ABSTRACT:

Objective:

To identify factors associated with breastfeeding in the first hour of life.

Methods:

A cross-sectional study conducted among mothers and children under one year of age, who attended the second stage of the polio vaccination campaign in the Federal District, Brazil, in 2011. The sample was composed of 1,027 pairs of mothers and children. Breastfeeding in the first hour of life was considered as the dependent variable; and the independent variables were: socio-demographic characteristics of the mother, prenatal, delivery and postpartum care, reference to physical or verbal violence/neglect during delivery, and children health. Unadjusted and adjusted prevalence ratios (PR) were used as measures of association, calculated by Poisson regression.

Results:

The prevalence of breastfeeding in the first hour of life was 77.3%. Inadequate prenatal care (PR = 0.72), cesarean section (PR = 0.88) and no access to rooming-in after birth (PR = 0.28) were factors that interfered negatively in breastfeeding in the first hour of life. No factor was associated with breastfeeding in the first hour of life for mother and children.

Conclusions:

Factors related to health services such as prenatal care, type of delivery and postpartum rooming-in interfered with breastfeeding in the first hour of life, indicating that health services, as well health professional practices were major determinants the breastfeeding in the first hour of life.

Keywords:
Breast feeding; Mass vaccination; Health services; Maternal and child health; Prenatal care; Rooming-in care

INTRODUCTION

The World Health Organization (WHO) recommends that immediately after delivery the mother and child skin to skin contact should be allowed. In this opportunity, mothers should be oriented on how to recognize the moment when their children are ready for breastfeeding for the first time¹1. Children's Rights & Emergency Relief Organization (UNICEF), World Health Organization (WHO). Baby-friendly hospital initiative: revised, updated and expanded for integrated care. Section 4, Hospital self-appraisal and monitoring. Geneva: UNICEF/WHO; 2009.^,22. World Health Organization (WHO). Maternal, newborn, child and adolescent health approved by the WHO Guidelines Review Committee. Handbook for guideline development. Geneva: WHO; 2012..

Breastfeeding (BF) guarantees children the nutrients necessary for their healthy growth and development and its benefits can be seen beyond early childhood. A recent study conducted in Pelotas, Rio Grande do Sul - Brazil, showed that children who were breastfed for 12 months or more presented higher intelligence quotient, educational level and income at 30 years of age, compared to children who were breastfed for less than one month³3. Victora CG, Horta BL, Mola CL, Quevedo L, Pinheiro RT, Gigante DP, et al. Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil. Lancet 2015; 3(4): 199-205..

Early initiation of breastfeeding in the first hour of life provides the newborn immunological and psychosocial benefits, strengthens the mother-child bond⁴4. World Health Organization (WHO). Global strategy for infant and young child feeding. A joint WHO/UNICEF statement. Geneve: WHO; 2003., and increases the child's chance to receive colostrum, which is highly nutritious, easily digestible and presents substantial immunological properties for this phase of life⁵5. Children's Rights & Emergency Relief Organization (UNICEF), World Health Organization (WHO). Baby-friendly hospital initiative: revised, updated and expanded for integrated care. Section 3, Breastfeeding promotion and support in a baby-friendly hospital: a 20-hour course for maternity staff. Geneve: WHO; 2009.. Therefore, breastfeeding within one hour of birth is considered an important protective factor against newborn mortality⁶6. Boccolini CS, Carvalho ML, Oliveira MIC, Pérez-Escamilla R. Breastfeeding during the first hour of life and neonatal mortality. J Pediatr 2013; 89(2): 131-6.. The main findings of a study conducted in Ghana, Africa, from 2003 to 2004, showed that 16.3% of neonatal deaths could be prevented if breastfeeding initiated on the first day of life and 22.3% if breastfeeding occurred in the first hour of life⁷7. Edmond KM, Zandoh C, Quigley MA, Amenga-Etego S, Owusu-Agyei S, Kirkwood BR. Delayed breastfeeding initiation increases risk of neonatal mortality. Pediatrics 2006; 117(3): 380-6..

Systematic literature review, conducted by Esteves et al.⁸8. Esteves TMB, Daumas RP, Oliveira MIC, Andrade CAF, Leite IC. Fatores associados à amamentação na primeira hora de vida: revisão sistemática. Rev Saúde Pública 2014; 48(4): 697-703. indicated that the prevalence of breastfeeding within one hour of birth ranged from 11.4% in one province in Saudi Arabia⁹9. El-Gilany AH, Sarraf B, Al-Wehady A. Factors associated with timely initiation of breastfeeding in Al- Hassa province, Saudi Arabia. East Mediterr Health J 2012; 18(3): 250-4. to 83.3% in Sri Lanka¹⁰10. Senarath U, Siriwardena I, Godakandage SS, Jayawickrama H, Fernando DN, Dibley MJ. Determinants of breastfeeding practices: an analysis of the Sri Lanka Demographic and Health Survey 2006-2007. Matern Child Nutr 2012; 8(3): 315-29.. Data from the 2^nd Research on the Prevalence of Breastfeeding in Brazilian State Capitals and in the Federal District (DF) showed that 67.7% of children breastfed in the first hour of life in the Brazilian cities in 2008¹¹11. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas e Estratégicas. II Pesquisa de Prevalência de Aleitamento Materno nas Capitais Brasileiras e Distrito Federal. Brasília: Ministério da Saúde; 2009.. The Research Born in Brazil, conducted in the five geographical regions of the country in 2011 and 2012, found a prevalence of 50.4% of breastfeeding within one hour of birth among newborns in the Midwest region¹²12. Moreira MEL, Gama SGN, Pereira APE, Silva AAM, Lansky S, Pinheiro RS, et al. Práticas de atenção hospitalar ao recém-nascido saudável no Brasil. Cad Saúde Pública 2014; 30(Suppl 1): 128-39..

The health team's role is to assist and support the mother and the child in order to guarantee that the breastfeeding within one hour of birth occurs adequately¹1. Children's Rights & Emergency Relief Organization (UNICEF), World Health Organization (WHO). Baby-friendly hospital initiative: revised, updated and expanded for integrated care. Section 4, Hospital self-appraisal and monitoring. Geneva: UNICEF/WHO; 2009.^,22. World Health Organization (WHO). Maternal, newborn, child and adolescent health approved by the WHO Guidelines Review Committee. Handbook for guideline development. Geneva: WHO; 2012.. The literature has indicated that the practices of health professionals⁸8. Esteves TMB, Daumas RP, Oliveira MIC, Andrade CAF, Leite IC. Fatores associados à amamentação na primeira hora de vida: revisão sistemática. Rev Saúde Pública 2014; 48(4): 697-703.^,1313. Patel A, Badhoniya N, Khadse S, Senarath U, Agho KE, Dibley MJ, et al. Infant and young child feeding indicators and determinants of poor feeding practices in India: secondary data analysis of National Family Health Survey 2005-06. Food Nutr Bull 2010; 31(2): 314-33.^,1414. Oliveira MI, Silva KS, Gomes Junior SC, Fonseca VM. Delivering rapid HIV tests results after delivery: a threat to breastfeeding at birth. Rev Saúde Pública 2010; 44(1): 60-9.^,1515. Will TK, Arndt JG, Torres GG, Andrade JR, Pereira TSS, Molina MCB. Fatores de proteção para a amamentação na primeira hora de vida. Rev Bras Promoc Saúde 2013; 26(2): 274-80.^,1616. Adugna DT. Women's perception and risk factors for delayed initiation of breastfeeding in Arba Minch Zuria, Southern Ethiopia. Int Breastfeed J 2014; 9: 8.^,1717. Setegn T, Gerbaba M, Belachew T. Determinants of timely initiation of breasftfeeding among mothers in Goba Woreda, South East Ethiopia: a cross sectional study. BMC Public Health 2011; 11: 217.^,1818. Vieira TO, Vieira GO, Giugliani ER, Mendes CM, Martins CC, Silva LR. Determinants of breastfeeding initiation within the first hour of life in a Brazilian population: cross-sectional study. BMC Public Health 2010; 10: 760., as well as the organization and management of health services, are essential to the initiation of breastfeeding immediately after childbirth¹²12. Moreira MEL, Gama SGN, Pereira APE, Silva AAM, Lansky S, Pinheiro RS, et al. Práticas de atenção hospitalar ao recém-nascido saudável no Brasil. Cad Saúde Pública 2014; 30(Suppl 1): 128-39.. Mothers who got the prenatal care¹³13. Patel A, Badhoniya N, Khadse S, Senarath U, Agho KE, Dibley MJ, et al. Infant and young child feeding indicators and determinants of poor feeding practices in India: secondary data analysis of National Family Health Survey 2005-06. Food Nutr Bull 2010; 31(2): 314-33., who were counseled during prenatal about breastfeeding¹⁸18. Vieira TO, Vieira GO, Giugliani ER, Mendes CM, Martins CC, Silva LR. Determinants of breastfeeding initiation within the first hour of life in a Brazilian population: cross-sectional study. BMC Public Health 2010; 10: 760. and who received postpartum assistance from health professionals for breastfeeding were more likely to breastfeed their children in the first hour¹⁶16. Adugna DT. Women's perception and risk factors for delayed initiation of breastfeeding in Arba Minch Zuria, Southern Ethiopia. Int Breastfeed J 2014; 9: 8.^,1717. Setegn T, Gerbaba M, Belachew T. Determinants of timely initiation of breasftfeeding among mothers in Goba Woreda, South East Ethiopia: a cross sectional study. BMC Public Health 2011; 11: 217.. With regard to health services, allowing companion in childbirth, having deliveries paid by the Unified Health System (SUS) and in hospitals that received the title of Child Friendly Hospital Initiative (IHAC)¹²12. Moreira MEL, Gama SGN, Pereira APE, Silva AAM, Lansky S, Pinheiro RS, et al. Práticas de atenção hospitalar ao recém-nascido saudável no Brasil. Cad Saúde Pública 2014; 30(Suppl 1): 128-39. were appointed as stimulating factor for the breastfeeding within one hour of birth.

Few studies have investigated the factors associated with breastfeeding within one hour of birth in the Brazilian population¹⁵15. Will TK, Arndt JG, Torres GG, Andrade JR, Pereira TSS, Molina MCB. Fatores de proteção para a amamentação na primeira hora de vida. Rev Bras Promoc Saúde 2013; 26(2): 274-80.^,1818. Vieira TO, Vieira GO, Giugliani ER, Mendes CM, Martins CC, Silva LR. Determinants of breastfeeding initiation within the first hour of life in a Brazilian population: cross-sectional study. BMC Public Health 2010; 10: 760.^,1919. Pereira CRVR, Fonseca VM, Oliveira MIC, Souza IEO, Mello RR. Avaliação de fatores que interferem na amamentação na primeira hora de vida. Rev Bras Epidemiol 2013; 16(2): 525-34.^,2020. Boccolini CS, Carvalho ML, Oliveira MIC, Vasconcelos AGG. Fatores associados à amamentação na primeira hora de vida. Rev Saúde Pública 2011; 45(1): 69-78.^,2121. Boccolini CS, Carvalho ML, Oliveira MIC, Leal MC, Carvalho MS. Fatores que interferem no tempo entre o nascimento e a primeira mamada. Cad Saúde Pública 2008; 24(11): 2681-94.^,2222. Silveira RB, Albernaz E, Zuccheto LM. Fatores associados ao início da amamentação em uma cidade do sul do Brasil. Rev Bras Saúde Mater Infant 2008; 8(1): 35-43. and none of them were conducted in the Midwest region. This study aimed at investigating the prevalence of breastfeeding in the first hour of life, as well as the factors that interfered in this practice in the Federal District, the country capital, in 2011.

METHODS

STUDY DESIGN

This is a cross-sectional study, conducted in August 2011, during the second phase of the polio campaign in the Federal District. The research subjects were mother-child pairs, aged 0 to 12 months, who attended health units selected as the sample design.

The sample was applied by conglomerate with selection in two stages and probability proportional to cluster size. A conservative prevalence of 50% was considered to calculate the sample size, due to the various investigated indicators, in addition to the confidence level of 95% and maximum sampling error of 4%. The calculation resulted in a sample size of 1,170 mother-child pairs, after adjusting for a sample loss of up to 30% and correcting the design effect (deff) equal to 1.5.

The selection of the first sampling stage (vaccination units) has been carried out in order to have represented all administrative regions of the Federal District (DF) that had health centers eligible to participate in the survey according to the following:

The selection of the eligible vaccination units resulted in a total of 25 units to be analyzed, distributed in 21 of the 30 administrative regions of the Federal District in 2011.

The second sampling stage referred to the systematic selection of mother and child pairs in the vaccination queue on the date of the survey. The sample interval for each selected unit was calculated according to the attendance estimate based on the number of children vaccinated at that unit in the previous year's campaign. The pre-determined interval ranged from 1:2 to 1:10 children, to achieve the target sample in each vaccination unit. The coordinating team monitored, throughout the data collection day, the achievement of the sample size in each surveyed unit. In cases where the search for vaccination was lower than expected, the selection range was lowered to reach the target sample at shorter intervals to the pre-determined, which occurred in 9 of 25 vaccination units (36.0 %). However, the inclusion criteria and the randomness of the sample were preserved.

The mother-child pairs eligible for this study were those whose children were younger than one year and was accompanied by his or her mother; must have been resident in the administrative region where the vaccination unit was located; should not have presented disease or immobilization that interfered with measurement of weight and height of both; should not be twin and or an adopted son or daughter. If the eligible mother took more than one child under one year old to the vaccination unit, the eldest was selected to participate in the study. For the analysis, 143 mother-child pairs were excluded due to inconsistent or inexistent data about the breastfeeding within one hour of birth. Mother-child pairs remaining in the study was equivalent to 1,027.

The weighting factor was calculated according to the number of children under one year of age vaccinated in the second phase of the polio campaign in the Federal District, considering the data provided by the Federal District Health Department, in addition to the sample design, which considered the vaccination units as the primary sampling units. The coverage of the second phase of the polio vaccination campaign for the child under 12 months, held in 2011 in the Federal District when the data was collected, was equivalent to 97.9%, ranging from 67, 1% in the administrative region Asa Norte (North Wing) to 151.1% in the administrative region Lago Norte (North Lake)²³23. Governo do Distrito Federal. Secretaria de Estado de Saúde. Relatório estatístico da Secretaria de Estado de saúde do Distrito Federal e Hospital Universitário de Brasília. Brasília: Secretaria de Estado de Saúde; 2011.. The high coverage ratio contributes to the reduction of the selection bias in such data collection strategy²⁴24. Santos LM, Paes-Sousa R, Silva Junior JB, Victora CG. National Immunization Day: a strategy to monitor health and nutrition indicators. Bull World Health Organ 2008; 86(6): 474-9..

DATA COLLECTION

A pre-tested form was used to the data collection, adapted from the Neonatal Call held in the Brazil's Legal Amazon and Northeast regions²⁵25. Brasil. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Ciência e Tecnologia. Avaliação da atenção ao pré-natal, ao parto e aos menores de um ano na Amazônia Legal e no Nordeste, Brasil, 2010. Brasília: Ministério da Saúde; 2013.. The form was applied to the child's mother, in addition to a module on violence at birth²⁶26. Souza KJ. Violência institucional na atenção obstétrica: proposta de modelo preditivo para depressão pós-parto [dissertação de mestrado]. Brasília: Universidade de Brasília; 2014.. Interviewers who were students or health professionals, using a Personal Digital Assistant (PDA), digitally filled in the form. The survey investigated several factors related to prenatal, childbirth, women's and child's health. In the present study we used the questions on socio-demographic characteristics of the mother (age, educational level and race); prenatal care (adequate prenatal care and evaluation of the mother about the quality of the prenatal care received), delivery care (type of labor and delivery service, type of delivery, presence of companion during labor, childbirth and postpartum, violence during delivery and evaluation of the user on the quality of the delivery care) and postpartum care (rooming-in and breastfeeding within one hour of birth); children's health and their characteristics (the child's gender, birth weight, gestational age and Apgar score at 5 minutes after birth).

CLASSIFICATION OF STUDY VARIABLES

The dependent variable of this study was breastfeeding in the first hour of life. It was identified by the mother's answer to the following question: "Was the child placed in the chest to breastfeed in the first hour of life, soon after birth?". The responses should be classified in "no" or "yes".

Maternal age was classified into four age groups: 14 to 19, 20 to 29, 30 to 34 and ≥ 35 years of age. Maternal education was classified into three levels: 0 to 8, 9 to 11 and ≥ 12 years of schooling. Race or skin color was classified into three categories: white, black or yellow / indian and was considered a representative of the socioeconomic status.

Conformity of assistance in prenatal care was classified as the model proposed by Leal et al.²⁷27. Leal MC, Theme-Filha MM, Moura EC, Cecatti JG, Santos LMP. Atenção ao pré-natal e parto em mulheres usuárias do sistema público de saúde residentes na Amazônia Legal e no Nordeste, Brasil 2010. Rev Bras Saúde Mater Infant 2015; 15(1): 91-104., which were based on process indicators of the National Program of Prenatal Humanization (PHPN). Thus, prenatal care has been classified into two categories. Adequate prenatal care was considered when the woman met the 11 established criteria as follows:

Prenatal care was considered inadequate in the absence of any of these items. The evaluation of the mother about the quality of prenatal care and childbirth was classified as very good/good, satisfactory or poor/very poor. The type of birth was categorized as the type of delivery in two categories: vaginal or cesarean.

The indicators of violence on parturient women by health professionals were analyzed according to the method used by Souza²⁶26. Souza KJ. Violência institucional na atenção obstétrica: proposta de modelo preditivo para depressão pós-parto [dissertação de mestrado]. Brasília: Universidade de Brasília; 2014.. Physical violence was considered when the interviewed mother answered 'yes' to one of the following questions: During labor any of the health professionals:

Verbal violence was identified if the mother answered 'yes' to any of these questions: During labor any of the health professionals:

Neglect was identified if the mother answered 'yes' to one of the following questions: Any of the health professionals:

Physical and verbal violence and neglect were characterized as 'no', when the mother answered 'no' to all questions of each block.

With regard to the characteristics of the children, they were classified as underweight children when the birth weight was < 2,500 g; gestational age was classified into three categories: pre-term, when the child was born before the 37^th week of pregnancy; term, when the child was born between the 37^th and 41^st week of pregnancy; post-term, in case the birth have occurred after the 42^nd week²⁸28. Ballard JL, Khoury JC, Weding K, Wang L, Eilers-Ealsman BL, Lipp R. New Ballard Score, expanded to include extremely premature infants. J Pediatr 1991; 119(3): 417-23.. The Apgar score at 5 minutes was classified into two categories: 8-10 (without asphyxia) and less than 8 (with asphyxia in some degree)²⁹29. Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg 1953; 32(4): 260-7..

DATA ANALYSIS

All estimates were calculated with post-stratification weights. Initially, we calculated the distribution of population according to the variables studied with a 95% confidence interval (95%CI). The prevalence of breastfeeding within one hour of birth was calculated according to the socio-demographic characteristics of the mother, prenatal care, childbirth and postpartum, reference to physical, verbal violence and neglect during childbirth and child health.

We then calculated the prevalence ratios (PR) for all study variables, crude and adjusted, by log-linear model (Poisson regression) considering 95%CI and p < 0.05. In the ratio of adjusted prevalence, we have included all study variables in the model. For the calculation of the adjusted rations, breastfeeding within one hour of birth was considered as the dependent variable and all other variables as independent, establishing as reference category the category presenting greater protection for breastfeeding in the first hour of life. Data analysis was performed in the statistical software Stata, version 12.0, using survey commands that consider the sample complexity.

ETHICAL ASPECTS

The research named "Chamada Neonatal: diagnóstico das condições de saúde e da linha de cuidado à saúde da população materno infantil no Distrito Federal (DF)" was approved by the Ethics Committee of the Universidade de Brasília, Protocol number 130/10 of February 9, 2011. All mothers participating in the survey signed the Informed Consent form.

RESULTS

Among the 1,027 mothers interviewed, 77.3% breastfed in the first hour of life. The majority of the sample did prenatal non-appropriately (78.4%), but assessed the quality of their prenatal care as good and very good (85.9%). With regard to the care during birth, 61.5% of deliveries were cesarean. Verbal violence by health professionals during childbirth was reported by 17.8% of the mothers, followed by physical violence (17.3%) and neglect (16.7%); On the other hand, 80.0% of women rated the quality of delivery care as good and very good. Regarding the characteristics of children under 1 year of age, 91.8% were born with weight equal or greater than 2,500 g and the majority born at term (80.7%) (Table 1). All the women who had appropriate prenatal care, breastfed within one hour of birth. The prevalence of breastfeeding within the first hour of life was also significantly higher among women who had vaginal delivery (84.4%), which stayed rooming-in with their children in the postpartum (83.8%) and among those with lower education (82.0%). Children born with weight equal or greater than 2,500 g had a higher prevalence of breastfeeding within one hour of birth, as well as those who had a companion in the postpartum. After adjusting for all variables of the study, it was observed that a non-proper prenatal and cesarean delivery decreased the probability of breastfeeding within one hour of birth by 28 and 12%, respectively. Standard care for newborn after delivery (no rooming-in) reduced by 72% the probability of breastfeeding within one hour of birth (Table 2).

DISCUSSION

In this study, the factors that negatively interfere in the breastfeeding within the first hour of life, after adjusting for all variables in the model, are related to the prenatal care (not having received prenatal care appropriately), the delivery (Caesarean section) and postpartum (standard care for newborn instead of rooming-in).

The prevalence of breastfeeding within one hour of birth in this study in the Federal District (77.3%) is above the prevalence found in Brazil, in the Midwest region and in the Federal District itself in previous studies. The 2^nd Research on Breastfeeding Prevalence, conducted in 2008, showed that 67.7% of all children were breastfed in the first hour of life. In the Federal District the observed prevalence was 72.5%³⁰30. Venancio SI, Escuder MML, Saldiva SRDM, Giugliani ERJ. A prática do aleitamento materno nas capitais brasileiras e Distrito Federal: situação atual e avanços. J Pediatr 2010; 86(4): 317-24.. Data from the 2006 National Demographic and Health Survey (PNDS) showed that 43.0% of children breastfed in the first hour of life in Brazil. In the Midwest, this prevalence was 39.7%. However, a comparison of data from this study with the PNDS is limited, since the age of the children included in the two studies are different³¹31. Brasil. Ministério da Saúde. Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher - PNDS 2006. Brasília: Ministério da Saúde; 2008..

Among the women interviewed in this study, 21.6% did not undergo prenatal properly, according to National Program of Prenatal Humanization (PHPN) criteria. However, 85.9% of respondents assessed the quality of care for prenatal care as very good or good. Leal et al.²⁷27. Leal MC, Theme-Filha MM, Moura EC, Cecatti JG, Santos LMP. Atenção ao pré-natal e parto em mulheres usuárias do sistema público de saúde residentes na Amazônia Legal e no Nordeste, Brasil 2010. Rev Bras Saúde Mater Infant 2015; 15(1): 91-104., in a study conducted in the Legal Amazon region and in the Northeast of Brazil, showed that only 3.4% of respondents had access to prenatal classified as appropriate. In a research in Rio de Janeiro, Domingues et al.³²32. Domingues RMSM, Hartz ZMA, Dias MAB, Leal MC. Avaliação da adequação da assistência pré-natal na rede SUS do Município do Rio de Janeiro, Brasil. Cad Saúde Pública 2012; 28(3): 425-37. found adequacy of prenatal care in only 38.5% of the investigated pregnant women. The difference between the two studies may be explained, partially, by differences related to sampling, to access to health services and to different criteria for classifying prenatal care as adequate or not. With regard to the degree of satisfaction with the assistance received during the prenatal, it is known that the individual expectation about the care influences its evaluation, which often does not reflect the quality of care. However, is considered an important indicator for social control³³33. Espiridião MA, Trad LAB. Avaliação de satisfação de usuários: considerações teórico-conceituais. Cad Saúde Pública 2006; 22(6): 1267-76.. The literature has shown that women's satisfaction with the quality of prenatal care is related to the number of doctor's visits during prenatal³⁴34. Vieira SM, Bock LF, Zocche DA, Pessota CU. Percepção das puérperas sobre a assistência prestada pela equipe de saúde no pré-natal. Texto Contexto Enferm 2011; 20(Esp): 255-62., as well as to the effective communication, attention given, confidence and respect of health professionals for them³⁵35. Queiroz MVO, Jorge MSB, Marques JF, Cavalcante AM, Moreira KAP. Indicadores de qualidade da assistência ao nascimento baseados na satisfação de puérperas. Texto Contexto Enferm 2007; 16(3): 479-87..

All respondents classified as receiving adequate prenatal care, breastfed in the first hour of life. Access to medical appointments during prenatal has been identified in the literature as a protective factor for breastfeeding within one hour of birth¹³13. Patel A, Badhoniya N, Khadse S, Senarath U, Agho KE, Dibley MJ, et al. Infant and young child feeding indicators and determinants of poor feeding practices in India: secondary data analysis of National Family Health Survey 2005-06. Food Nutr Bull 2010; 31(2): 314-33.^,3636. Mihrshahi S, Kabir I, Roy SK, Agho KE, Senarath U, Dibley MJ, et al. Determinants of infant and young child feeding practices in Bangladesh: secondary data analysis of Demographic and Health Survey 2004. Food Nutr Bull 2010; 31(2): 295-313.. Data from Uganda PNDS, conducted in 2006, showed that women who sought prenatal care were more likely to breastfeed within the first hour (6 to 7%) when compared to those who did not seek prenatal care³⁷37. Bbaale E. Determinants of early initiation, exclusiveness, and duration of breastfeeding in Uganda. J Health Popul Nutr 2014; 32(2): 249-60.. Cross-sectional study conducted in Rio de Janeiro indicated that get prenatal care was a protective factor for non-breastfeeding within one hour of birth (PR = 0.23) 19.

Several studies have demonstrated that health professionals, through their practices and actions, influence both the initiation and duration of breastfeeding³⁸38. Regan J, Thompson A, DeFranco E. The influence of mode of delivery on breastfeeding initiation in women with a prior cesarean delivery: a population-based study. Breastfeed Med 2013; 8(2): 181-6.^,3939. Holbrook KE, White MC, Heyman MB, Wojcicki J. Maternal sociodemografic characteristics and the use of the Iowa Infant Attitude Feeding Scale to describe breastfeeding initiation and duration in a population of urban, Latina mothers: a prospective cohort study. Int Breastfeed J 2013; 8(1): 7-14.. The orientation on breastfeeding by health professionals soon after birth increased the chance of women to breastfeed in the first hour of life¹⁷17. Setegn T, Gerbaba M, Belachew T. Determinants of timely initiation of breasftfeeding among mothers in Goba Woreda, South East Ethiopia: a cross sectional study. BMC Public Health 2011; 11: 217.. Boccolini et al.²⁰20. Boccolini CS, Carvalho ML, Oliveira MIC, Vasconcelos AGG. Fatores associados à amamentação na primeira hora de vida. Rev Saúde Pública 2011; 45(1): 69-78. found that mothers have limited or no power to make decisions about breastfeeding their children in the first hour of life, and shall be subject to the practices and actions of the professionals involved in the delivery, as well as to the institutional procedures in place in maternity wards. Inadequate hospital procedures in healthy newborns, such as aspiration of air and gastric tract immediately after birth⁵5. Children's Rights & Emergency Relief Organization (UNICEF), World Health Organization (WHO). Baby-friendly hospital initiative: revised, updated and expanded for integrated care. Section 3, Breastfeeding promotion and support in a baby-friendly hospital: a 20-hour course for maternity staff. Geneve: WHO; 2009. and providing food before breastfeeding⁹9. El-Gilany AH, Sarraf B, Al-Wehady A. Factors associated with timely initiation of breastfeeding in Al- Hassa province, Saudi Arabia. East Mediterr Health J 2012; 18(3): 250-4. have also been identified in the literature as factors that may interfere in the early breastfeeding, which reinforces the importance of the WHO's recommendation that mother and baby should not be separated in the delivery room, except if there is a medical reason to justify such action¹1. Children's Rights & Emergency Relief Organization (UNICEF), World Health Organization (WHO). Baby-friendly hospital initiative: revised, updated and expanded for integrated care. Section 4, Hospital self-appraisal and monitoring. Geneva: UNICEF/WHO; 2009.. Therefore, the professional practice at delivery becomes crucial for breastfeeding within one hour of birth.

Cesarean section was also a factor associated to a lower prevalence of breastfeeding in the first hour. Boccolini et al.²⁰20. Boccolini CS, Carvalho ML, Oliveira MIC, Vasconcelos AGG. Fatores associados à amamentação na primeira hora de vida. Rev Saúde Pública 2011; 45(1): 69-78. observed this same trend in Rio de Janeiro. Cesarean section influences the postponement of the first breastfeeding⁴⁰40. Zanardo V, Svegliado G, Cavallin F, Giustardi A, Cosmi E, Litta P, et al. Elective cesarean delivery: does it have a negative effect on breastfeeding? Birth 2010; 37(4): 275-79.?^,4141. Domingues RMSM, Dias MAB, Nakamura-Pereira M, Torres JA, D'Orsi E, Pereira APE, et al. Processo de decisão pelo tipo de parto no Brasil: da preferência inicial das mulheres à via de parto final. Cad Saúde Pública 2014; 30(Suppl 1):101-16. due to several factors, including those related to anesthesia and the surgical procedure itself²⁰20. Boccolini CS, Carvalho ML, Oliveira MIC, Vasconcelos AGG. Fatores associados à amamentação na primeira hora de vida. Rev Saúde Pública 2011; 45(1): 69-78.. The prevalence of cesarean delivery in this study was high (61.5%), and also higher than that observed in Brazil (55.4%)⁴¹41. Domingues RMSM, Dias MAB, Nakamura-Pereira M, Torres JA, D'Orsi E, Pereira APE, et al. Processo de decisão pelo tipo de parto no Brasil: da preferência inicial das mulheres à via de parto final. Cad Saúde Pública 2014; 30(Suppl 1):101-16., which indicates the need to review the current professional practice that elects caesarean section as a routine procedure, since Brazil accounted for 15% of the unnecessary cesareans occurred globally in 2008⁴²42. Gibbons L, Belizán JM, Lauer JA, Betrán AP, Merialdi M, Althabe F. World Health Report. Health systems financing. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. Geneve; 2010..

The prevalence of breastfeeding within one hour of birth was higher among mother-child pairs who remained rooming-in (83.8%), maintaining the association (PR = 0.28) even after adjusting for all study variables. Rooming-in is a hospital environment that enables the mother and her baby to remain together during the whole postpartum hospital stay⁴³43. Brasil. Ministério da Saúde. Portaria nº 1016, de 26 de agosto de 1993. Normas básicas de alojamento conjunto. Brasília: Diário Oficial da União.. Several studies have demonstrated the importance of the rooming-in for breastfeeding, providing greater confidence to the mother in relation to the latch-on and proper positioning for breastfeeding, autonomy to understand and care for the child, in addition to providing increased interaction between mothers and health professionals, which can take advantage of this environment to address essential aspects to enhancing the effectiveness of breastfeeding⁴⁴44. Beck AMO, Assunção KO, Barbosa LR, Gomes E. Influência do ambiente hospitalar nos aspectos relacionados ao aleitamento materno. Rev Soc Bras Fonoaudiol 2012; 17(4): 464-8.^,4545. Rodrigues AP, Padoin SMM, Guido LA, Lopes LLD. Fatores do pré-natal e do puerpério que interferem na autoeficácia em amamentação. Esc Anna Nery 2014; 18(2): 257-61.. Cochrane systematic review found that the prevalence of exclusive breastfeeding until the fourth day before hospital discharge was higher among women who remained rooming-in than among those who were separated from their child⁴⁶46. Jaafar SH , Lee KS , Ho JJ. Separate care for new mother and infant versus rooming-in for increasing the duration of breastfeeding. Cochrane Database Syst Rev 2012; CD006641..

Although in this study the physical, verbal and neglect reported by women during childbirth have not been associated with breastfeeding within one hour of birth, these are important factors to be considered in other studies, since the practices of health professionals were associated with early breastfeeding initiation. It is necessary to provide care and a proper environment to women's health, which are more vulnerable physically and emotionally at birth, prioritizing the humanization of birth and maximizing the attention given to the woman, which often is focused only in the newborn and subordinate to the practices of health professionals⁴⁷47. D'Orsi E, Brüggemann OM, Diniz CSG, Aguiar JM, Gusman CR, Torres TA, et al. Desigualdades sociais e satisfação das mulheres com o atendimento ao parto no Brasil: estudo nacional de base hospitalar. Cad Saúde Pública 2014; 30(Suppl 1): 154-68^,4848. Aquino EML. Para reinventar o parto e o nascimento no Brasil: de volta ao futuro. Cad Saúde Pública 2014; 30 (Suppl): S8-10.. Some authors have suggested that stressful experiences in childbirth can delay the initiation of breastfeeding⁴⁹49. Foster DA, McLachalan HL. Breastfeeding initiation and birth setting practices: a review of the literature. J Midwifery Womens Health 2007; 52(3): 273-80., however, none of these studies investigated the possible association between violence in childbirth and breastfeeding within one hour of birth. The present study is pioneer in the investigation of this association. Therefore, it is necessary to conduct further research in order to elucidate this factor.

CONCLUSION

The conduction of researches during the vaccination campaigns has been a widely employed strategy in Brazil due to the following advantages: data is obtained quickly, survey is conducted with a relatively low cost, it allows the mobilization and involvement of local managers¹¹11. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas e Estratégicas. II Pesquisa de Prevalência de Aleitamento Materno nas Capitais Brasileiras e Distrito Federal. Brasília: Ministério da Saúde; 2009.^,2424. Santos LM, Paes-Sousa R, Silva Junior JB, Victora CG. National Immunization Day: a strategy to monitor health and nutrition indicators. Bull World Health Organ 2008; 86(6): 474-9.^,2727. Leal MC, Theme-Filha MM, Moura EC, Cecatti JG, Santos LMP. Atenção ao pré-natal e parto em mulheres usuárias do sistema público de saúde residentes na Amazônia Legal e no Nordeste, Brasil 2010. Rev Bras Saúde Mater Infant 2015; 15(1): 91-104.. However, this type of research can only be performed if the National Immunization Program maintains the continuity of the "D-Day" in vaccination campaigns.

With regard to the limitations of this study, we can mention that the main investigation objective of the Federal District Call was not the factors associated with breastfeeding within one hour of birth, which limited the inclusion of other important information that could be associated with this outcome such as: if the mother received help while positioning the child for breastfeeding, if breastfeeding was initiated at the delivery room, if inadequate hospital procedures were performed in healthy newborns as aspiration in upper airways and pharynx, among other aspects, in addition to the inclusion of the population living in rural areas of the Federal District.

The health professionals' practices and services in all stages of the comprehensive health care of both mother and child are essential to breastfeeding within one hour of birth. It is necessary that appropriate assistance in prenatal is granted to women as well as in the delivery and postpartum, in order for them to be empowered and take an active role, being protagonists in the decisions related to own and their children's health during hospitalization for childbirth. The findings of this study can support improvements in the planning and management of health services in order to promote breastfeeding within the first hour of life.

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