Introduction

Breastfeeding is in decline world wide and depends on the local customs. The social and economic progress has provided an inverse reason regarding to breastfeeding₁,₂,₃,₄

The Brazilian government initiated in 1981 the National Program of Incentive to the Maternal Breastfeeding with the objective of changing the early weaning high index in the country. Considering that internal projects do not resolve this question, international and national agencies have committed in uncovering this situation that afflicts the Brazilian mothers₅,₆,₇,₈,₉.

Some studies about breastfeeding have not only shown advantages of this practice, but as well some difficulties regarding early weaning due to factors diversified which interfere in this process₁₀,₁₁,₁₂,₁₃,₁₄,₁₅.

Literature Review

Breastfeeding is an active process which requires two participants: mother and her baby. This process is a personal choice and can't be induced by parents, friends, doctors, nurses, husband or other people. It is a personal decision that a woman makes according her needs such as biological, psychological, social and economical₁₄,₁₅,₁₆,₁₇,₁₈.

In the last decade,s the social and economic factors has influenced and determined changes in the life of mothers and their babies. Women and infants in developing countries have been also the most vulnerable to problems caused by illnesses that weakend them and consequently prevented them from breastfeed, often causing death₁₉,₂₀.

Statistical studies reveal that even being objects of the sanitary vigilance, mothers and infants are not being watched properly by the Integral Aid Programs at Woman Health (PAISM), and Integral Aid Programs at Infant Health (PAISC). WHO Committee Experts in the Mother and Infant Health uncovered that social and economic factors such as the wife participation in the work, maternal malnutrition, inefficient assistencials programs, as well as lack of education in health were important in trials of breastfeeding₅,₆.

These risk factors demonstrate the importance of a nurse. Steele₂₁ affirmed: “The nurse as the mediator serves as an intermediary in the clinic, school and community. The nurse as the support person shows awareness of the client's needs, provides appropriate interventions, assists in referrals, does client follow-up, provides a supportive milieu for interactions, and shows respect and acceptance of the client”.

Another factor that can influence the early weaning is the introduction of artificial milk. Experts about breastfeeding designate that main reason for the use of such foods are the own mother's relatives. In the majority of the times those factors are related to the family structure whose mother is breastfeeding. According to Renfrew et al₂₂ , Wiezorek, Natapoff₂₃, “the family structure and interaction may indeed influence actual health [breastfeeding] and health-seeking or health maintaining behaviors in some way. Health is determined by societal norms and affected by genetic inheritance and cultural and environmental factors”.

Genetic factors are also a problem in early weaning. The baby's birth with a defect or disorder is a traumatic event with the potential for either total disruption or growth of the involved family. Congenital problems in feeding may be result from diseases such as Pierre Robin Syndrome, Cleft Lip and Palate, or Choanal Atresia₂₄.

In the literature, the etiology of the Pierre Robin Syndrome isn't clearly understood. It may be transmitted by a dominant gene with variable expressivity, or it may be the result of polygenic or multifactorial inheritance₂₃. Several factors seem to be responsible for Cleft Lip and Palate. Polygenic inheritance and interaction between genetic and environmental factors (fetal viral infection, radiation, hypoxia and teratogenic insult of drugs during the lather part of the first trimester of pregnancy) may be the great responsible for malformation₂₄.

In the United States, research has indicated some women that suffer from postpartum depression may be a great problem for the early weaning. A meta-analysis research revealed that patients with postpartum depression present with characteristics of anxiety, concentration impairments, and depressive mood “may exert effects on maternal-infant relationships”, resulting in causal effect for ineffective breasfeeding.₂₅

Ziemer, Cooper, Pigeon₂₆ evaluated the use of a polyethylene film dressing to reduce nipple pain, concluded that nipple pain is a substantial problem among breastfeeding due to occurrence of erythema, eschar formation, and skin fissures. Their study provided a reduction the nipple pain with use of an occlusive film but had limited influence on other observed factors.

In the last decades, Montessoro, Blixen₂₇ inferred that economics factors had a growing influence in the pregnancy and childbirth. For these authors the “United States has no coherent policy on this issue resulting in confusion over exactly what the poverty problem is ₂₈.

Methodology

A cohort study, descriptive and exploratory, using a qualitative approach through ethnographic methodology, was conducted to identify the phenomena that can interfere with breastfeeding. They were described as internal and external determinants factors of the early weaning.

The study purpose was to increase the usefulness of the diagnosis Interrupted Breastfeeding that was adopted as a nursing diagnosis by NANDA₂₉ in 1990, by developing a new nomenclature related with a new definition by revising and testing, from a client perspective, resulting in a list of risk factors. Data were collected through a case study carried out with postpartum patients through six visits at home.

Using the steps for concept analysis outlined by Bardin₃₀ a conceptual framework was created.

Findings

Case Study

Definition

Risk Factors

Figure 1

Conclusion

Based on information analysis, it was determined that there are two attributes for validating the content and the construct of Risk For Ineffective Breastfeeding: For this study, the two critical attributes must be presented before determining the diagnosis of Risk for Ineffective Breastfeeding:

1. A relationship that exists between the client and the factors of risk environmental external and,

2. The client has experienced ineffective breastfeeding caused by one or more negative situation in their life or impaired life-style.

Additional studies should be done using expert nurses selected systematically from an interest's group of Risk For Ineffective Breastfeeding to identify and to validate others factors of risk.

Correspondence to

Araújo Ednaldo Cavalcante de, PhD, RN. Nursing School. Federal University of Pernambuco/Brazil's Northeast. ednenjp@ig.com.br Address: Rua: Severino Nicolau de Melo, 582 - Edifício Ilha da Restinga, Ap. 904-b - CEP: 58036-260 – Bessa – João Pessoa (PB) – Northeast of the Brazil