Abstract:

Introduction:
Breastfeeding provides benefits both for the mother-baby binomial and for the family, society and the environment. Efforts are needed to increase breastfeeding indicators around the world. This study aimed to examine the effects of an in situ simulation scenario on breastfeeding, as an educational intervention devoloped among pregnant women, on breastfeeding self-efficacy and outcomes.

Methodology:
This is a quasi-experimental study with a control group, non-randomized. Participants were 40 pregnant women undergoing prenatal care in Primary Health Care in a city of the state of São Paulo, Brazil. The participants were divided into a Control Group (n= 20), which received routine guidance, and an Experimental Group (n= 20), which participated in the educational intervention, in addition to the routine guidance. The educational intervention carried out was an in situ simulation entitled "Breastfeeding The Newborn". The scenario has a clinical case and is set in a typical postpartum situation. Its objective is to increase women's confidence in breastfeeding. After the scenario, it is expected that the pregnant woman will be able to assess the baby's signs of hunger and satiety, in addition to performing breastfeeding and manual milking techniques correctly. The Breastfeeding Self-Efficacy Scale was applied as pre-test (third trimester of pregnancy) and post-test (two months after birth). Data regarding the type of breastfeeding practiced and breastfeeding difficulties, two months after childbirth, were also collected.

Results:
The simulation scenario was implemented through individual home visits to pregnant women and their families. The team was made up of a facilitator and an actor (playing a community health agent), with participants being a pregnant woman and a family member, per scenario. A breastfeeding simulator was used, which features the ejection of liquid through the nipple, as well as an infant mannequin, with crying being controlled by a smartphone. The groups were homogeneous regarding socioeconomic and obstetric data. Regarding breastfeeding self-efficacy scores, a statistically significant difference was found in the intragroup comparison - pre and post-test - of the Experimental Group (p= 0.01). There was no statistically significant difference in the intragroup comparison of the Control Group (p= 0.63), as well as in the intergroup comparisons (p= 0.12) for changes in breastfeeding self-efficacy, in the percentages of women on Exclusive Breastfeeding two months after childbirth (p= 0.74) or having any difficulty breastfeeding (p= 0.75).

Conclusions:
The in situ breastfeeding simulation scenario proved to be effective in increasing participants' breastfeeding self-efficacy scores and providing positive breastfeeding outcomes, although no statistically significant difference was found in comparison to pregnant women who only received routine guidance.

Keywords:

Breast Feeding, Simulation Training, Health Education.