Always	5	19.2%;	2	7.4%;	2	7.1%;
16	0.79	1	Moderate	-	-	1	3.7%;	3	10.7%;	0.079
	0.66-0.91		Many	8	30.8%;	9	33.3%;	13	46.4%;
			Always	18	69.2%;	17	63.0%;	12	42.9%;
		2	Moderate	-	-	1	3.7%;	5	17.9%;	0.008
			Many	8	30.8%;	11	40.7%;	14	50.0%;
			Always	18	69.2%;	15	55.6%;	9	32.1%;
		3	Moderate	1	3.8%;	-	-	4	14.3%;	0.054
			Many	8	30.8%;	10	37.0%;	13	46.4%;
			Always	17	65.4%;	17	63.0%;	11	39.3%;
21	0.80	1	Moderate	3	11.5%;	8	29.6%;	12	42.9%;	0.137
	0.69-0.91		Many	15	57.7%;	14	51.9%;	9	32.1%;
			Always	8	30.8%;	5	18.5%;	7	25.0%;
		2	Moderate	3	11.5%;	8	29.6%;	12	42.9%;	0.012
			Many	15	57.7%;	14	51.9%;	14	50.0%;
			Always	8	30.8%;	5	18.5%;	2	7.1%;
		3	Moderate	2	7.7%;	7	25.9%;	12	42.9%;	0.008
			Many	17	65.4%;	15	55.6%;	14	50.0%;
			Always	7	26.9%;	5	18.5%;	2	7.1%;

Authors / Year of publication	Title	Main findings
Bradley et al (1983)¹⁸18 Bradley CFB, Ross SE, Warnyca J. A prospective study of mothers’ attitudes and feelings following cesarean and vaginal births. Birth. 1983;10(02):79–83. Doi: 10.1111/j.1523-536x.1983.tb01405.x https://doi.org/10.1111/j.1523-536x.1983...	A prospective study of mother's attitudes and feelings following cesarean sections and vaginal deliveries.	According to the results of the study, women who had vaginal delivery had the best attitudes toward the baby.
Cranley et al (1983)¹⁹19 Cranley MS, Hedahl KJ, Pegg SH. Women’s perceptions of vaginal and cesarean deliveries. Nurs Res. 1983;32(01):10–15	Women's perceptions of vaginal delivery and cesarean section	Among the three groups studied - vaginal delivery, emergency cesarean section and elective cesarean section - the emergency cesarean group had more negative perception regarding the experience of delivery. In addition, women in cesarean groups are less likely to breastfeed, a fact that disqualifies mother-child interaction.
Hwang (1987)²⁰20 Hwang CP. Cesarean childbirth in Sweden: effects on the mother and father infant relationship. Infant Ment Health J. 1987;8(02): 91–99. Doi: 10.1002/1097-0355(198722)8:2<91:AID-IMHJ2280 080202>3.0.CO;2-D https://doi.org/10.1002/1097-0355(198722...	Cesarean childbirth in Sweden: Effects on the mother and father infant relationship.	The results of the study show that mothers of babies born by caesarean section reacted less positively when they first saw their children and had more difficulty breastfeeding than mothers of vaginal deliveries.
Gathwala et al (1991)¹⁷17 Gathwala G, Narayanan I. Influence of cesarean section on mother- baby interaction. Indian Pediatr. 1991;28(01):45–50	Influence of cesarean section on mother-baby interaction	Mothers in the representative group of vaginal delivery show an affective more significant behavior compared with mother's representative of the cesarean section.
Rocha et al (2003)²¹21 Rocha SM, Simpionato E, de Mello DF. [Mother-child bonding: comparative study of mothers after normal delivery and cesarean section]. Rev Bras Enferm. 2003;56(02):125–129. Doi: 10.1590/ S0034-71672003000200002 https://doi.org/10.1590/S0034-7167200300...	[Mother-child attachment: a comparative study between mothers with vaginal delivery and cesarean section]	Mothers of cesarean section need more attention to initiate breastfeeding. Both perform well in the care of the newborn in the postpartum period.
Olza Fernández et al (2013)²²22 Olza Fernández I, Marín Gabriel MA, García Murillo L, Malalana Martinez AM, Costarelli V, Millán Santos I. Mode of delivery may influence neonatal responsiveness tomaternal separation. Early Hum Dev. 2013;89(05):339–342. Doi: 10.1016/j.earlhumdev.2012.11.005 https://doi.org/10.1016/j.earlhumdev.201...	Mode of delivery may influence neonatal responsiveness to maternal separation	No differences were observed related to the mode of delivery; however, it was observed that children born by caesarean section cry less when they are separated from their mothers.
Carlander et al (2010)²³23 Carlander AK, Edman G, Christensson K, Andolf E, Wiklund I. Contact between mother, child and partner and attitudes towards breastfeeding in relation to mode of delivery. Sex Reprod Healthc. 2010;1(01):27–34. Doi: 10.1016/j.srhc.2009.10.001 https://doi.org/10.1016/j.srhc.2009.10.0...	Contact between mother, child and partner and attitudes toward breastfeeding in relation to mode of delivery	The mode of delivery does not seem to affect the way mothers experience their contact with the newborn. However, mothers who had a vaginal delivery started breastfeeding in a less stressful manner than mothers who had cesarean delivery.
Zanardo et al (2010)²⁴24 Zanardo V, Svegliado G, Cavallin F, Giustardi A, Cosmi E, Litta P, Trevisanuto D. Elective cesarean delivery: does it have a negative effect on breastfeeding? Birth. 2010;37(04):275–279. Doi: 10.1111/j.1523-536X.2010.00421.x https://doi.org/10.1111/j.1523-536X.2010...	Elective cesarean delivery: does it have a negative effect on breastfeeding?	Emergency and elective cesarean sections achieve lower success rates in exclusive breastfeeding compared with vaginal delivery.
Lai et al (2015)²⁵25 Lai YL, Hung CH, Stocker J, Chan TF, Liu Y. Postpartum fatigue, baby-care activities, and maternal-infant attachment of vaginal and cesarean births following rooming-in. Appl Nurs Res. 2015;28 (02):116–120. Doi: 10.1016/j.apnr.2014.08.002 https://doi.org/10.1016/j.apnr.2014.08.0...	Postpartum fatigue, babycare activities, and maternal-infant attachment of vaginal and cesarean births following rooming-in.	Women undergoing cesarean section had greater postpartum fatigue and, consequently, greater difficulty in baby care activities than women who had vaginal delivery.
Pilch (2015)²⁶26 Pilch D. [The influence of birth modus on the emotional state of the mother, bonding, and the newborn’s neurobehavioural state]. Pomeranian J Life Sci. 2015;61(03):249–256	The influence of birth modus on the emotional state of the mother, bonding, and the newborn's neurobehavioral state	Babies born vaginally had higher levels of cortisol and more frequent direct contact with mothers after delivery, which creates favorable conditions for the formation of bonds.

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[1] Address for correspondence Edward Araujo Júnior, PhD, Rua Botucatu, 740, Vila Clementino, São Paulo, SP, 04023-061, Brazil (e-mail: araujojred@terra.com.br).