Of the 118 surveyed professionals, 91 (77.12% of the total) answered the self-administered electronic questionnaire. The average age of dentists was 39.89 ± 0.86 years (mean ± SD), and 78% were female, 97.8% were civil servants, and 83.5% had specialization.
Regarding the knowledge and practices about BF, 81.3% (n=74) of dentists fully agreed or agreed that they know the implications of BF for the child's oral health. Moreover, 72.8% (n = 68) often/always provide mothers or pregnant women with guidance about the benefits of this practice (Table 1).
Table 1
Knowledge and practices about breastfeeding among dentists. Campo Grande-MS, Brazil, 2019.
Variables
|
n
|
%
|
CI 95%
|
Knows the implications of breastfeeding for the child's oral health
|
I totally agree
|
17
|
18.7
|
11.8 – 28.2
|
Agree
|
57
|
62.6
|
52.1 – 72.1
|
I do not agree, nor disagree
|
11
|
12.1
|
6.7 – 20.7
|
Disagree
|
5
|
5.5
|
2.2 – 12.7
|
I totally disagree
|
1
|
1.1
|
0.1 – 7.6
|
The absence of breastfeeding can generate changes in the growth of the face and in the oral motor system
|
I totally agree
|
42
|
46.2
|
36.0 – 56.6
|
Agree
|
45
|
49.5
|
39.1 – 59.7
|
I do not agree, nor disagree
|
3
|
3.3
|
1.0 – 9.9
|
Disagree
|
1
|
1.1
|
0.1 – 7.6
|
I totally disagree
|
-
|
-
|
-
|
Works in a multidisciplinary team
|
Always
|
29
|
31.9
|
22.9 – 42.3
|
Oftentimes
|
43
|
47.3
|
37.0 – 57.6
|
Sometimes
|
17
|
18.7
|
11.8 – 28.2
|
Rarely
|
2
|
2.2
|
0.5 – 8.5
|
Never
|
-
|
-
|
-
|
I have the habit of advising mothers/pregnant women on the recommended duration of exclusive breastfeeding
|
Always
|
40
|
44.0
|
33.9 – 54.4
|
Oftentimes
|
19
|
20.9
|
13.6 – 30.6
|
Sometimes
|
19
|
20.9
|
13.6 – 30.6
|
Rarely
|
10
|
11.0
|
5.9 – 19.4
|
Never
|
3
|
3.3
|
1.0 – 9.9
|
I advise mothers/pregnant women on the importance of maintaining breastfeeding for up to 02 years or more
|
Always
|
21
|
23.1
|
15.4 – 33.0
|
Oftentimes
|
19
|
20.9
|
13.6 – 30.6
|
Sometimes
|
27
|
29.7
|
21.0 – 40.0
|
Rarely
|
12
|
13.2
|
7.5 – 22.0
|
Never
|
12
|
13.2
|
7.5 – 22.0
|
I advise mothers/pregnant women on the benefits of breastfeeding
|
Always
|
45
|
49.5
|
39.1 – 59.7
|
Oftentimes
|
23
|
25.3
|
17.2 – 35.3
|
Sometimes
|
17
|
18.7
|
11.8 – 28.2
|
Rarely
|
5
|
5.5
|
3.3 – 12.7
|
Never
|
1
|
1.1
|
0.1 – 7.6
|
I advise mothers/pregnant women that breastfeeding contributes to facial growth and the development of the oral motor system
|
Always
|
39
|
42.9
|
32.9 – 53.3
|
Oftentimes
|
25
|
27.5
|
19.1 – 37.7
|
Sometimes
|
15
|
16.5
|
10.0 – 25.7
|
Rarely
|
5
|
5.5
|
2.2 – 12.7
|
Never
|
7
|
7.7
|
3.6 – 15.4
|
I carry out health education activities for pregnant women/mothers and babies
|
Always
|
24
|
26.4
|
18.2 – 36.5
|
Oftentimes
|
28
|
30.8
|
22.0 – 41.1
|
Sometimes
|
30
|
33.0
|
23.9 – 43.4
|
Rarely
|
7
|
7.7
|
3.6 – 15.4
|
Never
|
2
|
2.2
|
0.5 – 8.5
|
The predominant method of health education activities performed
|
Lectures
|
50
|
54.9
|
44.4 – 65.0
|
Workshops, groups and conversation circles
|
29
|
31.9
|
22.9 – 42.3
|
Others
|
8
|
8.8
|
4.3 – 16.8
|
Does not perform
|
4
|
4.4
|
1.6 – 11.3
|
I develop health education activities on breastfeeding in other social facilities (schools, daycare centers, community centers, among others)
|
Always
|
2
|
2.2
|
0.5 – 8.5
|
Oftentimes
|
12
|
13.2
|
7.5 – 22.0
|
Sometimes
|
20
|
22.0
|
14.5 – 31.8
|
Rarely
|
26
|
28.6
|
20.1 – 38.8
|
Never
|
31
|
34.1
|
24.9 – 44.5
|
I make home visits in the First Week of Integral Health
|
Always
|
1
|
1.1
|
0.1 – 7.6
|
Oftentimes
|
11
|
12.1
|
6.7 – 20.7
|
Sometimes
|
30
|
33.0
|
23.9 – 43.4
|
Rarely
|
28
|
30.8
|
22.0 – 41.1
|
Never
|
21
|
23.1
|
15.4 – 33.0
|
Nursing mothers’ participants
For the other group, 76.2% of nursing mothers were 25 years of age or older, 57.15% had secondary education, and 52.38% had a partner. For 52.38% of nursing mothers, the type of BF is exclusive (Table 2).
Table 2
Sociodemographic characterization of the participants in the semi-structured interviews (nursing mothers).
Variables
|
n
|
%
|
Characteristics of nursing mothers
|
|
|
Age
|
|
|
18-20
|
2
|
9.5
|
21-24
|
3
|
14.3
|
25-29
|
8
|
38.1
|
≥30
|
8
|
38.1
|
Self-reported skin color
|
|
|
White
|
11
|
52.4
|
Black
|
2
|
9.5
|
Brown
|
8
|
38.1
|
Marital status
|
|
|
With partner
|
11
|
52.4
|
Without partner
|
10
|
47.4
|
Schooling
|
|
|
University education
|
3
|
14.3
|
High school
|
12
|
57.1
|
Elementary school
|
6
|
28.6
|
Parity
|
|
|
01
|
7
|
33.3
|
02
|
8
|
38.1
|
03
|
4
|
19.1
|
Above 03
|
2
|
9.5
|
Delivery
|
|
|
Vaginal
|
13
|
61.9
|
Cesarean
|
8
|
38.1
|
Characteristics of babies
|
|
|
Baby’s age in months (average ± SD [interval])
|
3.18 ± 0.95 [1-6]
|
Baby’s gender
|
|
|
Male
|
13
|
61.9
|
Female
|
8
|
38.1
|
Breastfeeding type
|
|
|
Exclusive
|
11
|
52.4
|
Predominant
|
8
|
38.1
|
Artificial
|
2
|
9.5
|
From the analysis of the interviews, through content analysis by Bardin17, three analytical categories emerged: “Knowledge and practice in everyday life”, “Influence of community networks”, and “Performance of family health teams/oral health teams in actions to promote, protect, and support BF”.
Knowledge and practice in everyday life
BF benefits the child's health, especially concerning growth, nutrition, and protection against disease.
“Besides being good for the child, it helps the baby to grow fast; thus, the child will have a healthier life, having immunity [...]. And, for six months, it helps the child, like, gain weight, develop, makes him healthier.” (E2, 19)
In some speeches, however, it was noticeable that the interviewees were unable to associate BF with the baby's oral health benefits. For some, ignorance is linked to a lack of guidance:
“In this part, I'm a bit of a layman, even ... I don't even have a clue [...]. I know that breastfeeding is good for everything for him, but, I don't know how to tell you right in that part, I didn't have any guidance, either. I really don't know…”(E3, 30)
"But, like this, I don't know what it can do for the baby's mouth, there's no way to talk, if it has any advantage ... Because it strengthens the teeth, like this, but I never heard of it ..." (E10, 25)
One factor reported by mothers was the sensation of insufficient milk production, in contrast to the desire to breastfeed.
"[...] I really wanted to breastfeed her, but I didn't have any milk, so it was what made it more difficult." (E5, 20)
“I wish I had breastfed more, but I didn't have a lot of milk, no. It ended up drying up.” (E3, 30)
Part of the identified speeches associates the experience of BF with a practice accompanied by suffering and anguish:
"I remember that I suffered the issue of his grip the most, he got it wrong, it hurt my chest a lot, and then I couldn't breastfeed right." (E3, 30)
"I don't think it's cool [...], I know it's important, but I don't find it pleasant." (E20, 29)
Despite facing difficulties related to the practice of BF, the speeches of the nursing mothers shows the desire to overcome them, and the determination to continue in the recommended BF duration are noticeable:
“I imagined one thing and it was another. Like, my milk got stuck, and even then, I gave breast, right, I kept giving him breast, who doesn't even talk ... oh, no pregnancy is the same as another.” (E1, 26).
Influence of community networks
Family and community support emerged in some interviews, and, in particular, the company in moments of fragility was valued at the expense of the transmission of technical and scientific knowledge:
“For my family, yes (support). Everyone. Plus my husband and my mother, who stay with me at home. Difficulty in the morning, waking up to breastfeed, my husband gets up, he talks to me and helps me put the baby to breastfeed.” (E1, 26)
Some barriers were related to the abandonment of BF, such as in moments of fragility and discrimination, either by the family, condemning BF or encouraging weaning, or by external individuals. An example is when they feel constrained to breastfeed in public places:
“The family and friends themselves, they want us to introduce food ahead of time, right? So I'm going to breastfeed until the age of six months, then the mother says: “No, it is already three to four months to give food, already asking for food, it will be weak, your milk is weak, the child is crying, the child needs of food!” I realize that the main barrier is the opinions of others.” (E12, 27)
“[...] the biggest difficulty is that there is no place to breastfeed. I think that sometimes people feel uncomfortable [...], they look very ugly at you. They do not understand that the child is hungry and wants to breastfeed at that time [...], you cannot leave the child without breastfeeding for a long time.”(E11, 32)
Performance of family health teams and oral health teams in actions to promote, protect, and support BF
The performance of family health teams and the oral health team’s professionals was valued in some interviewees:
“The nurse. I have a lot of difficulty because I don’t have a beak, right, then she asked me to go to the health center, she talked to me and helped me to stimulate the right catch.” (E1, 26)
“And the dentist… she didn't say that about suction, right: “Boot to suck is better!””(E11, 32)
The absence of home visits during the First Week of Comprehensive Health (PSSI) – accompanied by all sorts of doubts, misinformation, and suffering during this period – was pointed out by some interviewees:
“No, not here at home (no home visits during PSSI). If I had been here at home (team), you could have explained to me not to worry as we did. I would have explained what I could do ...” (E1, 26)
The quality of the approach to the theme during the prenatal and puerperium periods, associated with the claiming tension, is present in most of the speeches:
“[...] there is a little lack of encouragement from public health professionals for this, right, and guidance as well. You feel lost because there are things I didn't know, so you ask the doctor and sometimes he doesn't pay much attention to what you say, he just passes the exam, look if the baby is okay, and just ... I don't know if due to lack of time or interest, right? ...”(E14, 31)
“And in that, I looked for support at the post, I looked for support for health agents, but there was no second alternative. It was “you have to see the handle!”, “You have to see the position! ", except that all of this I already knew, there was no support ... Then, when she was very hungry, then we couldn't stand it and had to give her milk." (E8, 29)
The role of dentists in actions to promote, protect, and support BF emerged in part of the speeches as either giving this role predominantly associated with the job of doctors and nurses or criticizing it as a vague action without further in-depth guidelines:
“No (guidance on BF). More was the nurse who spoke, and my doctor was saying some things. Dentist did not participate, neither of them participated.” (E1, 26)
“During the consultation, no (guidance on BF), at any time.” (E12, 27)
“She came here to see if I had already extracted it (dental element). They came here [...], asked if I was breastfeeding. That was basically it. But it didn't go any deeper. ” (E13, 21).