Online braz j nurs

The meaning of neonatal surgery in congenital malformations: the maternal vision for the nursing care

O significado da cirurgia neonatal na presença de malformações congênitas: a visão materna para o cuidar de enfermagem

Autora: Adriana Teixeira Reis, Professora Assistente da Faculdade de Enfermagem da Universidade do Estado do Rio de Janeiro-UERJ; Tecnologista em Saúde Pública do Instituto Fernandes Figueira- FIOCRUZ, Rio de Janeiro, Brasil.

Advisor/ Leader: Rosângela da Silva Santos, Professora Titular da Escola de Enfermagem Anna Nery– UFRJ, Rio de Janeiro, Brasil.

Bibliografic reference: Reis AT. O significado da cirurgia neonatal na presença de malformações congênitas: a visão materna para o cuidar de enfermagem. Rio de Janeiro, [Tese-Doutorado em Enfermagem] Rio de Janeiro(RJ): Escola de Enfermagem Anna Nery- UFRJ, 2010.

Problem: From the diagnosis of a fetal or neonatal congenital malformation, the woman needs to desconstruct their beliefs, values and aspirations devised so as to be beset  by a series of scientific informations about the abnormality of the baby, which makes this frightening and distressing time. The baby may need a corrective surgery right after birth, which implies an admission to the Neonatal Intensive Care Unit (NICU). Experiencing this moment is shared by professionals and families, seeking recovery or upgrading to a new condition of the child's life. However, assistance to these women still suffer consequences of current public health policy, based on medical technology(1), depletion of soft technologies of care and recognition that the mother is the principal figure of support for the newborn(2). Whereas the stress in parents of newborns admitted to NICU surgery is an unexplored field of study(3), valuing the voices of these women-mothers, aims to provide nursing care consistent and congruent(4) with their needs during the experience of motherhood, especially in this condition.

Objective: To know the meaning given by women-mothers to neonatal surgery of their children carriers of congenital malformations; understand how the meaning attributed to neonatal surgery can interfere in the mothering process of newborns carriers of congenital malformations; to discuss the performance of the nursing from the meaning attributed to neonatal surgery to women-mothers of newborns carriers of congenital malformations.

Method: This is a descriptive qualitative research that used the history of life method through recorded interviews with eighteen women-mothers of newborns undergoing neonatal surgery for congenital malformations. The study was approved by the Ethics Committee of Instituto Fernandes Figueira and School of Nursing Anna Nery. Data collection was conducted between July and August 2009, the Department of Pediatric Surgery of the Instituto Fernandes Figueira.

Results: The reports pointed to the emergence of three units of meaning: The meaning of neonatal surgery in the presence of the malformation; The postponement of motherhood, mothering and the social construction of family and the need for a coherent and consistent care. The categories could explain that the surgery is the great hope of recovering a "normal" life for the baby and the woman. There is great expectation towards the elimination of imperfection marked on the biological (physical body of the baby), but also in the imaginary and the in the social dimension. Some women experience the "surgical primary concern." The statements point to a re-signification of the motherhood, with re patterning of behaviors and functions of maternal roles before the surgery. The rite of passage from the woman to woman-mother can not be completed; which may be replaced by the ritual of misfortune or be experienced differently, as a "new ritual," characterized by the experience of ambiguous feelings. Surgery can help performance of the mothering, but is not the only factor that interferes with this process. Deconstruct beliefs before the meeting between technical knowledge and experiences is a challenge for the assistance´ s daily. 

Conclusions:The nursing can help in the support and adaptation of these women in front of their new condition, being promoter agent of the therapeutic listening. Understand what is behind each unveiled story brings subsides to the use of soft technologies in the institutional welcome of the woman and her family.

Keywords: Mothers; nursing care; surgery; congenital abnormalities.

Main bibliography

1.      Merhy EE. Um ensaio sobre o médico e suas valises tecnológicas. Contribuições para compreender as reestruturações produtivas do setor saúde. Interface. Comunic Saúde Educ. 2000; (6):109-11.

2.      Winnicott DW. Os bebês e suas mães. São Paulo: Martins Fontes; 2006.

3.      Joseph RA., Mackley AB, Davis CG, Spear ML, Locke RG. Stress in fathers of surgical neonatal intensive care unit babies. Ethical issues in newborn care. Advances in neonatal care [serial on the Internet].2007 Dec [cited 2008 Dec 12]; 7(6):321-325. Avaliable from:;jsessionid=Jd8GQCLKnFhdnZCL1fbYb3Q6jbnn8GCs9mp4Ljyvx0fH7hPtv1Gw!1553038018!181195628!8091!-1.

4.      Leininger MM. Caring an essential human need: proceedings of three National Caring Conferences. Detroit: Wayne State University Press; 1988.

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