Análise do atendimento remoto durante a pandemia pelos bancos de leite humano e proposta de sistematização das práticas

Abstract

Introduction: Breastfeeding is beneficial for children and women, and interventions to improve their standards are among those with the greatest potential for reducing infant morbidity and mortality. Optimal levels of breastfeeding could prevent more than 820,000 deaths of children under five each year worldwide. The emergence of the COVID-19 pandemic on the global, with the subsequent confinement and social distancing, led to a sudden change in the routine of breastfeeding support for nursing mothers, infants and health professionals, requiring rapid restructuring of milk banks to ensure adequate service, safe for the mother-child binomial. Given this scenario, due to social distancing measures, many limitations in the care provided by health professionals emerged. At the same time, health professionals made use of remote care strategies, such as the use of available information technologies. Thus, the use of technology through mobile devices (telephony, texts, videos, internet and applications for smartphones) was and continues, even after the pandemic, as a reality that has transformed people’s daily lives, through differentiated learning experiences, bringing benefits to health care and greater possibility of understanding knowledge by patients and professionals. In the Federal District, many of the human milk banks (HMB) in public hospitals adopted remote care for breastfeeding women due to the pandemic. The abrupt change in the routine of Human Milk Banks (HMB) resulted in teleservices carried out without prior preparation of professionals and with low technology infrastructure, encouraged by the health emergency. However, a detailed examination of these practices, the object of this study, contributed to the suggestion of creating a document to standardize practices and improve the population’s access to remote care as an alternative to support human breastfeeding. Objectives: To analyze the potentials and limits of support from health professionals at human milk banks through remote assistance to families carried out during the COVID-19 pandemic, in the perception of professionals working during this period. Method: This is a qualitative, exploratory-descriptive study. The research was carried out with professionals who work in the Human Milk Bank (BLH) services of the State Department of Health of the Federal District (SES-DF) between May 29 and September 27, 2021. Of the 14 milk banks and 7 human milk collection points, in the SES-DF network, professionals from 8 units were interviewed. Results: It was possible to find four cores of meaning that were divided into 4 categories and 16 subcategories: category 1 – Organization of the work process (Welcome and qualified listening; Construction of an action plan; Counseling with clear guidelines; Expectations of mothers regarding the remote service; and Servers' expectations regarding the resolution of remote service); category 2 – Main identified demands (Insecurity regarding latch, position and support; Breast engorgement and milking; Little milk, weak milk and low baby weight; Pain, breast candidiasis, fissure and mastitis); category 3 – Visualized potential (Optimizes time for patient and server; Avoids unnecessary travel; Promotes easy access to the service with quick response); category 4 – Limits and Challenges (Adjusting the handling of the latch without touching the patient; Identifying the moment to schedule in-person care; Clearly transmitting all instructions; and Tool for monitoring the binomial after hospital discharge). Conclusions: Through this study it was possible to understand that the act of breastfeeding during the COVID-19 pandemic had to overcome barriers that initially caused insecurity. The pandemic impacted both the way of offering care to women and the way in which they received support to heal the doubts and difficulties regarding the act of breastfeeding. Despite the numerous challenges, most of women adhered to the proposed model and the practice was maintained and reinforced among mothers with the help of remote support, with a positive impact on care. Products: An article to be submitted to a scientific journal and a Teleservice Manual for Breastfeeding Counseling in post-discharge follow-up to Human Milk Banks (HMB) and Human Milk Collection Stations (HMCS).