Profesional que asistió al parto y amamantamiento en la primera hora de vida

estudio transversal con datos de la investigación Nascer no Brasil (Nacer en Brasil), conducida en el periodo de 2011-2012. Se analizaron datos de 8.466 puérperas por medio de modelo de regresión logística con abordaje jerarquizado.

Resultados:

La proporción de madres que amamantaron al nacimiento fue mayor en los partos asistidos por el enfermero (70%). El parto asistido por enfermero presentó una probabilidad un 64% mayor de lactancia en la primera hora de vida. Otros factores asociados al desenlace: residir en el Norte; edad inferior a 35 años; multiparidad; orientación en el prenatal sobre lactancia materna en la primera hora de vida; nacimiento en el Hospital Amigo del Niño; acompañante en el parto; y el recién nacido de sexo femenino.

Conclusiones:

El parto asistido por el enfermero/enfermero obstetra fue un importante factor independiente asociado a la lactancia materna en la primera hora de vida, sugiriendo la importancia del fortalecimiento del papel del enfermero obstetra.

Descriptores:
Enfermeras Obstetrices; Partería; Periodo Posparto; Lactancia Materna; Estudios Transversales

Variables	n (%)	Breastfeeding in the first hour of life (%)	Crude OR (95%CI)	p value
Geographic region (n=8,466)
North	759 (9.0)	71.8	1.78(1.16-2.75)	0.008
Midwest	509 (6.0)	66.2	1.37(0.88-2.15)	0.159
South	1.013 (12.0)	65.3	1.32(0.84-2.09)	0.224
Northeast	2.405 (28.4)	58.0	0.97(0.68-1.37)	0.864
Southeast	3.780 (44.7)	58.7	1
Area of residence (n=8,466)
Capital	3.372 (39.8)	61.5	1
Inland	5.093 (60.2)	60.5	0.95(0.70-1.29)	0.781
Skin color (n=8,464)
White	2.401 (28.4)	60.8	1
Non-white	6.062 (71.6)	61.0	1.00(0.84-1.20)	0.931
Maternal age (n=8,466)
12-19 years	2.032 (24.0)	62.3	1.45(1.12-1.88)	0.004
20-34 years	5.805 (68.6)	61.3	1.40(1.11-1.75)	0.004
≥ 35 years	629 (7.4)	53.1	1
Schooling (n=8,466)
≥ 11 years of study	3.117 (36.8)	59.3	1
< 11 years of study	5.349 (63.2)	61.8	1.11(0.96-1.28)	0.157
Parity (n=8,466)
Primiparous	3.544 (41.9)	58.9	1
Multiparous	4.922 (58.1)	62.4	1.15(1.00-1.33)	0.044
Economic class (n=8,404)
A; B	1.261(15.0)	59.9	1
C	4.598 (54.7)	59.4	0.97(0.79-1.20)	0.840
D; E	2.544 (30.3)	63.8	1.17(0.91-1.52)	0.212

Variables	n (%)	Breastfeeding in the first hour of life (%)	Crude OR (95%CI)	p value
Number of PN visits^* * PN - Prenatal care. (n=8,290)
Did not perform PN	125 (1.5)	56.5	1
1-5 visits	2.545 (30.7)	63.6	1.34(0.77-2.34)	0.293
6 or more visits	5.620 (67.8)	59.8	1.14(0.65-1.99)	0.634
Guidance on breastfeeding in the first hour of life in PN (n=8,421)
No or did not perform PN	3.278 (38.9)	57.8	1
Yes	5.143 (61.1)	62.8	1.23(1.02-1.48)	0.031
Health professional who attended most PN visits (n=8,193)
Doctor	5.820 (71)	60.8	1
Nurse	2.373 (29)	61.3	1.02(0.83-1.25)	0.841

Variables	n (%)	Breastfeeding in the first hour of life (%)	Crude OR (95%CI)	p value
Professional that attended delivery (n=8,466)
Doctor	7.062 (83.4)	59.0	1
Nurse/obstetric nurse	1.404 (16.6)	70.5	1.66(1.17-2.36)	0.005
Use of oxytocin during labor (n=8,466)
Yes	4.087 (48.3)	60.0	1
No	4.379 (51.7)	61.8	1.08(0.91-1.28)	0.365
Companion during delivery (n=8,465)
No	5.572 (65.8)	58.0	1
Yes	2.893 (34.2)	66.6	1.44(1.17-1.77)	0.001
Hospital type (n=8,466)
Private	268 (3.2)	42.2	1
Mixed	3.815 (45.1)	58.6	1.93(1.06-3.53)	0.031
Public	4.383 (51.8)	64.1	2.44(1.36-4.38)	0.003
Baby-Friendly Hospital (8,466)
No	4.217 (49.8)	54.3	1
Underway	789 (9.3)	61.6	1.34(0.81-2.22)	0.239
Yes	3.460 (40.9)	68.8	1.85(1.37-2.49)	<0.001
Use of non-pharmacological method for pain relief (n=8,466)
No	5.621 (66.4)	59.4	1
Yes	2.845 (33.6)	63.9	1.20(0.99-1.45)	0.051
Gestational age (n=8,465)
37 to < 39 weeks	3.052 (36.1)	59.4	0.79(0.64-0.99)	0.048
39 to < 41 weeks	4.645 (54.9)	61.3	0.86(0.70-1.07)	0.185
41 to < 42 weeks	768 (9.1)	64.6	1
Newborn gender (n=8,464)
Male	4.338 (51.3)	59.4	1
Female	4.126 (48.7)	62.5	1.13(1.00-1.28)	0.037

Variables	Distal model		Intermediate model^* * Intermediate model: adjusted for the statistically significant variables of the Distal Model (p <0.05);		Proximal model^ Proximal model: adjusted for the statistically significant variables of the distal and intermediate models (p <0.05).
	n=8,466		n=8,421		n=8,418
	Adjusted OR (95%CI)	p value	Adjusted OR (95%CI)	p value	Adjusted OR (95%CI)	p value
LEVEL 1
Geographic region		0.032		0.034		0.050
North	1.73(1.12-2.67)		1.71(1.10-2.66)		1.74(1.12-2.71)
Midwest	1.35(0.86-2.12)		1.31(0.83-2.05)		1.34(0.79-2.29)
South	1.33(0.84-2.10)		1.31(0.83-2.07)		1.26(0.80-1.97)
Northeast	0.97(0.68-1.38)		0.93(0.66-1.32)		0.99(0.70-1.42)
Southeast	1		1		1
Maternal age		0.001		0.001		0.001
12-19 years	1.67(1.26-2.21)		1.68(1.26-2.23)		1.61(1.22-2.13)
20-34 years	1.45(1.16-1.81)		1.44(1.15-1. 80)		1.42(1.13-1.77)
≥ 35 years	1		1		1
Parity		0.009		0.006		0.008
Multiparous	1.25(1.05-1.48)		1.26(1.07-1.50)		1.26(1.05-1.50)
Primiparous	1		1		1
LEVEL 2
Guidance on breastfeeding in the first hour of life in prenatal care	-	-		0.016		0.016
Yes	-	-	1.24(1.04-1.49)		1.25(1.04-1.50)
Did not receive or do prenatal care	-	-	1		1
LEVEL 3
Baby-Friendly Hospital	-	-	-	-		0.004
Yes	-	-	-	-	1.66(1.23-2.25)
Underway	-	-	-	-	1.40(0.88-2.24)
No	-	-	-	-	1
Professional that attended the delivery	-	-	-	-		0.004
Nurse/obstetric nurse	-	-	-	-	1.64(1.17-2.29)
Doctor	-	-	-	-	1
Companion at delivery	-	-	-	-		0.005
Yes	-	-	-	-	1.33(1.09-1.64)
No	-	-	-	-	1
Newborn gender	-	-	-	-		0.010
Female	-	-	-	-	1.17(1.03-1.32)
Male	-	-	-	-	1

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding Author: Laís Araújo Tavares Silva E-mail: laisaraujots@gmail.com