Introdução: O contato pele-a-pele (CPP) ao nascimento consiste no posicionamento imediato do recém-nascido (RN) sobre o abdome ou tórax desnudo da mãe. Idealmente, o binômio mãe-filho deve permanecer em CPP continuamente por 1 hora para que benefícios como a promoção do aleitamento materno, estabilidade térmica, hemodinâmica e respiratória, organização comportamental, entre outros, sejam alcançados. Apesar de ser uma prática recomendada, a adesão ao CPP é insuficiente nas instituições brasileiras. Objetivo: Analisar a prática do CPP ao nascimento no hospital. Método: Estudo transversal realizado em um Hospital Amigo da Criança do município de São Paulo, SP. Foram inclusas puérperas de gestação única e seus RN de termo. Foram excluídos RN por cesariana e binômios mãe-filho que apresentaram complicações clínicas, obstétricas ou neonatais. A amostra foi composta por 78 binômios com erro de prevalência estimada em 10%. A coleta foi realizada no período de 1 mês, nos horários da manhã, tarde, noite e madrugada. Os dados foram obtidos dos prontuários da puérpera e do RN e por observação não participante da prática do CPP ao nascimento. Foi registrado o CPP ao nascimento, sua duração e interrupção e a efetivação da pega da mama materna na 1ª hora de vida do RN. Os dados foram analisados de modo descritivo e inferencial. Resultados: O CPP foi realizado em 94,9% (n=74) dos nascimentos, 73% (n=54) dos RN permaneceram menos de 60 minutos em contato e 50% (n=27) destes, menos que 15 minutos. A duração média do CPP foi de 29 minutos. O principal motivo para a interrupção do CPP foi a prestação de cuidados de rotina ao RN. Houve diferença significativa no tempo de CPP, com duração maior em relação às seguintes variáveis: Apgar no 5º minuto com índice 10 (p=0,003); condição perineal (mulheres com períneo íntegro; p=0,022); partos assistidos por enfermeira obstétrica (p=0,027); RN sem aspiração de vias aéreas superiores (AVAS) (p<0,001), com aplicação de vitamina K (p=0,048) e vacina da hepatite B (p=0,030); assistência neonatal prestada por médico residente (p=0,028). Os RN que receberam a AVAS ficaram, em média, 27 minutos a menos em CPP. Houve diferença significativa em relação às seguintes variáveis, com maior proporção de RN que efetivaram a pega da mama na 1ª hora de vida: índice de Apgar mais elevado no 1º e 5º minuto (p=0,035 e p=0,009, respectivamente); sem AVAS (p=0,015); posicionamento no colo materno (p=0,011); ajuda profissional para efetivação da pega (p<0,001). A condição perineal materna com integridade mostrou tendência à efetivação da pega (p=0,053). Não houve associação significativa entre a efetivação da pega, que ocorreu em 64,1% (n=50) dos RN, e o maior tempo de CPP (p=0,142). Conclusão: O CPP foi realizado na quase totalidade dos nascimentos, mas com duração inferior a 1 hora, na maioria dos casos. Os fatores que facilitaram o prolongamento do CPP e a pega efetiva da mama materna relacionam-se à boa vitalidade ao nascer e à integridade perineal. A assistência ao parto por enfermeira obstétrica favorece o CPP. A ajuda profissional na pega da mama e a permanência do RN no colo materno favorecem a amamentação precoce, independentemente da duração do CPP. As barreiras ao CPP e à efetivação da pega relacionam-se com os cuidados neonatais de rotina prestados ao RN durante a 1ª hora de vida, em especial, a AVAS. / Introduction: Skin-to-skin contact (SSC) at birth consists in positioning the newborn (NB) on the mothers abdomen or naked chest immediately. Ideally, the mother-child binomial should remain in SSC continuously for 1 hour, so that benefits such as the promotion of breastfeeding, thermal, hemodynamic and respiratory stability, behavioral organization, among others, are achieved. Although it is a recommended practice, SSC adherence is insufficient in Brazilian institutions. Objective: To analyze the SSC practice at birth in a hospital. Methods: A cross-sectional study, which was carried out in a Child-Friendly Hospital in the city of São Paulo, SP, Brazil. Single-term postpartum women and their full-term NBs were included. NBs by caesarean section and mother-child binomials that presented clinical, obstetric or neonatal complications were excluded. The sample consisted of 78 binomials, with an estimated prevalence of error in 10%. Data collection was performed in the period of 1 month, in the morning, afternoon, night and dawn hours. Data were obtained from the medical records of the postpartum women and NBs and by non-participant observation of the SSC practice at birth. The SSC practice was recorded at birth, its duration and interruption, as well as the accomplishment of the maternal breast latching in the 1 hour of life of the NB. Data were analyzed in a descriptive and inferential manner. Results: SSC was performed in 94.9% (n=74) of births, and 73% (n=54) of NBs remained less than 60 minutes in contact, of which 50% (n=27) for less than 15 minutes. The mean SSC duration was 29 minutes. The main reason for SSC discontinuation was the provision of routine care to NB. There was a significant difference in SSC time, with a longer duration in relation to the following variables: Apgar at the 5th minute with score 10 (p=0.003); perineal condition (women with intact perineum; p=0.022); births assisted by nurse-midwife (p=0.027); NB without upper airway aspiration (UAA) (p<0.001) and with application of vitamin K (p=0.048) and hepatitis B vaccine (p=0.030); neonatal care provided by a resident physician (p=0.028). The NBs that received UAA remained, on average, 27 minutes less in SSC. There was a significant difference, with a higher proportion of NBs with effective breast latching in the 1 hour of life in relation to the following variables: higher Apgar score at the 1st and 5th minutes (p=0.035 and p=0.009, respectively); without UAA (p=0.015); positioning in the mothers lap (p=0.011); professional help to perform the latching (p<0.001). The intact maternal perineum showed tendency in favor to effective breast latching (p=0.053). There was no significant association between the accomplishment of the latching, which occurred in 64.1% (n=50) of NBs, and the highest SSC time (p=0.142). Conclusion: SSC was performed in almost all births, but lasting less than 1 hour in most cases. The factors that have facilitated the SSC prolongation and the accomplishment of the maternal breast latching are related to good vitality at birth and perineal integrity. Birth care provided by nurse-midwives favors SSC. The professional help in latching the breast and the stay of NB in the mothers lap favor early breastfeeding, regardless of the SSC duration. The barriers to SSC and to the accomplishment of the latching are related to the routine neonatal care provided to NB during the 1 hour of life, especially the UAA.

Abstract This study describes skin-to-skin contact, initial breastfeeding, rooming-in, and exclusive breastfeeding in accordance with the Baby-Friendly Hospital Initiative (BFHI) program. Furthermore, it addresses the connection of these factors in Finnish maternity hospitals and gathers information about the daily work of maternity ward staff, which is useful to develop ways to increase exclusive breastfeeding of infants and to plan the introduction of BFHI. The study uses a cross-sectional design that includes questionnaires. Random data came from mothers (n=111), midwives (n=272), and maternity ward staff (f=1554) in maternity hospitals during the spring of 2014. The questionnaires include background questions, questions concerning the implementation of skin-to-skin contact, initial breastfeeding, rooming-in, exclusive breastfeeding according to the BFHI, and open-ended questions about implementation barriers. The analysis used statistical methods to interpret the data and content specifications to explain the answers to open questions. In Finland, successful skin-to-skin contact, initial breastfeeding, and rooming-in results in multiparas and vaginally births women. After vaginally births, exclusive breastfeeding increases when skin-to-skin contact, initial breastfeeding, and rooming-in starts at an early stage. Rooming-in does not take place for many different reasons. Maternity staff state that 72% implement exclusive breastfeeding, and mothers state that 55% exclusively breastfeed. Primiparous mothers and those who underwent cesarean are the populations that least use exclusive breastfeeding mostly due to infant medical issues and to non-medical reasons. The results of the study bring to light that practices with skin-to-skin contact, initial breastfeeding, and rooming-in in Finnish maternity units are similar to BFHI steps. Exclusive breastfeeding during hospitalization, as well as implementation barriers, should receive special attention. Furthermore, maternity staff should have a clearer medical understanding. / Tiivistelmä Tutkimuksen tarkoituksena oli kuvata äitien ja hoitohenkilökunnan näkökulmista ihokontaktin, ensi-imetyksen, vierihoidon ja täysimetyksen toteutumista Vauvamyönteisyysohjelman mukaisesti ja niihin yhteydessä olevia tekijöitä Suomen synnytyssairaaloissa. Tavoitteena oli tuottaa synnytysosastojen henkilökunnan päivittäiseen hoitotyöhön tietoa, jota voidaan hyödyntää kehitettäessä menetelmiä vastasyntyneiden täysimetyksen lisäämiseen ja Vauvamyönteisyysohjelman käyttöönoton suunnitteluun. Tutkimus oli poikkileikkaustutkimus, joka toteutettiin kyselytutkimuksena. Aineisto kerättiin satunnaisesti valituissa synnytyssairaaloissa äideiltä (n=111), synnytyssalikätilöiltä (n=272) ja vuodeosastojen hoitajilta (f=1554, f=hoitoraporttien/kyselylomakkeiden määrä) keväällä 2014. Kyselylomakkeessa oli taustatietokysymysten lisäksi ihokontaktin, ensi-imetyksen, vierihoidon ja täysimetyksen toteutumisesta Vauvamyönteisyysohjelman mukaisesti mittaavia kysymyksiä sekä avoimia kysymyksiä niiden toteutumista estävistä tekijöistä. Aineisto analysoitiin tilastollisin menetelmin ja avoimet kysymykset sisällön erittelyllä. Ihokontakti, ensi-imetys ja vierihoito toteutuivat Suomessa hyvin alateitse synnyttäneillä uudelleensynnyttäjillä. Täysimetys lisääntyi ihokontaktin ja ensi-imetyksen alkaessa varhain ja vierihoidon toteutuessa. Vierihoidon toteutumista estivät useat eri syyt. Täysimetys toteutui Suomessa hoitajien arvioimana 72 %:lla ja äitien arvioimana 55 %:lla. Se toteutui vähiten ensisynnyttäjillä ja keisarileikatuilla ja estyi enimmäkseen lääketieteellisistä syistä. Tutkimus osoittaa, että Suomen synnytyssairaaloiden hoitokäytännöt ihokontaktin, ensi-imetyksen ja vierihoidon toteutumisessa eivät poikkea suuresti Vauvamyönteisyysohjelman suosituksista. Täysimetys sairaalassa vaatii lisätarkastelua ja sen osalta sairaaloissa tulee kiinnittää huomiota lisäruoan antamisen syihin ja selkiyttää hoitohenkilökunnalle sen antamisen lääketieteellisiä syitä.

<p>Kangaroo mother care (KMC) was first initiated in Colombia due to shortages of incubators and the incidence of severe hospital infections of new-born infants during hospital stay (Feldman, 2004). Currently it is identified by UNICEF as a universally available and biologically sound method of care for all new-borns, particularly for low birth weight infants (Department of Reproductive Health and Research, 2003) in both developed and developing countries. The Western Cape Provincial Government implemented a policy on KMC as part of their strategy to decrease the morbidity and mortality of premature infants in 2003 (Kangaroo Mother Care Provincial task team, 2003). Essential components of KMC are: skin-to-skin contact for 24 hours per day (or as great a part of the day as possible), exclusive breastfeeding and support to the motherinfant dyad. Successful implementation of KMC requires relevant education of nurses, education of mothers on KMC by nursing staff, monitoring of the implementation of KMC by nurses, planning for a staff mix with varying levels of skill and experience with KMC, the identification of institution specific barriers to the implementation of KMC, and the implementation of institution specific strategies to overcome these barriers (Wallin,et al., 2005 / Bergman &amp / Jurisco, 1994 / Cattaneo, et al., 1998). This study aims to determine the knowledge of and attitude towards kangaroo mother care, of nursing staff and kangaroo mothers in the Eastern sub-district of Cape Town.</p>

<p>Kangaroo mother care (KMC) was first initiated in Colombia due to shortages of incubators and the incidence of severe hospital infections of new-born infants during hospital stay (Feldman, 2004). Currently it is identified by UNICEF as a universally available and biologically sound method of care for all new-borns, particularly for low birth weight infants (Department of Reproductive Health and Research, 2003) in both developed and developing countries. The Western Cape Provincial Government implemented a policy on KMC as part of their strategy to decrease the morbidity and mortality of premature infants in 2003 (Kangaroo Mother Care Provincial task team, 2003). Essential components of KMC are: skin-to-skin contact for 24 hours per day (or as great a part of the day as possible), exclusive breastfeeding and support to the motherinfant dyad. Successful implementation of KMC requires relevant education of nurses, education of mothers on KMC by nursing staff, monitoring of the implementation of KMC by nurses, planning for a staff mix with varying levels of skill and experience with KMC, the identification of institution specific barriers to the implementation of KMC, and the implementation of institution specific strategies to overcome these barriers (Wallin,et al., 2005 / Bergman &amp / Jurisco, 1994 / Cattaneo, et al., 1998). This study aims to determine the knowledge of and attitude towards kangaroo mother care, of nursing staff and kangaroo mothers in the Eastern sub-district of Cape Town.</p>

Introdução: O contato pele-a-pele (CPP) ao nascimento consiste no posicionamento imediato do recém-nascido (RN) sobre o abdome ou tórax desnudo da mãe. Idealmente, o binômio mãe-filho deve permanecer em CPP continuamente por 1 hora para que benefícios como a promoção do aleitamento materno, estabilidade térmica, hemodinâmica e respiratória, organização comportamental, entre outros, sejam alcançados. Apesar de ser uma prática recomendada, a adesão ao CPP é insuficiente nas instituições brasileiras. Objetivo: Analisar a prática do CPP ao nascimento no hospital. Método: Estudo transversal realizado em um Hospital Amigo da Criança do município de São Paulo, SP. Foram inclusas puérperas de gestação única e seus RN de termo. Foram excluídos RN por cesariana e binômios mãe-filho que apresentaram complicações clínicas, obstétricas ou neonatais. A amostra foi composta por 78 binômios com erro de prevalência estimada em 10%. A coleta foi realizada no período de 1 mês, nos horários da manhã, tarde, noite e madrugada. Os dados foram obtidos dos prontuários da puérpera e do RN e por observação não participante da prática do CPP ao nascimento. Foi registrado o CPP ao nascimento, sua duração e interrupção e a efetivação da pega da mama materna na 1ª hora de vida do RN. Os dados foram analisados de modo descritivo e inferencial. Resultados: O CPP foi realizado em 94,9% (n=74) dos nascimentos, 73% (n=54) dos RN permaneceram menos de 60 minutos em contato e 50% (n=27) destes, menos que 15 minutos. A duração média do CPP foi de 29 minutos. O principal motivo para a interrupção do CPP foi a prestação de cuidados de rotina ao RN. Houve diferença significativa no tempo de CPP, com duração maior em relação às seguintes variáveis: Apgar no 5º minuto com índice 10 (p=0,003); condição perineal (mulheres com períneo íntegro; p=0,022); partos assistidos por enfermeira obstétrica (p=0,027); RN sem aspiração de vias aéreas superiores (AVAS) (p<0,001), com aplicação de vitamina K (p=0,048) e vacina da hepatite B (p=0,030); assistência neonatal prestada por médico residente (p=0,028). Os RN que receberam a AVAS ficaram, em média, 27 minutos a menos em CPP. Houve diferença significativa em relação às seguintes variáveis, com maior proporção de RN que efetivaram a pega da mama na 1ª hora de vida: índice de Apgar mais elevado no 1º e 5º minuto (p=0,035 e p=0,009, respectivamente); sem AVAS (p=0,015); posicionamento no colo materno (p=0,011); ajuda profissional para efetivação da pega (p<0,001). A condição perineal materna com integridade mostrou tendência à efetivação da pega (p=0,053). Não houve associação significativa entre a efetivação da pega, que ocorreu em 64,1% (n=50) dos RN, e o maior tempo de CPP (p=0,142). Conclusão: O CPP foi realizado na quase totalidade dos nascimentos, mas com duração inferior a 1 hora, na maioria dos casos. Os fatores que facilitaram o prolongamento do CPP e a pega efetiva da mama materna relacionam-se à boa vitalidade ao nascer e à integridade perineal. A assistência ao parto por enfermeira obstétrica favorece o CPP. A ajuda profissional na pega da mama e a permanência do RN no colo materno favorecem a amamentação precoce, independentemente da duração do CPP. As barreiras ao CPP e à efetivação da pega relacionam-se com os cuidados neonatais de rotina prestados ao RN durante a 1ª hora de vida, em especial, a AVAS. / Introduction: Skin-to-skin contact (SSC) at birth consists in positioning the newborn (NB) on the mothers abdomen or naked chest immediately. Ideally, the mother-child binomial should remain in SSC continuously for 1 hour, so that benefits such as the promotion of breastfeeding, thermal, hemodynamic and respiratory stability, behavioral organization, among others, are achieved. Although it is a recommended practice, SSC adherence is insufficient in Brazilian institutions. Objective: To analyze the SSC practice at birth in a hospital. Methods: A cross-sectional study, which was carried out in a Child-Friendly Hospital in the city of São Paulo, SP, Brazil. Single-term postpartum women and their full-term NBs were included. NBs by caesarean section and mother-child binomials that presented clinical, obstetric or neonatal complications were excluded. The sample consisted of 78 binomials, with an estimated prevalence of error in 10%. Data collection was performed in the period of 1 month, in the morning, afternoon, night and dawn hours. Data were obtained from the medical records of the postpartum women and NBs and by non-participant observation of the SSC practice at birth. The SSC practice was recorded at birth, its duration and interruption, as well as the accomplishment of the maternal breast latching in the 1 hour of life of the NB. Data were analyzed in a descriptive and inferential manner. Results: SSC was performed in 94.9% (n=74) of births, and 73% (n=54) of NBs remained less than 60 minutes in contact, of which 50% (n=27) for less than 15 minutes. The mean SSC duration was 29 minutes. The main reason for SSC discontinuation was the provision of routine care to NB. There was a significant difference in SSC time, with a longer duration in relation to the following variables: Apgar at the 5th minute with score 10 (p=0.003); perineal condition (women with intact perineum; p=0.022); births assisted by nurse-midwife (p=0.027); NB without upper airway aspiration (UAA) (p<0.001) and with application of vitamin K (p=0.048) and hepatitis B vaccine (p=0.030); neonatal care provided by a resident physician (p=0.028). The NBs that received UAA remained, on average, 27 minutes less in SSC. There was a significant difference, with a higher proportion of NBs with effective breast latching in the 1 hour of life in relation to the following variables: higher Apgar score at the 1st and 5th minutes (p=0.035 and p=0.009, respectively); without UAA (p=0.015); positioning in the mothers lap (p=0.011); professional help to perform the latching (p<0.001). The intact maternal perineum showed tendency in favor to effective breast latching (p=0.053). There was no significant association between the accomplishment of the latching, which occurred in 64.1% (n=50) of NBs, and the highest SSC time (p=0.142). Conclusion: SSC was performed in almost all births, but lasting less than 1 hour in most cases. The factors that have facilitated the SSC prolongation and the accomplishment of the maternal breast latching are related to good vitality at birth and perineal integrity. Birth care provided by nurse-midwives favors SSC. The professional help in latching the breast and the stay of NB in the mothers lap favor early breastfeeding, regardless of the SSC duration. The barriers to SSC and to the accomplishment of the latching are related to the routine neonatal care provided to NB during the 1 hour of life, especially the UAA.

Magister Public Health - MPH / Kangaroo mother care (KMC) was first initiated in Colombia due to shortages of incubators and the incidence of severe hospital infections of new-born infants during hospital stay (Feldman, 2004). Currently it is identified by UNICEF as a universally available and biologically sound method of care for all new-borns, particularly for low birth weight infants (Department of Reproductive Health and Research, 2003) in both developed and developing countries. The Western Cape Provincial Government implemented a policy on KMC as part of their strategy to decrease the morbidity and mortality of premature infants in 2003 (Kangaroo Mother Care Provincial task team, 2003). Essential components of KMC are: skin-to-skin contact for 24 hours per day (or as great a part of the day as possible), exclusive breastfeeding and support to the motherinfant dyad. Successful implementation of KMC requires relevant education of nurses, education of mothers on KMC by nursing staff, monitoring of the implementation of KMC by nurses, planning for a staff mix with varying levels of skill and experience with KMC, the identification of institution specific barriers to the implementation of KMC, and the implementation of institution specific strategies to overcome these barriers (Wallin,et al., 2005; Bergman & Jurisco, 1994; Cattaneo, et al., 1998). This study aims to determine the knowledge of and attitude towards kangaroo mother care, of nursing staff and kangaroo mothers in the Eastern sub-district of Cape Town. / South Africa