W OMEN’S SOCI AL SPACE AND THE REFERENCE FOR BREASTFEEDI NG PRACTI CE
Ana Már cia Spanó Nak ano1 Már cia Cr ist ina Guer r eir o dos Reis2 Mar ia José Bist afa Per eir a3 Fláv ia Azev edo Gom es3
Nak an o AMS, Reis MCG, Per eira MJB, Gom es FA. Wom en ’s social space an d t h e r efer en ce for br east feedin g pr act ice. Rev Lat ino- am Enfer m agem 2007 m ar ço- abr il; 15( 2) : 230- 8.
This st udy aim ed t o ident ify agent s or inst it ut ions t aken as reference by wom en when breast feeding. A qualit at ive st udy was carried out on 20 prim iparous who were assist ed, for reasons not relat ed t o breast feeding, in t he five healt h services select ed by t his st udy. Dat a were collect ed by sem i- st ruct ured int erviews carried out in t he part icipant s’ households and were analyzed by cont ent analysis in t he t hem at ic m ode. We ident ified t hat h ealt h p r of ession als p lay a st an d ar d ize r ole of b r east f eed in g b ased on scien t if ic k n ow led g e. I n t h e d aily br east feeding r out ine, t he fam ily is t he fir st r efer ence for w om en, t r ansm it t ing beliefs, habit s and behav ior s. We believe in t he valorizat ion of t he fam ily cont ext by t he healt h professional, in which act ions and int eract ions in t h e b r east f eed in g issu e ar e d ev elop ed in or d er t o con st it u t e t h e f ou n d at ion s f or a n ew car e m od el in br east feeding. This m odel should, t her efor e, consider t he pr act ice div er sit y , adapt ing act ions t o t he m ult iple r oles of being m ot her / for t r ess/ w ife/ w or k er in t he social cont ex t .
DESCRI PTORS: br east feeding; w om en’s healt h; m at er nal- child nur sing
EL ESPACI O SOCI AL DE MUJERES Y SU REFERENCI A PARA EL CUI DADO EN
LA PRÁCTI CA DE LA LACTANCI A
Est e est udio t uv o com o obj et iv o ident ificar los agent es o inst it uciones consider adas com o r efer encia por las m adr es lact ant es en la pr áct ica de am am at ación. I nv est igación cualit at iv a con 20 puér per as quienes bu scar on por r azon es aj en as a la lact an cia u n a de las 5 u n idades básicas de salu d seleccion adas en est e est udio. Los dat os fuer on r ecolect ados a t r av és de ent r ev ist as sem i- est r uct ur adas r ealizadas en su dom icilio; su análisis se apoy ó en el análisis de cont enido, m odalidad t em át ica. Fue ident ificado que el pr ofesional de salud asum e un r ol nor m at iv o en est e pr oceso, apoy ándose en conocim ient os cient íficos. Dent r o del pr oceso d e am am an t ar , la f am ilia ocu p a el p r im er lu g ar d e r ef er en cia p ar a las m u j er es, t r an sm it ien d o cr een cias, hábit os y conduct as. Se cree que la valorización del cont ext o fam iliar por el profesional de salud, al desarrollar acciones e int er acciones dur ant e la lact ancia, se const it uy en en bases par a un nuev o m odelo de at ención en lact ancia, que considere las diversidades de est a práct ica, adecuándolas a la pluralidad de ser m adre/ lact ant e/ esposa/ t r abaj ador a dent r o de su cont ex t o social.
DESCRI PTORES: lact ancia m at er na; salud de la m uj er ; enfer m er ía m at er no- infant il
O ESPAÇO SOCI AL DAS MULHERES E A REFERÊNCI A PARA O CUI DADO
NA PRÁTI CA DA AMAMENTAÇÃO
Est e est u do t ev e com o obj et iv o iden t if icar os agen t es ou in st it u ições t om adas por r ef er ên cia pelas nut r izes, na pr át ica da am am ent ação. Realizou- se pesquisa qualit at iva, cuj os suj eit os for am 20 puér per as que pr ocur ar am , por r azões alheias à am am ent ação, as 5 Unidades Básicas de Saúde, selecionadas nest e est udo. Os dados foram colet ados por ent revist a do t ipo sem i- est rut urada realizada no dom icílio e a análise foi baseada n a t écn ica de an álise de con t eú do- m odalidade t em át ica. I den t ificou - se qu e o pr ofission al de saú de assu m e p a p e l n o r m a t i za d o r d a a m a m e n t a çã o , r e sp a l d a n d o - se e m co n h e ci m e n t o s ci e n t íf i co s. No co t i d i a n o d a am am ent ação, a fam ília ocupa o pr im eir o lugar de r efer ência par a as m ulher es, t r ansm it indo cr enças, hábit os e condut as. Acr edit a- se na v alor ização do cont ex t o fam iliar pelo pr ofissional de saúde, desenv olv endo ações e int er ação nas quest ões da am am ent ação, const it uindo- se as bases de um nov o m odelo de assist ência em am am ent ação, que consider e as div er sidades dessa pr át ica, adequando as ações à plur alidade de ser m ãe/ n u t r iz/ esposa/ t r abalh ador a n o con t ex t o social.
DESCRI TORES: aleit am ent o m at er no; saúde da m ulher ; enfer m agem m at er no- infant il
1
RN, Free Lect urer, e- m ail: [email protected]; 2 RN, Post graduat ing, Coordinat or of t he Breast feeding Program at Municipal Healt h Secret ary of Ribeirão Pr et o; 3 RN, PhD Pr ofessor e- m ail: zezebis@eer p.usp.br ; flagom es@eer p.usp.br. Univ er sit y of São Paulo at Ribeir ão Pr et o College of Nur sing WHO Collaborat ing Cent re for Nursing Research Developm ent
I NTRODUCTI ON
D
espit e t he adv ancem ent s accom plished in w om en’s adher ence t o br east feeding in r ecent year s,ear ly w eaning is st ill a concer n, and occupies space
in t he public agenda relat ed t o breast feeding policies( 1). Act i o n s t o st i m u l at e, p r o t ect an d su p p o r t
br east feeding ar e sust ained by t he acknow ledgem ent
o f b r e a s t f e e d i n g a s a n i m p o r t a n t f a c t o r i n t h e
m a i n t e n a n c e a n d d e v e l o p m e n t o f a c o u n t r y ’ s
econom ic st ruct ures of a count ry and by it s influence
on childr en’s sur v iv al. Ear ly w eaning put s t he child’s
life at r isk , incr easing infant m or bidit y and m or t alit y
rat es. One of t he causes appoint ed for early weaning
is t he m ot her’s lack of knowledge about t he qualit y of
her m ilk , bot h t o feed and t o conduct t he adequat e
dev elopm ent of her child. Wom en’s k now ledge is an
im port ant fact or in t he process of changing behaviors.
Ho w e v e r, k n o w l e d g e p e r se d o e s n o t a ssu r e t h e
at t it ude change. I nform at ion and inadequat e pract ices
by healt h professionals also have a negat ive influence
i n t h e e s t a b l i s h m e n t a n d m a i n t e n a n c e o f
b r east f eed in g . Th ese in clu d e t h e lack of ab ilit y t o
suppor t m ot her s w ho br east feed and t he inadequat e
clinical handling of breast feeding. Anot her obst acle is
relat ed t o t he healt hcare pract ices t hat are based on
n o r m s a n d r o u t i n e s t h a t d e l a y t h e f i r st n u r si n g ,
separ at in g m ot h er an d ch ild, est ablish in g t im es f or
b r east f eed in g an d f r eq u en t ly in d icat in g n on - h u m an
m ilk , bot t le nipples and pacifier s unnecessar ily( 2). Bi o l o g i ca l r e d u ct i o n i sm i s p r e se n t i n t h e
w o m e n ’ s b r e a s t f e e d i n g r o u t i n e , w h i l e o t h e r
dim ensions of t his pract ice, such as t he psychological,
soci al an d cu l t u r al d i m en si on s ar e l ef t asi d e. Th e
br east feeding pr act ice ov er w helm s w om en w hen it is
r ed u ced t o b i o l o g i ca l r ed u ct i o n i sm , b eca u se t h ey
ex pect it t o be an easy pr ocess, nat ur al, inst inct iv e
pr ocess w hile, in fact , t hey exper ience a com plicat ed
pr ocess t hat dem ands lear ning, w hich in t ur n m ak es
t h e m f e e l i n a p p r o p r i a t e f o r t h e i r b r e a s t f e e d i n g
funct ion( 3).
The period in which t he binom ial st ays in t he
puer per al unit s is not alw ays sufficient for w om en t o
get t he necessary orient at ion in order t o feel apt and
confident t o handle breast feeding at hom e. According
t o scient ific lit erat ure, problem s in t he lact at ion period
t en d t o appear in t h e f ir st w eek s af t er bir t h , w h en
w om en ar e ou t side t h e h ealt h car e en v ir on m en t , at
t h e i r h o m e s. Ma n y t i m e s, t h e y d o n o t h a v e t h e
n ecessar y social su ppor t t o m in im ize or solv e t h eir
p r o b l e m s , w h i c h t e n d s t o c o m p l i c a t e t h e
int ercurrences and const it ut es an early weaning fact or.
The m issing or insufficient support t he fam ily
co n t ex t , h ea l t h p r o f essi o n a l s a n d t h e co m m u n i t y
pr ov ide t o t hose br east feeding has affect ed w om en’s
con fiden ce in t h eir abilit y t o fu lly br east feed( 2 ). Th e con dit ion of br east feedin g w om en is far fr om bein g
af f ect ed b y p olicies in f av or of b r east f eed in g . Th e
a c t i o n s u n d e r t a k e n a r e c e n t e r e d i n b i o l o g i c a l l y
f ocu sed t ech n ical ab ilit ies an d ar e f r ag m en t ed , as
o p p o se d t o w h a t i s e x p e ct e d f r o m a n e w h e a l t h
p ar ad ig m t h at con t em p lat es t h e in t eg r alit y of t h e
subj ect( 4). I n a pr ofessional healt h car e per spect iv e, it can be ident ified t hat , alt hough t hese professionals
r ecogn ize t h e social an d em ot ion al elem en t s in t h e
br east feeding pr ocess, in pr act ice, t hey do not seem
t o m ast er t hem yet .
We can consider breast feeding a sociocult ural
process wit h a hist ory. Thus, t he linear explanat ion of
t he fact s and causes det erm ining breast feeding is not
suit able as an int erpret at ion. I t is under t he range of
t his new perspect ive t hat we at t em pt ed t o underst and
t h e e x p e r i e n ce s o f w o m e n i n t h e b r e a st f e e d i n g
p r o cess.
I n t h e c o n t e x t o f o u r h e a l t h s e r v i c e s ,
em er g en cy car e is t h e p r ed om in an t car e m od el of
a s s i s t a n c e a n d a c t i o n s r e s u l t f r o m b i o l o g i c a l
com p lain t s. Th is m ak es it im p ossib le t o ap p r eh en d
what lies beyond t he present ed signs and sym pt om s.
I f, on t he one hand, healt h professionals look
a t t h e b o d y a s a m e r e d e p o s i t o r y o f b i o l o g i c a l
processes t hat indicat e healt h and illness, on t he ot her,
t h er e ar e t h e w o m en w h o t en d t o i n t er p r et b o d y
sensat ions according t o codes t hat are specific of t heir
environm ent and not always in agreem ent wit h t hose
of healt h pr ofessionals.
I n t his par t icular aspect , w e hav e obser v ed
in our pract ice, in a not syst em ized way, t hat wom en
facing br east feeding pr oblem s t end t o t ak e t oo long
t o seek pr ofession al h elp, pr im ar ily t u r n in g t o t h eir
r elat ion al en v ir on m en t . Th er efor e, w e in qu ir e abou t
t he role of healt h professionals as a reference elem ent
for help in br east feeding quest ions?
I n t his st udy, we at t em pt ed t o underst and t he
breast feeding experience in a group of fem ale healt h
ser v ice user s in Ribeir ão Pr et o, SP, Brazil, aim ing t o
ident ify t he act ing propert ies of agent s and inst it ut ions
in t he const r uct ion of m eanings of br east feeding for
t he wom en. This obj ect ive is part of a larger research
We b e l i e v e t h a t u n d e r s t a n d i n g t h e s e
q u est ion s w ill allow u s t o v isu alize m or e ef f ect iv e
st r at egies for car e deliv er y t o w om en, as w e get t o
k n o w t h e r e p r e se n t a t i o n t h e y a t t r i b u t e t o t h e i r
breast feeding experiences. This will allow us dem yst ify
t he t echnical discourse in order t o adequat e it t o t he
pr esen t ed r ealit y.
OBJECTI VE
I den t if y t h e agen t s or in st it u t ion s t ak en as
references by breast feeding wom en in care regarding
br east f eedin g dif f icu lt ies.
METHODOLOGY
Th e u n d e r s t a n d i n g a n d a n a l y s i s o f t h e
r e f e r e n ce s f o r ca r e w h i ch b r e a st f e e d i n g w o m e n
con sid er in case of b r east f eed in g d if f icu lt ies w er e
based on t he qualit at iv e appr oach, w hich focuses on
t h e m ean i n g s an d i n t en t i o n al i t y o f act i o n s i n t h e
cont ex t s of social st r uct ur es( 6).
Th e f ield w or k w as dev eloped at f iv e Basic
Healt h Unit s of t he Ribeir ão Pr et o Healt h Secr et ar y.
Fr om t he 3 5 basic unit s t hat ex ist ed at t he t im e of
dat a collect ion, for t his research, we select ed t he five
unit s t hat , according t o t he result s of epidem iological
r esear ch ab o u t f eed i n g i n t h e f i r st y ear o f l i f e i n
Ribeirão Pret o in 1999 and 2003, obt ained t he highest
an d l o w est sco r es o n t h e Ex cl u si v e Br east f eed i n g
indicat or ( EB)( 7).
The em pir ical ex t r act of t he st udy consist ed
of 20 puerperal wom en who at t ended t he basic healt h
unit s and were select ed for t his research due t o ot her
r e a so n s b e si d e s b r e a st f e e d i n g , i n d e p e n d e n t l y o f
whet her t hey were breast feeding. These wom en were
in clu d ed b ased on t h e f ollow in g cr it er ia: f ir st - t im e
m ot h er s, aim in g at g r eat er h om og en izat ion am on g
t he st udy subj ect s; less t han one m ont h aft er bir t h,
si n ce m o st b r e a st f e e d i n g p r o b l e m s o ccu r i n t h i s
per iod. Non e of t h e w om en h ad pr em at u r e babies,
w i t h m a l f o r m a t i o n o r a n y o t h e r i n t e r c u r r e n c e
int er fer ing w it h br east feeding.
The r esear ch subj ect s w er e cont act ed at t he
basic healt h unit s, w her e int er v iew dat es and places
w e r e sch e d u l e d . Al l i n t e r v i e w s w e r e h e l d a t t h e
w om en ’s h om es an d t ook an av er ag e of 1 h 3 0 m in .
We used a sem i- st r uct ur ed int er v iew, w hich included
con t en t s r elat ed t o iden t if icat ion dat a, r epr odu ct iv e
p r o c e s s , p a r t i c u l a r l y a b o u t b r e a s t f e e d i n g a s a d escr ip t ion of ex p er ien ces; p r oced u r es; h ab it s an d
r o u t i n e s ; k n o w l e d g e ; p e r c e p t i o n s a n d v a l u e s regarding difficult ies and inform at ion about t he fam ily
unit / r elat ional cont ex t . All int er v iew s w er e r ecor ded aft er t he int er v iew ees’ infor m ed consent .
The corpus of t he analysis was com posed by dat a fr om t he int er v iew s and obser v at ions descr ibed
in t he field diar ies. Them at ic cont ent analy sis( 8) w as u se d f o r d a t a t r e a t m e n t , w h i ch co n si st s o f “ ( …)
d i sco v er i n g t h e ‘n u cl ei o f m ean i n g ’ t h at co m p o se
com m unicat ion and w hose pr esence, or fr equency of a p p ea r a n ce m a y m ea n so m et h i n g f o r t h e ch o sen
analy t ical obj ect iv e”( 6). I n t his analy t ical pr ocess, t he “ nucleus of m eaning” is seen as a unit of m eaning in
a com m unicat ion( 6). I n t his st udy, t he nuclei of m eaning w er e under st ood as ideas- ax es sur r ounded by ot her
id eas. Accor d in g t o t h e t h em at ic an aly sis, on e can also m ove t owards t he “ discovery of what lies behind
t h e m a n i f e s t e d c o n t e n t s , m o v i n g b e y o n d t h e appear ances of w hat is com m unicat ed”( 9).
The analysis involved t he following st eps: ( a)
init ial r eading t o hav e a global under st anding of t he m at erial; ( b) ident ificat ion of t he unit s of m eaning t hat
em erged from t he int erviewees’ report s; ( c) discovery o f n u cl ei o f m ean i n g su r r o u n d ed b y t h e t h em at i c
cat egories and d) int erpret at ion and discussion. I n t his sense, t he research at t em pt ed t o work
w i t h t w o t h e m a t i c ca t e g o r i e s: “ t h e si t u a t i o n s o f difficult y in br east feeding” and “ t he agent s act ing in
c a r e ” . Th e d i s c u s s i o n s o f t h e i n f e r r e d t h e m a t i c
cat egories are based on t he concept ions of body and m ot h er h ood .
I n our societ y, m ot herhood is socially valued an d est ablish ed as t h e w om an ’s r espon sibilit y / du t y
t o t ake car e of t he child, w hich is par t ially based on h er abilit y t o get pr egn an t , deliv er an d br east f eed,
and on social const ruct ions of wom en being m ore kind, affect iv e and sk illful t o car e for t heir offspr ing. The
social appropriat eness of t he fem ale body t o exercise m o t h e r h o o d a n d s p e c i f i c a l l y b r e a s t f e e d i n g i s
st r at egically im por t ant t o be analy zed as a cat egor y
in it self. The r epr esent at ions of body and healt h ar e dir ect ly lin k ed t o t h e dif f er en t f or m s of per ceiv in g,
represent ing and act ing on t he social world individuals share w it h t heir social group( 10).
Th e r esear ch w as ap p r o v ed b y t h e Et h i cs Co m m i t t e e a t . To a s s u r e t h e a n o n y m i t y o f t h e
research subj ect s, in t he int erview fragm ent s, fict it ious
RESULTS AND DI SCUSSI ON
Ribeirão Pret o has a unique st ruct ure for care
in breast feeding quest ions. Since 1988, t he Municipal
Healt h Secret ary, t hrough t he Breast feeding Program ,
i n v est s i n t r ai n i n g p eo p l e f o r b r east f eed i n g car e,
j oint ly wit h t he Breast feeding Nucleus at t he Universit y
of São Pau lo at Ribeir ão Pr et o College of Nu r sin g
-NALMA- EERP/ USP. Besides t hese basic healt h services,
t h e ci t y o f f e r s t h e H u m a n Mi l k Ba n k a t t h e t h e
Un i v er si t y o f São Pau l o at Ri b ei r ão Pr et o Med i cal
Sch o o l Ho sp i t a l d a s Cl ín i ca s, w h i ch i s a r e f e r r a l inst it ut ion in t he st at e in t erm s of Hum an Milk Banks
in t h e in t er ior of São Pau lo. Cu r r en t ly, t h e cit y h as
t hr ee Child- Fr iendly Hospit als.
Th e s t u d y g r o u p w a s c o m p o s e d o f 2 0
puerperal wom en of low incom e who lived in peripheral
n eig h b or h ood s. Th ir t een of t h em w er e ad olescen t s
bet ween 15 and 19 years old, and seven were bet ween
20 and 26 years old. Only six wom en in t he st udy had
finished high school; t en had abandoned school, six
o f w h o m p r i m a r y a n d f o u r se co n d a r y e d u ca t i o n .
D u r i n g t h e r e s e a r c h , f o u r w o m e n w e r e t a k i n g
secon d ar y ed u cat ion an d w er e on m at er n it y leav e
from t he school. Five wom en were m arried, eight lived
in consensual union and seven were single. Regarding
t heir occupat ion, only t wo had a form al j ob, while all
t h e ot h er s w er e u n em p loy ed w it h f u t u r e p lan s f or
i n se r t i o n i n t h e j o b m a r k e t , d e p e n d i n g o n t h e i r
m at er nal obligat ions and on t he suppor t t hey w ould
r eceiv e fr om t heir fam ilies.
I n t h e se t o f r e p o r t s, w e i d e n t i f i e d t w o
art iculat ed t hem at ic nuclei: “ t he sit uat ions of difficult y
in breast feeding” and “ t he agent s act ing in care”, which
char act er ize t he br east feeding pr act ice of a gr oup of
w om en in d if f er en t social sp aces ( in st it u t ion al an d
f am ily ) .
Th e w o m a n b e g i n s h e r b r e a s t f e e d i n g
experience based on t he t echnical and norm at ive lim it s
o f a ct i o n s t o st i m u l a t e b r ea st f eed i n g . Th e h ea l t h
p r o f e s s i o n a l , w h o i s a n a u t h o r i t y i n s c i e n t i f i c
k n o w l ed g e, assu m es t h e r o l e o f st an d ar d i zer an d
r egu lat or of t h e br east f eedin g pr act ice, based on a
b o d y o f k n o w l e d g e ce n t e r e d o n t h e n u t r i t i o n a l ,
im m u n ological, em ot ion al an d ph y siological ben efit s
t o t he child’s healt h.
I breast fed him at t he delivery room , t he nurse held
him , put him on m y breast ( Selm a, 19y., 1st SC, single) .
Fo r t h e Ch i l d - Fr i e n d l y H o s p i t a l ( CFH )
program , breast feeding in t he first half hour of life is
a r e c o m m e n d e d p r o c e d u r e , a n d h a s b e e n
im plem ent ed at m at er nit y hospit als since t he 1990s.
How ever, w e hav e not obser v ed hom ogeneit y in t he
a d o p t i o n o f t h e s e p r o c e d u r e s a m o n g h e a l t h
pr ofessionals. The CFH act ion pr ogr am has pr oduced
a d v a n c e m e n t s i n t h e e l i m i n a t i o n o f b a r r i e r s t o
b r e a st f e e d i n g p r a ct i ce s, q u e st i o n i n g e st a b l i sh e d
p r a c t i c e s a t t h e i n s t i t u t i o n s a n d p r o p o s i n g a
r eo r g a n i za t i o n o f t h e p h y si ca l st r u ct u r e a n d ca r e
philosophy delivered at hospit als and m at ernit ies. This
r equ ir es adj u st m en t s t h at go bey on d t h e t ech n
ical-inst r um ent al car e, inv olv ing t he deconst r uct ion of a
pr act ice based on cr y st allized con cept ion s, allow in g
t he healt h t eam t o hav e a cr it ical and open v iew on
t he underst anding of new approaches in breast feeding
p r act ice.
Reg ar d in g t h e f ield of p r of ession al act ion ,
healt h professionals are condit ioned by and condit ions
t heir r ole in t he encour agem ent of br east feeding as
ed u cat or s an d p r om ot er s of t h is p r act ice, w h ich is
c h a r a c t e r i z e d b y t h e d i s c i p l i n a r y a c t i o n o f
br east f eedin g( 4 ).
Us i n g s c i e n t i f i c r a t i o n a l i t y, h e a l t h
pr ofessionals, as agent s, assum e a st r at egic posit ion
in t he social space of t he healt h inst it ut ion. The act ive
aspect of t heir scient ific discourse about breast feeding
can be ident ified in t he m eaning t he w om en of t his
st udy at t ribut ed t o breast feeding: “ giving t he best t o
t he baby”, based on t he social experience, t aking t he
m edical discourse and reint erpret ing it , as we inferred
in t he report below .
Mot her’s m ilk is t he best food for t he child t o develop,
it h as ev er y t h in g , w at er , v it am in , su g ar , it is t h e n or m al
t em perat ure for t he child and t he m ilk does not need t o be heat ed
or a bot t le does not have t o be prepared. Mot her’s m ilk has all
t hat . I t prevent s several diseases, an allergy, we also prevent
cancer t hat affect t he breast , and ot her t hings, so m ot her’s m ilk
is very im port ant for growt h as well as for good feeding ( Lucila,
20y., 2nd SC, consensual union) .
I t is in t he healt h inst it ut ion’s space t hat t he
br east feeding pat t er n is est ablished for m ot her s and
childr en, in a gam e of per m issions and r est r ict ions.
The pediat rician said t hat t here is no need t o wake him
up...t hat sleep sust ains ( …) when he wakes up… he will cat ch
up( …) At t he hospit al, t hey said t hat t he right t hing is t o breast feed
t he baby every hour ( Tais, 16y., 1st I C, consensual union) .
The act ing propriet ies of healt h professionals
are present t o t he ext ent t hat t hey are considered as
Su ch p r o p er t i es ar e a set o f r el at i o n sh i p s am o n g
obj ect iv e for ces im posed t o any one w ho ent er s t his field, and do not succum b t o t he int ent ions of individual
a g e n t s, n o r e v e n t o d i r e ct i n t e r a ct i o n s b e t w e e n agent s( 11).
We h av e l ear n ed t h at , so m et i m es, h eal t h p r o f e ssi o n a l s t r a n sm i t co n t r a d i ct o r y i n f o r m a t i o n ,
m ak in g w om en in secu r e an d con cer n ed abou t t h eir br east feeding pr act ice. I n t he hospit al’s inst it ut ional
co n t e x t , w h e r e b r e a st f e e d i n g i s a n o r m t h a t a l l hospit alized wom en have t o com ply wit h, t he fact t hat
“ t he baby does not w ant t o get t he br east ” acquir es
t he dim ension of a pr oblem .
The nurse helped m e, she said t hat he had t o get t he
breast like t his, t he areolas …He has t o get t he whole areola…I did
it , I j ust don’t know if I did it right , he couldn’t get it ( …) . She said
t hat I had t o keep t rying, force him t o get it ( Sonia , 26y., 1st CS,
consensual union) .
The healt h pr ofessionals assum e t he post ur e o f su p e r v i so r s o f b r e a st f e e d i n g p r a ct i ce , g i v i n g
o r i e n t a t i o n , t e c h n i c a l c a r e a n d u s i n g s c i e n t i f i c r a t i o n a l i za t i o n s t o j u st i f y t h e si t u a t i o n - p r o b l e m .
How ever, t hese rat ionalizat ions ar e not alw ay s based
o n p r a c t i c e , b e c a u s e t h e y i n v o l v e p s y c h o s o c i a l d i m e n s i o n s , w h i c h t h e c l i n i c a l m a n a g e m e n t o f
br east feeding does not cont em plat e. Anot her aspect t o b e co n si d e r e d i s h e a l t h p r o f e ssi o n a l s’ l a ck o f
t raining t o deal wit h t he present ed diversit y present ed, because healt h pract ices involve a set of procedures,
s t a n d a r d s a n d r o u t i n e s , l e a v i n g l i t t l e r o o m f o r ex p r essi n g d i f f er en ces. I n t h e i n t er act i v e p r o cess
bet w een pr ofessionals and w om en, educat iv e act ions
a t t e m p t t o t r a n s m i t i n f o r m a t i o n b a s e d o n t h e biom edical m odel, r est r ict ed t o t h e dev elopm en t of
cognit iv e abilit ies.
The current breast feeding policy, t hrough t he
CFH, est ablished t hat breast feeding is a pract ice t hat t en ds t o be obligat or y an d sh ou ld be adopt ed as a
nor m in hospit als. Recom m ended act ions include t he indicat ion of hospit al discharge only when t his pract ice
is ef f ect iv e accor din g t o t h e h ealt h pr of ession al. I n ou r st u dy, adh er en ce t o t h ese n or m s w as r ev ealed
by Suzana.
At t he hospit al, t hey t old m e t o be pat ient , t hat she is
pret t y young ( ...) a nurse always passes by and asked if she
hadn’t t aken t he breast yet ( …) she t aught m e ( …) , said t hat lat er
I would like t o breast feed, im agine! But it is t rue, now I do ( …) . I f
she didn’t breast feed, I would not be able t o leave…I was afraid
she would st ay t here ( …) . The baby does not have a specific t im e
t o breast feed, if he is sleeping t oo m uch I have t o offer ( Suzana,
15y., 2nd I S, single) .
At t he healt h inst it ut ion, professionals’ power
is shown in t heir act ions wit h t he breast feeding wom en.
Ho w ev er, t h i s p o w er i s t em p o r a r y, l i m i t ed t o t h e
hospit alizat ion period, which is short t o guarant ee t he
w o m e n ’ s a d h e r e n ce t o e st a b l i sh e d b r e a st f e e d i n g
st a n d a r d s. Th e se a sp e ct s m a k e u s r e t h i n k ca r e
pr act ice, in w hich healt h pr ofessionals, w ho possess
t h e t ech n iqu e an d scien t if ic k n ow ledge, act w it h ou t
c o n s i d e r i n g t h e c o n t e x t u a l e l e m e n t s o f t h e
br east f eedin g w om en ’s ex per ien ce.
I t i s i m p o r t a n t t o co n si d e r t h a t , f o r t h e
w o m e n , t h e b r e a s t f e e d i n g p r a c t i c e w i l l o n l y b e
co n so l i d a t e d i n a n o t h e r f i e l d , o u t si d e t h e h e a l t h
inst it ut ion, where ot her powers operat e. The different
species of pow er or capit al depen d on t h e posit ion t he agent occupies in t he different fields. The capit al s p e c i e s i n c l u d e t h e e c o n o m i c , c u l t u r a l , s o c i a l , sy m bolic, gen er ally called pr est ige, r epu t at ion an d/
or fam e( 11).
I n t h e soci al f i el d of t h ese w om en ’s d ai l y
b r ea st f eed i n g ex p er i en ces, t h e p o si t i o n o f h ea l t h
pr of ession als/ in st it u t ion s is h ier ar ch ically secon dar y
i n d e c i s i o n s a n d a c t i o n s i n t h e c o n t e x t o f
br east f eedin g dif f icu lt ies.
Bey o n d w h at i s co n si d er ed ap p r o p r i at e i n
t er m s of ser v ice st r u ct u r e for car e in br east feedin g
qu est ion s, t h e w om en in t h is st u dy seem t o or ien t
t h em selv es, at fir st , by ot h er v alu es pr esen t in t h e
f am ily con t ex t . An ot h er asp ect t o b e con sid er ed is
t hat t he search for care from healt h services is relat ed
w it h w hat t hey per ceiv e as pat hological, going back
t o a necessary allusion t o t he origins of clinical pract ice,
which st art s t o concent rat e on t he st udy of t he body
as t he space of disease, becom ing a t ext t hat allow s
f o r d i f f er en t r ead i n g s o f t h e si g n s an d sy m p t o m s
m anifest ed in it .
When breast feeding, wom en experience body
sensat ions in lact at ion problem s. This m akes t heir view
d i f f er en t f r om t h e cl i n i cal i n t er p r et at i on of h eal t h
pr ofessionals. I n clinical pr act ice, br east t r aum a and
t h e en gor gem en t ar e con sider ed lact at ion pr oblem s
t h a t r eq u i r e p r ev en t i v e a n d t r ea t m en t m ea su r es.
Acco r d i n g t o h e a l t h p r o f e ssi o n a l s, t h e b o d y i s a
deposit ary of biological processes t hat indicat e healt h
or disease. The body sensat ions individuals experience
( sym pt om s) and t he obj ect ive m anifest at ions t hat are
p a r t o f t h e v i si b l e a sp e ct o f t h e d i se a se ( si g n s)
const it ut e elem ent s of t he represent at ion syst em t hat
su p p o r t s t h e co n st r u ct i o n o f a d i a g n o si s a n d t h e
How ev er, t h e in t er pr et at ion is n ot don e on
t he basis of physiological sensat ions only, but also on
t he social const ruct ion. This m eans t hat t he percept ion
of f eelin g s as alt er at ion or n or m alit y, is p ar t of a
st r uct ur e of socially shar ed m eanings.
The int erpret at ion of t he body m anifest at ions
accor din g t o cu lt u r e, par t icu lar ly t h ose occu r r in g in
t h e m o t h e r ’ s b o d y, i s r e l a t e d t o t h e m o t h e r ’ s
abnegat ion t ow ar ds t he child( 12).
I t st art ed t o hurt , I was a lit t le concerned…t hen you
get used, you know ! ( Tais, 16y., 1st GI , consensual union) .
Th e cu l t u r al co n st r u ct i o n t h at w o m en ar e
resilient t o pain can com plicat e t he t echnical concept ion
and inst rum ent s of m edical sem iology, because it delays
t h e ear ly d et ect ion of b r east t r au m as, ag g r av at in g
t hem . Bot h t he percept ion of pain and t he search for
m edical r esour ces t o allev iat e it ar e dir ect ed r elat ed
t o t he r epr esent at ion of t he body( 13),w hich m ak es it possible t o underst and why wom en in our st udy t ended
n o t t o se e k e a r l y ca r e g i v e n t h e si g n s o f b r e a st
i n t e r cu r r e n ce s a s, f o r t h e m , i t i s a n a t u r a l a n d
char act er ist ic par t of t he m ot her ’s condit ion t o bear
everyt hing in favor of t he child’s well being. Likewise,
wom en bear t he int ensit y of pain because of her own
and nat ural condit ion of being a wom an( 14).
D i v e r g e n t i n t e r p r e t a t i o n s b e t w e e n h e a l t h
pr ofession als an d w om en abou t w h at is n or m al ar e
ev idenced in t he m anifest at ion of t he body it self, of
en gor gem en t , “ h ar d br east s”. I n clin ical sem iology,
prevent ive and t reat m ent act ions for t he engorgem ent
ar e based on t h e con t r ol of m ilk pr odu ct ion , w h ich
s e e m s t o d i s a g r e e w i t h t h e c u l t u r a l e l e m e n t s
present ed by t he wom en in our st udy. For t hem , good
m i l k p r o d u ct i o n i s a co n d i t i o n o f a h e a l t h y a n d
funct ional body, disart iculat ing t he not ion of full breast s
as a sign of unbalanced and abnorm al m ilk product ion,
accor ding t o t he r epor t below .
I t is get t ing hard because of t he m ilk; I am having a lot
of m ilk, t hanks God... ( Marisa, 20y., 2nd SC, consensual union) .
I t allow s u s t o u n d er st an d w h y p r ev en t iv e
and curat ive m easures of rem oving accum ulat ed m ilk
healt h pr ofessionals pr escr ibe gener ally ar e not m et
w it h t he ex pect ed adher ence am ong w om en.
For t he wom en in t he st udy, t he fam ily cont ext
carries a significant power of const ruct ing realit y. This
r ealit y t ends t o est ablish an or der or an im m ediat e
sense of t he social world, and t hese wom en const ruct ,
t h r o u g h f a m i l y b o n d s , t h e m e a n i n g o f t h e
b r e a s t f e e d i n g o b s e r v a t i o n s a n d e x p e r i e n c e s , a
pract ice t hat lit t le by lit t le adapt s it self t o t he rout ine.
I t is in daily life t hat indiv iduals acquir e all
t he essent ial abilit ies... for t heir m at urit y developm ent , as t hey assim ilat e how t o handle t hings ( learn how t o b r e a s t f e e d ) a n d e s t a b l i s h a m e d i a t i o n b e t w e e n c u s t o m s , n o r m s a n d t h e e t h i c s o f o t h e r l a r g e r int egrat ions. These m ediat ions include t he fam ily and r elat ional gr oup and healt h pr ofessionals, ex panding
t o ot her social env ir onm ent s in gener al( 15).
I t is in t h e social sp ace of t h e f am ily t h at
w o m en seek w el co m i n g an d h el p t o o r g an i ze t h e
household and m at ernal t asks, help which t radit ionally
com es fr om t heir ow n gender : m ot her s, m ot her s-
in-law , sist er s, sist er s- in - in-law an d f r ien d s, as w e can
obser v e in t he r epor t below :
The baby st art s t o cry, you don’t know w hat t o do…m y
m ot her- in- law t akes care and gives orient at ion…she’s experienced
( …) she passed confidence, I st art ed t o value m y m ot her- in- law
…I realized how m uch I m iss her ( Maria,19y., 2nd I S, m arried) .
The ack now ledgem ent of t he social v alue of
wom en’s care pract ice is based on t he prest ige of t he
ex per ien ce in t er ior ized an d ex per ien ced in h er ow n
body( 16). However, t his condit ion is not available t o all w om en in t he gr oup, as w e ident ified in t he case of
Josiana. The absence of t he fam ily affect s her m or e deeply t han not act ually having anyone t o share t asks
w it h, because she lack s a safe base t o anchor on in
her role as a m ot her, wife and housewife, a fact t hat
sh e ex p r esses t h r o u g h r esen t m en t o f n o t h a v i n g
som eone of her fam ily t o t alk w it h.
Th r ou g h t h e r ep or t s, w e id en t if y t h at m ilk
product ion was an aspect wom en highly valued in t heir
fam ily cont ext and was som et im es seen as a problem .
My sist er said t hat t he m ilk is not enough for him .( …)
he w as crying t oo m uch, crying of hunger( …) it doesn’t leak( …)
she said t o consult M. at t he basic care unit ( …) My m ot her, m y
m ot her- in- law said: give him t ea! ( …) I didn’t want t o give him
t ea ( …) I was afraid he would get t he bot t le and not get t he
breast ( …) , when I finished giving him t he t ea, he burped and
slept . For m e it was good because I was t ired ( Janet e, 18y., 2nd
SC, single) .
Despit e being infor m ed about r ecom m ended
breast feeding procedures and count er- indicat ions, t he
w om en in gen er al act accor din g t o t h e ex per ien ced
sit uat ion, adopt ing pr act ices of t heir cult ur al gr oup.
I n t hat sense, t ea is cult urally accept ed as a rem edy
t o alleviat e com m on discom fort in t he first m ont hs of
life, such as abdom inal colic. Used as a st r at egy t o
calm t he child, it gains space in t he realit y t he wom en
face and, as t his m easure show s sat isfact ory result s,
Am ong t he pr act ices and popular k now ledge
t hat m ake it possible t o keep up m ilk product ion, t he wom en in t his st udy recognize t hat good eat ing habit s
and a peaceful st at e of m ind ar e essent ial.
My neighbor says t hat I have t o eat well t o give m ilk t o
t he baby...I don’t feel like eat ing ( …) m y m ilk m ight dry ( …) I ’m
not eat ing right , no ( …) if m y m ilk dries it is bad for him ( Josiana,
18y., I nc prim ary school, consensual union) .
I t is cult ur ally believ ed t hat t he ingest ion of
cer t ain foods in cr eases m ilk pr odu ct ion . How ev er, a st udy per for m ed in Par á show s t hat t he condit ion of
t he m ot her’s eat ing habit s and t iredness as a result of
som e act ivit ies she perform s act ivit ies are det erm ining fact or s in t he decision of w het her t o adopt m ot her ’s
m ilk for t heir children in t he first year of life( 17). I n t h e f a m i l y e n v i r o n m e n t , w o m e n g e t
inv olv ed in a gam e of const ant at t ack s, char ges and ev aluat ions of t heir behav ior and at t it udes r egar ding
t h eir br east f eedin g per f or m an ce.
My m om says t hat I have t o be pat ient and do t hings
r ight , t hat it w ould not hur t . Then I st ar t ed t o sunbat he, t o
m assage t he nipple ( …) ( Selm a, 19y., 2nd CS, single) .
I n t h i s g a m e o f r e l a t i o n s h i p s , “c a p i t a l sp eci es” ar e i m p o r t an t i n t h e co n st r u ct i o n o f t h e elem en t s t h at con st it u t e t h e br east feedin g pr act ice,
d e p e n d i n g o n t h e e x t e n t t o w h i c h p e o p l e a r e m eaningful t o t hese wom en in t he social sphere, which
is “a m ult idim ensional space of posit ions”( 11).
Hist orically, wom en have been in t he spot light
in t h e r epr odu ct iv e cy cle an d t h e pr est ige t h ey ar e a t t r i b u t e d r e su l t s f r o m e x p e r i e n ce s a ccu m u l a t e d
t hrough ot her m at ernal experiences. Through act ions,
in t er act ion s an d in t er pr et at ion s, t h e agen t s ex pr ess t heir solidar it y t o w om en, at t he sam e t im e as t hey
r et r ansm it and r eaffir m t he ex ist ence of et hical and m or al pr ecept s r elat ed t o “being a good m ot her”( 12). Th e h ier ar ch ical r elat ion s ar e con f r on t ed depen din g on each agent ’s posit ion in t he social spher e, in t he
f a m i l y co n t e x t . Th e se r e l a t i o n sh i p s ca n g e n e r a t e dependency and responsibilit y am ong t hose involved,
lik e in Selm a’s, w h er e t h e gr an dm ot h er ’s au t h or it y seek s t o be im posed because of her ex per ience.
He ( baby) likes m y m ot her’s lap m ore t han m ine ( …) .
When m y m om is at hom e, she want s t o st ay wit h him ( …) , I st ay
close t o learn how she does it , everyt hing…( Selm a, 19y., 2nd CS,
single) .
The gr andm ot her ’s pr est ige r esult s fr om t he
a b i l i t y t o d e a l w i t h sm a l l si t u a t i o n s i n h e r e n t t o m at er n al car e, w h ich , f or t h ese w om en , con st it u t e
highly int ense m om ent s, due t o t heir feeling of inabilit y
t o ex ecut e t hem .
Th e d o m e s t i c a n d m a t e r n a l a s p e c t s a r e
socially st range t o m en/ part ners; however, as agent s,
t hey ar e “ent r enched in a posit ion”, ev idencing t heir “act ing pr opr iet ies”( 11).
He ( child’s fat her ) get s ner v ous because he t hinks
t hat I don’t want t o breast feed ( …) , he t hinks t hat I ’m afraid of
m y br east get t ing flabby …I st ay quiet , get a lit t le sad also
b e ca u se h e sa y s t h i s, I d i d n o t f e e l l i k e b r e a st f e e d i n g
( …) ( Rosim eire, 18yo., 1st I S, single) .
Th e m ale p ar t icip at ion p r esen t s it self in a
peculiar w ay. Their act ions im plicit ly cont ain t he r ole
t hat int egr at es t he r efer ence of t he gender sy st em ,
m oral aut hor it y and fam ily pr ov ider.
He ( husband) w orries about how she ( baby) is, if she
is breast feeding, if com plem ent at ion is needed ( ...) . He asked if
she w asn’t get t ing hungry…I hadn’t even paid at t ent ion yet ( …)
he get s worried because I said t he nipple was sore, he saw it ( …)
he get s worried about t he baby, but about m e t oo ( Aline, 22y., 2nd
CS, m arried) .
Som e p ar t n er s of t h e w om en in ou r st u d y
ex er cise a m or e f lex ib le an d af f ect iv e st y le. Th ey
p r op ose t o socialize t h e t ask s of car e an d look in g
aft er t he child. This is an im por t ant st ar t ing point t o
r ev ise or updat e t he fat her hood m odel.
When he ( part ner) is at hom e...because he w orks a
lot …he t ries t o t ake care of t he baby for m e, he t ries t o pay
at t ent ion at t he t im e of t he burp, when I breast feed at night ,
because som et im es I get very t ired ( Tais, 16y., 1st I S, consensual
union) .
I t w as in t he fam ily cont ext t hat t he wom en
under analysis prim arily sought help t o recognize what
t hey considered as a problem , in view of t he present ed
br east pr oblem s.
I m ent ioned it t o m y sist er- in- law, she said t hat she
was having a lot of m ilk, but t hat it wasn’t engorged. I went t o
m ake t he newborn screening t est , t he lady t alked t o m e and said
t he m ilk was engorging, t hat if I didn’t rem ove it , it would engorge,
get painful ( …) t hat I could donat e ( …) ( Silv ia, 23y ., 2nd CS,
m arried) .
I n t h i s r e g a r d , t h e f a m i l y i s t h e p r i m a r y
source of healt h care in any societ y and, t radit ionally,
it are wom en who deliver care( 18). I n t he ident ificat ion of care pract ice wit h wom en, since t he rem ot est t im es
of hum an hist or y in w est er n societ y, t he r ole of “t he w o m a n w h o h e l p s” i s e s t a b l i s h e d b y c u l t u r a l her it age( 16).
The fam ily’s know ledge of car e in “ engor ged
br east ” and “ sor e nipple” sit uat ions, j ust lik e for t he
healt h- disease process, is t he result of an experienced
n eigh bor s’ cou n selin g, diagn osis an d m edicat ion s of
academ ic m edical professionals are associat ed( 19). We a d d t h a t t h e f a ct o f u si n g i m p r o p e r p r o ce d u r e s
aggr av at es t he w om an’s clinical condit ion.
They t old m e ( friend of t he sist er who had a baby a
lit t le while before) t o put t he breast pum p t o rem ove som e m ilk in
order t o st op hurt ing ( ...) The doct ors said t hat it is not good, t hat
it m akes t he breast sore ( …) but t he pain was so bad t hat I used
it , I wouldn’t bear it unt il t he following day ( …) I t ook som e m ilk
out but t he pain didn’t go away because I couldn’t rem ove enough.
Then it cont inued engorged, t ill t he next day ( Janet e, 18y., 2nd S,
single) .
I n t he pr iv at e dom ain, alt hough t he w om en
in our st udy seem ed t o be inform ed about t he count
er-indicat ions of cer t ain car e pr act ices, in t he concr et e
b r east f eed in g ex p er ien ce, t h eir act ion s ar e g u id ed
m ore by em ot ions and urgency t han by rat ionalit y. I n
t hat sense, we can say t hat t he awareness of facing a
pr oblem and feeling bad or iginat es in a “conscience in sit uat ion”, relat ed t o proj ect s and specific exist ent ial con t ex t s.
Th e i r i n t e r p r e t a t i o n o f “ so r e n i p p l e ” a n d
“ engorged breast ” and t he care t hese require have a
t em por al dim ension, due t o t he concr et e ex per ience
liv ed an d t h e con f r on t at ion w it h div er se r ef er en ces
const ruct ed in t he relat ional environm ent , being, t hus,
r ecur r ent and in pr ocess. This can be infer r ed fr om
t he wom en’s report s when t hey at t ribut e reasons like
“ s o r e n i p p l e ” a n d “ e n g o r g e d b r e a s t ” a n d r e l i e f
m easu r es.
I t w as painful because t he breast w as sore.( …) . When
I went t o work in t he m orning, it was pret t y cold, got t hat wind,
t hen it got hurt like t his…dry ( …) . I t hought about applying som e
cocoa but t er, it would be good t o alleviat e t he dryness ( …) t hey
t old m e t he skin would get sm oot h…and t he baby would not be
able t o get t he nipple, t hat I had t o apply m ilk ( …) I applied m ilk
and t he dryness w as gone ( …) m y m ot her- in- law says t hat , if
t he child burps, wind get s in and t hen t he breast get s hard and
if you don’t put t he baby t o breast feed, it get s harder and even
form s hardened glands t hat explode t owards t he out side ( Maria,
19y., 2nd I S, m arried) .
Th e w o m en a sso ci a t ed co l d w ea t h er w i t h
“ dryness” and “ soreness”, and t he child’s burp at t he
b r ea st a s t h e ca u se o f i n t er n a l u n b a l a n ce i n t h e
or g an ism . I n t h eir r ein t er p r et at ion of t h e m ed ical
discour se about diseases, popular classes in gener al
use cat egories t hat “correspond t o t he m ost universal p r o p er t i es o f t h i n g s”, u si n g t h e sp a t i a l n o t i o n t o describe t he m ovem ent of t he disease, it s pat h in t he
agent ’s body( 10).
The experiences, choices and init iat ives refer
t o t h e w ay p eo p l e an d so ci al g r o u p s assu m e t h e
sit uat ion or ar e sit uat ed in it . We ident ified t hat t he
f a m i l y co n t e x t f u n d a m e n t a l l y co n t r i b u t e s t o t h e
con f ig u r at ion of m ean in g s an d t h e d ev elop m en t of
rout ine w ays of dealing w it h t he sit uat ions present ed
i n b r e a s t f e e d i n g p r a c t i c e , e s t a b l i s h i n g a n d
consolidat ing a specific breast feeding pat t ern for each
of t he wom en in t his st udy.
FI NAL CONSI DERATI ONS
Th r o u g h t h e r e s u l t s o f t h i s s t u d y, i t i s
r eaf f ir m ed t h at t h e or der of cu lt u r al m ean in gs t h at
orient t he wom en, in t erm s of breast feeding reference,
o r i e n t a t i o n , ca r e a n d su p p o r t , a r e su st a i n e d b y
affect ive bonds and relat ions of proxim it y. The fam ily
r elat ional env ir onm ent occupies t he fir st place in t he
w om en’s r efer ence, and t he fam ily t r ansm it s beliefs,
habit s, at t it udes and conduct s.
Am ong relat ives, t he wom en in t he fam ily exert
a decisive influence in t he counseling, support and care
of m ot hers and newborns. Our findings confirm fem ale
d o m i n a n ce i n t h e r e p r o d u ct i v e sp h e r e . Ho w e v e r,
despit e t he gender inequalit ies t hat can st ill be ident ified
in m odern societ y, changes are occurring and can be
inferred in t he fam ily arrangem ent s which som e wom en
in t his st udy ar e inser t ed in. Mor eover, w om en seem
t o st ar t an d ack n ow led g e m en ’s p ar t icip at ion in a
sphere t hat t radit ionally put s t hem as deviant .
I n br east feeding pr act ice, t he fam ily nucleus
ex er t s so ci al f u n ct i o n s, su p p o r t ed b y r el at i o n s o f
in t im acy, af f ect an d solid ar it y, I n f am ily d y n am ics,
reserves are m obilized t hat allow wom en t o art iculat e
o r d i s a r t i c u l a t e b e f o r e d a i l y b r e a s t f e e d i n g
ex per iences. These r eser v es go bey ond t he phy sical
and include fam ily m em bers’ m ent al and sociocult ural
r eso u r ces.
I n t h i s st u d y, w e i d en t i f i ed t h a t t h e ca r e
d e l i v e r e d i n t h e f a m i l y c o n t e x t , i n v i e w o f
b r e a st f e e d i n g d i f f i cu l t i e s t h e w o m e n p r e se n t e d ,
in clu des act ion s gu ided by em ot ion an d u r gen cy t o
t he det r im ent of rat ionalit y, show ing t hat failur es in
healt h pr ofessionals’ act ions ar e not j ust ified by t he
t echnical inabilit y t o handle breast feeding, but because
t h e y d o n o t co n si d e r t h e p l u r a l i t y t h a t i n v o l v e s
br east feeding and t hese w om en’s life cont ex t .
I n t h at sen se, as h ealt h p r of ession als, w e
based on t he m ot her- child binom ial, and t hat it should
int egr at e ot her healt h car e par t icipant s, such as t he
fam ily. Get t ing t o k now t he fam ily ’s r ealit y r equir es
seeking inform at ion about t he life hist ory, t he support
an d r esou r ces u sed , as w ell as t h e f am ily ’s n eed s
and pot ent ialit ies t o shar e r esponsibilit ies( 20). Con sider in g t h e f am ily as an essen t ial par t
of br east feeding car e const it ut es a concr et e st r at egy
f o r t h e co n st r u ct i o n o f a n ew b r ea st f eed i n g ca r e
concept ion, including act ions in t eaching, research and
car e, r ef er en ces w h er e act ion s ar e st r u ct u r ed an d
healt h professionals are st ruct ured as care agent s. I t
m eans m aking t he knowledge available t o t rain t hese
ag en t s i n o r d er t o t h i n k an d act w i t h t h e f am i l y,
const r uct ing healt h pr act ices on ot her bases, w it hout
t he norm at ive, vert ical and aut horit arian bias of t heir
act ion s, so t h at t h ey u n der st an d br east f eedin g n ot
only as a biological, but also as a socio- psycho- cult ural
p r o cess.
We believ e t h at t h e valu at ion of t h e f am ily
cont ex t by healt h pr ofessionals and t he dev elopm ent
of t heir act ions t hr ough t he int er act ion pr ocess w it h
t he fam ily in br east feeding quest ions, can const it ut e
t he bases for a new breast feeding care m odel, which
consider s t he div er sit y oper at ing in t his pr act ice and
w hich adapt s t he act ions t o t he plur alit y of being a
m ot her, giving breast feeding, being a wife and worker
in t he social cont ext .
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