Initial difficulties with breastfeeding technique and the impact on duration of exclusive breastfeeding

Abstract Objectives: the present study aimed to evaluate the influence of initial difficulties in breastfeeding on duration of exclusive breastfeeding. Methods: a prospective study with follow up of nursing mothers and their babies in the first six months of age. The studied population was randomly selected among the Brazilian public health system (SUS, Portuguese acronym) users in three hospitals. The breastfeeding observation protocol was used to collect initial data, which also included socio-demographic, prenatal assistance, delivery care, the postpartum period and the newborn variables. After hospital discharge, data were collected by phone. The multiple regression model was used for statistical analysis. Results: 175 mother-baby binomials were followed. Problems with breasts during the postpartum hospital stay (p= 0.030; OR=2.38; CI95%=1.02-5.48), maternal work outside home (p=0.027; OR=2.12; CI95%=1.03-4.31) and low maternal schooling level (p=0.017; OR=2.13; CI95%=1.10-4.06) were shown to be associated with the early interruption of exclusive breastfeeding before the child has completed 6 months of age. A family income lower than one minimum wage was a protective factor (p=0.048; OR=0.42; CI95%=0.17-0.97). Conclusions: socioeconomic aspects and difficulties in breastfeeding associated with problems with the puerperal breasts stood out as factors which restrict the duration of exclusive breastfeeding.摘要 研究目的：本研究旨在评估母乳喂养初期困难对纯母乳喂养（exclusive breastfeeding）持续时长的影响。 研究方法：本研究为前瞻性随访研究，对哺乳母亲及其婴儿在出生后前6个月开展随访。研究对象从三家医院的巴西公共卫生系统（Sistema Único de Saúde，葡萄牙语缩写SUS）使用者中随机选取。采用母乳喂养观察方案收集初始数据，内容涵盖社会人口学特征、产前保健、分娩护理、产后状况及新生儿相关变量。受试者出院后，通过电话随访采集数据。统计分析采用多元回归模型（multiple regression model）。 研究结果：本研究共随访175对母婴。产后住院期间出现乳房问题（p=0.030；比值比（Odds Ratio, OR）=2.38；95%置信区间（Confidence Interval, CI）=1.02~5.48）、母亲从事家庭外工作（p=0.027；OR=2.12；95%CI=1.03~4.31）及母亲受教育程度偏低（p=0.017；OR=2.13；95%CI=1.10~4.06），均与婴儿满6个月前提前终止纯母乳喂养显著相关。家庭收入低于当地最低工资标准为保护因素（p=0.048；OR=0.42；95%CI=0.17~0.97）。 研究结论：社会经济相关因素及与产褥期乳房问题相关的母乳喂养困难，是限制纯母乳喂养持续时长的突出影响因素。