Programa de Pós-Graduação em Epidemiologia em Saúde Pública, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
Rev Saude Publica. 2011 Feb;45(1):69-78. doi: 10.1590/s0034-89102010005000051. Epub 2010 Nov 12.
To identify factors associated with breastfeeding in the first hour of life (Step 4 of the Baby-Friendly Hospital Initiative).
A cross-sectional study was conducted with a representative sample of mothers who gave birth in maternity wards in the city of Rio de Janeiro, Southeastern Brazil, between 1999 and 2001. Newborns or mothers with restriction to breastfeeding were excluded, resulting in a sample of 8,397 pairs. A random effect--at maternity hospital level--Poisson model was employed in a hierarchical approach with three levels: distal, intermediate and proximal for characteristics of the mother, of the newborn, and of prenatal and hospital assistance.
Only 16% of the mothers breastfed in the first hour of life. Breastfeeding in this period was less prevalent among neonates with immediate intercurrences after birth (PR = 0.47; CI99% 0.15;0.80); among mothers who did not have contact with their newborns in the delivery room (PR = 0.62; CI99% 0.29;0.95); among mothers submitted to cesarean section delivery (PR = 0.48; CI99% 0.24;0.72); and among mothers who gave birth at private maternity hospitals (PR = 0.06; CI99% 0.01;0.19) or at maternity hospitals contracted out to National Health System (SUS) (PR = 0.16; CI99% 0.01;0.30). The context effect of maternity wards was statistically significant.
At an individual level, breastfeeding within one hour after birth was constrained by inappropriate practices in private or SUS-contracted maternity hospitals. The group effect of maternity hospitals and the absence of individual maternal-related factors that explain the outcome suggest that mothers have little or no autonomy to breastfeed their babies within the first hour of life, and depend on the institutional practices that prevail at the maternity hospitals.
确定与生命最初 1 小时内母乳喂养（婴儿友好医院倡议第 4 步）相关的因素。
本横断面研究采用了巴西东南部里约热内卢市产科病房分娩的母亲的代表性样本。排除了限制母乳喂养的新生儿或母亲，最终纳入了 8397 对母亲和新生儿。采用分层方法，以医院为随机效应，在三个层次（远端、中间和近端）上对母亲、新生儿、产前和医院援助的特征采用泊松模型。
仅有 16%的母亲在生命最初 1 小时内进行母乳喂养。在此期间，新生儿出生后立即出现并发症（PR=0.47；99%CI99% 0.15；0.80）、母亲在分娩室未与新生儿接触（PR=0.62；99%CI99% 0.29；0.95）、行剖宫产分娩（PR=0.48；99%CI99% 0.24；0.72）和在私立或纳入国家卫生系统（SUS）的产科医院分娩的母亲中，母乳喂养的情况不太常见（PR=0.06；99%CI99% 0.01；0.19；PR=0.16；99%CI99% 0.01；0.30）。产科病房的环境效应具有统计学意义。
在个体层面上，在出生后 1 小时内进行母乳喂养受到私立或 SUS 合同产科医院不当实践的限制。产科病房的群体效应以及缺乏解释结果的个体母亲相关因素表明，母亲在生命最初 1 小时内几乎没有或没有自主权来母乳喂养婴儿，而是依赖于医院普遍存在的机构实践。
