Da decepção à esperança: o olhar da mãe para seu bebê com fenda orofacial (FOF)

Abstract

This dissertation aimed to investigate the mother-baby relationship when the baby presents orofacial cleft. Birth is an unmatched moment for the relationship between mother and child, being characterized by the confrontation of the idealized baby psychically with the real baby. When the child is born with a malformation, the mother may experience a deep crisis as far as her emotional balance. Orofacial clefts are congenital malformations of variable presentation, which are formed by an non-closing in the lip and palate region, with aesthetic and functional implications. Winnicott accounts that the primary experience in the context of the mother-baby relationship, lay the foundation for the individual's emotional development. When the mother is identified with her baby, she is able to provide good enough maternal care ensuring the conditions of the newborn development. Maternal care at this stage also represents emotional support that promotes the development of the individual's self. We performed a theoretical-empirical study in order to investigate the experience of the mother when her baby is born with orofacial cleft. Specifically, we seek to know the maternal perceptions and feelings about an orofacial cleft baby. Considering repercussions for the affective bond with the baby and for the maternal capacity to offer sufficiently good care. The study was fulfilled through semi-structured interviews with six mothers assisted in a public hospital whose babies were between 05 days to 06 months of birth. In four of the six dyads, the diagnosis was post childbirth, with two cases of cleft lip and four cases of cleft lip and palate. The interviews were recorded in audio and later transcribed in full. The moment of the interview was considered privileged to perceive the interaction between the dyad and the maternal care offered to the baby. We prick down in the field diary the verbal and non-verbal aspects of the mother-infant interaction observed during the interview. The systematization of the interview transcripts in articulation with the field diary data originated the individual narratives. To analyze the data, we opted for a qualitative method that valorized the subjective aspects implicit in the speeches and attitudes of the mothers. Like this, the narratives were analyzed according to the Content Analysis method and the systematized data for discussion. From the summary of each interview, we identified the emerging issues of maternal reports and group these themes into five axes of analysis to know: a) Psychosocial environment; b) Maternal feelings about the baby; c) The look of the mother for her baby; d) Maternal feelings compared of the other's gaze; e) Maternal care. The interviews reveal that the socioeconomic context of poverty in which the participants are inserted and affects directly the environmental provision of mothers and their children, mainly in nutritional provision that is essential for the success of the first surgical corrections. The female family network provides the support (holding) necessary for mothers to develop the skills that are adaptive to the needs of the children. The impact of the diagnosis after birth is marked by initial feelings of disappointment, sadness and rejection. The guilty feeling propelled the search for an explanation for the malformation, while hope was propelling the investments in search of treatment. Concern about the social effects of malformation and expectations of facing prejudice appear in speech as a source of suffering and anxiety. The shame goes through the maternal search for the acceptance of the other's gaze but does not incapacitate mothers to seek the treatment of children. Privileging the case-by-case singularity, we sought to understand how this kind of malformation affects the mother's feelings and the mother-baby relationship, articulating the reports from Winnicott concepts of primary maternal concern and the specular role of the mother's face. We realized primary maternal preoccupation through reports of empathic and creative adaptations in the mothers' routines to the special needs of these infants. Despite the initial disappointment, the mothers interviewed saw their babies beyond the orofacial cleft. Babies, mindful of the reflection of themselves provided by the mothers' gaze, become active individuals on the scene, trying to talk, smile, and play From this study, we launched a reflection on the possible contributions of multidisciplinary dialogue in the care of mothers of children with congenital malformations, considering the relevance of the psychological conditions for the provision of the maternal care indispensable to the survival and development of the human being in the beginning of life. This research may also help to reflections in other contexts of congenital conditions that is reflected in the mother-baby relationship, and may thus affect maternal identification and / or the provision of a good enough mothering.