Efeitos da auriculoacupuntura na ansiedade e na dor mamária de nutrizes

Abstract

Attention to women and newborns in the immediate postpartum period and in the first weeks after delivery is extremely important for the health of both. In addition to problems with breastfeeding, anxiety is an emotional state that can present since the arrival of the baby. There are recommendations for essential actions for prenatal, perinatal and puerperal care, including non-medicalization, providing care using a minimum of interventions. Acupuncture can be an important resource in the puerperium, especially in the lactation period, as nursing mothers can feel calmer and safer. The objective was to evaluate the effects of auriculoacupuncture therapy on the level of anxiety and breast pain in nursing mothers. This is an experimental study, of the type randomized controlled clinical trial, carried out in the city of Fortaleza, in the sectors of the Neonatal Intensive Care Unit and Kangaroo Unit of the Maternity School Assis Chateaubriand, developed with puerperal women who accompanied their hospitalized babies, from February to July 2019. Participants were randomly assigned to two groups, the intervention group being puerperal women who received sessions of auriculoacupuncture with semi-permanent needles at the points Shemen, kidney, SNV, anxiety, heart, lung and neurasthenia and routine care of the service, and the control group, composed of puerperal women who received placebo acupuncture, which needles were inserted in regions of the ear that have no effects, and routine care at the service. The treatment consisted of up to three sessions, with intervals of 3 days. This study used the recommendations of the checklist items in the Standards for Reporting Interventions in Clinical Trials of Acupuncture. The instrument used to investigate the sociodemographic, clinical and obstetric profile, the visual analog scale, to assess the intensity of nipple / breast pain felt and the Beck inventory of anxiety and state STAI, which estimated the level of anxiety. For data treatment, descriptive analysis was performed, Shapiro Wilk test to verify possible normality, Wilcoxon test for analysis of responses before and after each session, Chi-square test for association between variables, Mann Whitney Wilcoxon test to compare the intervention and control groups. The descriptive level used was 5%. As for the sociodemographic, sexual and reproductive characteristics of the mothers, the groups were homogeneous in almost all variables. According to the assessment of pain and anxiety, there was a statistically significant reduction in symptoms from the first session and showed a greater gradual decrease with the increase in the number of sessions. Before the intervention, anxiety on the Beck scale had an average of 13.83 points for all participants and, after a significant decrease was observed after the first (6.78), second (7.0) and third session ( 5.85), with a significant reduction in scores, mainly after the first session (p = 0.000). In the analysis of the comparison of anxiety in groups, from one session to another, the 11 data reveal that the effect of the intervention is significant in the first session, since the intervention group showed a significant difference in the assessment from before to the first session (p = 0.000 ). The same did not happen in the control group. There were no statistically significant differences in the p value in all sessions, when comparing the groups. It was verified by means of the state anxiety scale in all participants, that the puerperal women had average level of anxiety before the intervention and that there was a reduction of the level down shortly after a session (p = 0.02), comparing the scores of the before (41.83) and after the first auriculoacupuncture session (39.3), obtaining a reduction of 2.53 scores on the scale. When analyzing the measurements of the state anxiety scale, per session, between the intervention and control groups, there was a considerable reduction in the scores in both groups, however, there is a significant reduction (p = 0.03) in the intervention group, in evaluation of before (41.9) and after the first session (38.92). There was no significant reduction in scores for the control group. Comparing the groups, there were no statistically significant differences between them at any time. Regarding breast pain, the general assessment of the participants, according to the visual analogue scale, concluded that there was a reduction in the average pain, mainly after the first (p = 0.00102) and after the third session (p = 0.009) session of auriculoacupuncture. Analyzing the groups, pain reduction happened more significantly in the intervention group, in the evaluation after the first session (p = 0.0052). Looking at the groups separately, it is considered that there is no significant difference in the reduction between them. The relationship between baby on exclusive breastfeeding and anxiety was highly significant, as well as the relationship between the baby breastfeeding in the first hour of life with the Beck scale. Women had effects on other self-reported sensations, such as: increased milk production (81.3%); body relaxation (81.3%); change in sleep (75%); in the mood state (75%); energy (75%); patience (68.8%); anguish (68.8%), among others. The women in the control group reported an improvement in energy (90%); patience (90%); relaxation (90%); increase in milk production (70%), among others. It was concluded that the effects of auriculoacupuncture therapy on anxiety and breast pain in nursing mothers are beneficial for reducing symptoms and consequently promoting the health of postpartum women.