Factores condicionantes de la lactancia materna en tiempos de COVID-19 / Conditioning factors for breastfeeding in times of COVID-19

Objetivo: identificar los condicionantes del establecimiento y duración de la lactancia materna (LM) durante la COVID-19 desde la perspectiva de las matronas de la provincia de Castellón (España).Métodos: estudio cualitativo realizado en 2021 mediante la realización de cuatro grupos focales (GF) con matronas de la provincia de Castellón. La recolección de la información se hizo mediante videoconferencias con grabación de voz, que fueron transcritas para posterior análisis del discurso con el programa ATLAS.ti.Resultados: las matronas identificaron como facilitadores de la LM, la puesta en valor de la LM ante las madres y el fomento de la accesibilidad a recursos para solucionar situaciones problemáticas, entre otros. Como barreras refirieron ideas maternas sobre alimentación con fórmulas artificiales construidas desde su biografía, consideración social sesgada sobre el amamantamiento, falta de protocolos para extracción de calostro y déficit en la calidad de información en las redes sociales, principalmente. Reconocen que la pandemia COVID-19 produjo impactos positivos y negativos en la LM. Surgieron medidas para optimizar la promoción de la LM como aumentar la ratio matronas/madres gestantes, asistencia domiciliaria a las 24 h del alta, unificación de protocolos intercentros, ampliación a seis meses el tiempo de incorporación al trabajo y adaptación de la promoción de la LM en redes sociales.Conclusiones: se reportaron condicionantes de la lactancia emergentes del escenario sociosanitario español que sirven de base para diseñar acciones específicas de promoción. Los impactos de la pandemia COVID-19 sobre la LM deben considerarse en situaciones de confinamiento prolongado de la madre. (AU)

Objective: to identify the conditioning factors for implementation and duration of breastfeeding during COVID-19 from the perspective of midwives from the Castellón province (Spain).Methods: a qualitative study conducted in 2021 through four focus groups (FGs) with midwives from the Castellón province. Data collection was carried out via videoconferences with audio recording, which were transcribed for subsequent discourse analysis with the Atlas Ti program.Results: the enablers for breastfeeding identified by midwives were the promotion of breastfeeding for mothers and the development of access to resources to solve troublesome situations, among others. They reported as barriers the maternal beliefs regarding feeding with artificial formulas based on their biography, a biased social consideration on breastfeeding, lack of protocols for colostrum extraction, and deficient quality of information in social networks, mostly. They acknowledged that the COVID-19 pandemic had positive and negative impacts on breastfeeding. Some measures came up to optimize breastfeeding promotion, such as an increase in the midwife/pregnant mother ratio, home care 24 hours after discharge, unification of protocols among centres, extending to six months the time for incorporation to work, and adaptation of breastfeeding promotion in social networks.Conclusions: conditioning factors for breastfeeding were reported, originating in the Spanish sociosanitary scenario, which are useful as the basis for designing specific promotion actions. The impact of the COVID-19 pandemic on breastfeeding must be considered in situations of prolonged lockout of mothers. (AU)

Umbilical cord clamping time and maternal satisfaction.

OBJECTIVE: Clamping of the umbilical cord is part of the third stage of delivery. Delayed cord clamping (DCC) is recommended due to its contribution to prevention of anaemia. There is no evidence on the effect of DCC on maternal satisfaction. The aim of this study is to evaluate the effect of different sociodemographic and obstetric factors, including the timing of cord clamping, on maternal satisfaction with the birth experience in our healthcare system. DESIGN: Pragmatic non-drug intervention study with simple random assignment of participating mothers (Clinical Trials N°: NCT03624335). SETTING: A public, university-level hospital in Villarreal city, eastern Spain. PARTICIPANTS: Childbearing woman, gestation week between 35 and 42 weeks, with regular medical pregnancy checks, single pregnancy and vaginal delivery (N = 198, 80% of the women recruited). INTERVENTIONS: umbilical cord clamping within 60 seconds of the birth (Early cord clamping, ECC) versus umbilical cord clamping after pulsation had been ceased (Delayed cord clamping, DCC). MEASUREMENTS: Birth satisfaction was measured using the Mackey Childbirth Satisfaction Rating Scale (MCSRS). Additionally, sociodemographic data, degree of knowledge about the moment of clamping and type of breastfeeding data were recorded. The Mann-Whitney and Kruskal-Wallis tests for comparison of the mean of two, three, or more groups, respectively, and Chi-square and Spearman for comparison of two qualitative and quantitative variables, respectively, were used. To determine the weight of each factor of MCSRS, an exploratory factor analysis was carried out using the maximum likelihood method for factor extraction and the varimax method for factor rotation. The adequacy of the factor analysis was checked by mean of Kaiser-Meyer-Olkin test and Bartlett sphericity test. The level of significance was set at a p-value of < 0.05. FINDINGS: The average degree of satisfaction was 4.55/5 (SD: 0.37). No statistically significant difference was observed between mothers' satisfaction according to mother level of study or mother's place of birth, while it changed significantly with age (p = 0.0398). Within the obstetric variables, satisfaction was significantly associated with spontaneous amniorrhexis, the duration of the second stage of delivery, and the Apgar value of the newborn at the first minute of life, and was independent of the number of previous pregnancies and deliveries, use of intrapartum oxytocin, epidural analgesia, episiotomy, the weight of the child at birth and type of breastfeeding. Furthermore, there was no relationship between the time of clamping and satisfaction (p = 0.5178). KEY CONCLUSIONS: Maternal satisfaction with the birth experience varies with the age of the childbearing woman, and some intrapartum factors and the result is not influenced by the time of clamping of the umbilical cord. Therefore, this component of the physiological management of childbirth provides additional benefits for the health of the neonate, without negative consequences on the final perception of the maternal health care received. IMPLICATIONS FOR PRACTICE: If there are no reasons that justify an early umbilical cord clamping, delaying it brings benefits to the neonate, without negatively affecting the maternal assessment of the experience of childbirth.