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Estrs y ansiedad materna y su relacin con el xito de la lactancia materna.
Maternal stress and anxiety and their association with successful
breastfeeding.
KEYWORDS: exclusive breastfeeding, vulnerability to stress, state of anxiety.
Breastfeeding responds to a biological fact, but inevitably is subject to social,
economic and cultural influences. Experts agree that should be offered exclusive
breastfeeding until six months of life and then supplemented breastfeeding, at least
until two years.
In different studies shown a decline in establishing successful breastfeeding, which
has not been reversed, despite the efforts made by various international
organizations and countries.
The arguments about why not to use breastfeeding have tried to explain and
resolve. All mothers need information and training about how to feed and care for
their babies, as well as support, encouragement and family and social support after
birth. Never enough time spent on the matter. Someone said that although it was
possible to circumnavigate the world in eighty days, two hundred eighty
pregnancies were generally not sufficient to educate mothers about the
breastfeeding.
They are known physiological mechanisms involved in the production of breast
milk, but often forgotten irrationally. Any child's crying is interpreted as "hungry",
"you do not have enough milk" and added formula supplements that have the
catastrophic consequence of decreasing the number of times that breastfeeds the
child, and thus reduces the production of breast milk. Parents, and often
professional, expect the child to gain weight in an almost programmed manner, and
as deviates in the slightest what supposedly is expected, the LM is sacrificed and
adapted formula is introduced, without weigh the future consequences of these
decisions little justified.
Mothers can present problems such as engorgement; difficulty knowing how much
milk the baby is taking, filtration of milk from the breast, ejection reflex milk different
from those in which they are breastfeeding moments and pain nipples. In addition,
they may feel anxious, tense and confused, and lack of experience or support, and
fear or shame to ask for help, they play sometimes a trick in such "natural" activity.
These problems must be properly handled with the guidance of health
professional.
It is necessary to continue investigating other aspects related to the underutilization
of breast milk, and implement consistent strategies to improve existing results.
Are well established effects of maternal anxiety and stress for expectant mothers
and baby future changes in the placental circulation specifically, the flow of the
uterine artery and maternal cortisol levels are known, and how they are produced
subtle structural changes in the neurobiological control system of the fetus. It has
established a close relationship between stress and production of preterm delivery
and low birth weight. Stress maintained during the first trimester of pregnancy has
been linked to defects of the neural crest, and specifically, with the lip leporine.
Maternal anxiety is related to child behavioral defects, difficult character,
adjustment problems, hyperactivity, attention deficit cognitive development, and
have been shown in cases such high levels of maternal cortisol in saliva. They
have already identified from week nineteen of pregnancy, changes in the density of
the fetal gray matter, which have been linked to anxiety levels maternal.
In parallel, the mental state of the mother, is also a trigger for many neurological
and psychological disorders of the future child, and can relate to their feeding,
including the process lactation.
A pregnant, dissatisfied with their social status, marital status or emotionally
unstable, adopt attitudes manifestations, including physical rejection of her
pregnancy. In turn, the effects of anxiety, emotional disturbance and chronic
sadness during pregnancy are highly related to hyperactivity, irritability, crying and
feeding difficulties and sleep in infants. Mothers with children prone to colic were
tense and anxious during pregnancy. From this it follows that the attitude of
rejection of pregnancy seems to be the central issue that will affect the quality of
the mother and child interaction, greatly hindering the psychological disposition to
breast feed.
We considered then investigate what relationship may have levels of vulnerability
to stress and the state of maternal anxiety, with the results achieved in the
exclusive breastfeeding during the first half of life.
INTRODUCCIN
La lactancia materna (LM) responde a un hecho biolgico, pero inevitablemente
est sujeta a influencias sociales, econmicas y culturales. Los expertos estn de
acuerdo en que se debe ofrecer lactancia materna exclusiva (LME) hasta los 6
meses de vida, y despus, lactancia materna complementada (LMC), al menos
hasta los 2 aos.1-4
En diferentes estudios se muestra una declinacin en el establecimiento de la LM
exitosa, que no se ha logrado revertir, a pesar de los esfuerzos desarrollados por
diferentes organismos internacionales y pases.1,2
Los argumentos esgrimidos acerca de por qu no utilizar la LM se han tratado de
explicar y solucionar. Todas las madres necesitan informacin y adiestramiento
acerca de cmo alimentar y cuidar a sus bebs, as como apoyo, estmulo y
asistencia familiar y social despus del nacimiento. Nunca es suficiente el tiempo
empleado al respecto. Alguien dijo que aunque era posible dar la vuelta al mundo
en 80 das, los 280 del embarazo generalmente no eran suficientes para educar a
las madres con respecto a la LM.3
Son conocidos los mecanismos fisiolgicos implicados en la produccin de leche
materna, pero con frecuencia olvidados irracionalmente. Cualquier llanto del nio
se interpreta como que "pasa hambre", "no se tiene suficiente leche", y se le
aaden suplementos de frmula que tienen la consecuencia catastrfica de
disminuir el nmero de veces que lacta el nio, y as disminuye la produccin de
leche materna. Los padres, y en muchas ocasiones los profesionales, esperan que
el nio gane peso de una forma casi programada, y en cuanto se desva en lo ms
mnimo de lo que supuestamente se espera, se sacrifica la LM y se introduce la
frmula adaptada, sin sopesar las consecuencias futuras de estas decisiones poco
justificadas.1,4
Las madres pueden presentar problemas, como congestin mamaria, dificultad
para saber la cantidad de leche que el beb est tomando, filtracin de leche de
las mamas, reflejo de salida de la leche en momentos diferentes a aquellos en que
se est amamantando, as como dolor en los pezones. Adems, pueden sentirse
ansiosas, tensas y confundidas, y la falta de experiencia o apoyo, y el miedo o la
vergenza a pedir ayuda, les juega, en ocasiones, una mala pasada en una
actividad tan "natural". Estos problemas deben ser manejados convenientemente
con la orientacin de los profesionales de salud. 5,6
Se hace necesario continuar investigando otros aspectos relacionados con la
insuficiente utilizacin de la leche materna, e instrumentar estrategias congruentes
para mejorar los resultados existentes.
Estn bien establecidos los efectos de la ansiedad materna y el estrs para la
gestante y el futuro beb.6-11 Se conocen las modificaciones en la circulacin
placentaria especficamente, el flujo de la arteria uterina y los niveles de cortisol
maternos, y cmo se producen cambios estructurales sutiles en el control del
sistema neurobiolgico del feto. Se ha establecido una relacin estrecha entre el
estrs y la produccin de parto pretrmino y el bajo peso al nacer. El estrs
mantenido durante el primer trimestre del embarazo ha sido relacionado con
defectos de la cresta neural, y especficamente, con el labio leporino. 2,6-11
La ansiedad materna est relacionada con defectos conductuales del nio,
carcter difcil, inadaptabilidad, hiperactividad, dficit de atencin del desarrollo
cognitivo, y se han evidenciado en esos casos elevados niveles de cortisol
materno en saliva. Se han identificado ya desde la semana 19 del embarazo,
cambios en la densidad de la materia gris fetal, que se han relacionado con los
niveles de ansiedad materna.7
Paralelamente, el estado psquico de la gestante, tambin es un factor
desencadenante de muchas alteraciones neurolgicas y psicolgicas del futuro
hijo, y pueden relacionarse con su alimentacin, incluido el proceso de