Fatores associados com a amamentação na hora de ouro em uma maternidade pública: estudo transversal analítico

Abstract

Breastfeeding within the first hour of life is recognized as one of the most effective interventions for reducing neonatal morbidity and mortality, being associated with immunological protection, strengthening of the mother–infant bond, and longer duration of exclusive breastfeeding. Despite national and international recommendations regarding the “golden hour,” its occurrence remains influenced by clinical, obstetric, neonatal, and healthcare-related factors. This study aimed to analyze the factors associated with breastfeeding within the first hour of life in a public maternity hospital in Ceará, Brazil. This was a cross-sectional study with a quantitative approach, conducted with 604 postpartum women hospitalized in Rooming-in Units. Data collection took place in the wards through individual interviews using a structured form that addressed sociodemographic, obstetric, neonatal, and healthcare-related variables. Statistical analysis included descriptive and inferential measures, with calculation of prevalence ratios (PR) and their respective 95% confidence intervals (95% CI), adopting a significance level of 5%. The study was approved by a Research Ethics Committee. The prevalence of breastfeeding within the first hour of life was 58.44%. No statistically significant associations were identified with sociodemographic variables. Among obstetric characteristics, vaginal delivery was significantly associated with a higher occurrence of the outcome (PR = 1.65; 95% CI: 1.44–1.89). Maternal clinical conditions such as gestational diabetes mellitus (PR = 0.81; 95% CI: 0.67–0.97), gestational hypertension (PR = 0.82; 95% CI: 0.69–0.97), and preeclampsia (PR = 0.61; 95% CI: 0.44–0.82) showed a negative association with breastfeeding in the first hour of life. Regarding neonatal aspects, newborns with an Apgar score ≥7 at the first minute (PR = 1.41; 95% CI: 1.04–1.99) and those born at term (PR = 1.27; 95% CI: 1.01–1.60) showed a positive association with early breastfeeding. A higher prevalence of the outcome was also observed among postpartum women who received guidance on the importance of breastfeeding within the first hour of life (PR = 1.37; 95% CI: 1.19–1.57), guidance on exclusive breastfeeding until six months (PR = 1.19; 95% CI: 1.03–1.38), received support during prenatal care (PR = 1.33; 95% CI: 1.15–1.55), and reported a desire to breastfeed after receiving prenatal support (PR = 1.27; 95% CI: 1.10–1.47). It is concluded that breastfeeding within the first hour of life is a multifactorial phenomenon determined by the interaction between maternal clinical conditions, neonatal characteristics, and institutional practices in mother–infant care. These findings highlight the need to strengthen and qualify healthcare provided to women throughout the pregnancy–puerperal cycle in order to promote early initiation of breastfeeding and reinforce exclusive breastfeeding.