Research-care in the breastfeeding process of babies with cleft lip and palate in light of Kolcaba’s theory

3 Enfermeira. Mestre no Ensino nas Ciências da Saúde pelas Faculdades Pequeno Príncipe. Faculdades Pequeno Príncipe. Docente. Curitiba, Paraná, Brasil. E-mail. deboramakuch@hotmail.com ORCID iD: https://orcid.org/0000-0001-7060-4414 Objective: to unveil the experience of mothers of babies with cleft lip and palate as to breastfeeding, identify the care needs of these mothers and propose nursing care to mothers and babies in light of Kolcaba’s theory. Method: this is a research-care with a qualitative approach with 20 mothers of babies with cleft lip and palate through nursing consultation. Content analysis was adopted. Results: the context units emerged: physical and private comfort during breastfeeding; baby satiety; breastfeeding management; support from health professionals. Conclusion: it is concluded that the most important need reported by most mothers is babies’ hunger satiety. It is notorious to transfer mother comfort to baby comfort, which can configure transcendence in this aspect, i.e., comfortable newborn, comfortable mother.

Cleft lip and palate is a congenital craniofacial malformation that occurs in one out of 650 live births in Brazil, the most common being unilateral left cleft lip in males and cleft palate in females (1)(2) . It occurs due to the lack of fusion between the embryonic facial processes and the palatal processes, with multifactorial etiology and can cause difficulties in quality of life (3) .
Cleft lip and palate can bring functional disorders related to breastfeeding, however such disorder does not constitute an impediment factor for early skin-to-skin contact between mother and child (4) . In addition to the nutritional benefits of breast milk for physical growth, neuropsychological development, immune resistance and caloric intake, the bond established by breastfeeding is quite significant and desired by motherhood, and failure to breastfeed is a cause for frustration for many mothers (2,(4)(5)(6) .
In view of this, breastfeeding management in children with cleft lip and palate is a health need of people being cared for, mother, baby and family, for which nursing care should result in actions that provide their comfort (7) .
For Kolcaba, comfort is reported "as an immediate experience, strengthened by a feeling of relief, tranquility and transcendence, considering the physical, psycho-spiritual, sociocultural and environmental context" (8) . The author defines relief as "the state of having a specific need for comfort met", calm as "the state of contentment", and transcendence as "the state in which problems or pain can be overcome". Relief, calm, and transcendence constitute the first dimension of the theory, the second dimension referring to the contexts in which comfort occurs, mentioned above (7) . Therefore, for many mothers, baby satiety is considered the main comfort regardless of how the feeding happens.
It is to satisfy her will, whether with my milk or not. (MOTHER 9) However, many mothers are only completely satisfied when breastfeeding management feeding occurs, due to its importance and nutritional value. During the whole pregnancy, they were probably oriented to feed their children with breast milk because of its benefits, which results in an adequate and healthy growth.  (14) . frustration is expressed not as physical pain but as emotional pain, as they will not be able to carry out this long-awaited experience.

DISCUSSION
The birth of a baby is the beginning of a new stage in the life of a woman and her family, a stage that demands "the construction of a healthy bond between the mother and the baby" (11) , which is "established based on maternal sensitivity, because in breastfeeding, in addition to food, babies look for mothers" (11) .
It is important to note that the general guidelines for breastfeeding management are the same for mothers of a baby with cleft lip and palate (12) ; however, a more reserved place is convenient, where their intimacy can be preserved, since the specific assistance to this mother may differ from that usually provided to other mothers in rooming-in, which may attract speculation (13) .
Moreover, attention to latching on and position of a baby with cleft lip and palate during breastfeeding is fundamental to its success; "these babies should be Some mothers transcend pain during breastfeeding because they consider it a normal process to satisfy their child, highlighting a greater concern about the bond they are establishing. When puerperal women are calm and calm, their bodies release oxytocin, which favors uterine contraction, in addition to increasing the contractility of the myoepithelial cells of the breast alveoli, which promotes the ejection of breast milk and facilitates breastfeeding (11,(14)(15) .
Nurses are indispensable in this process and the interaction between professionals and users, since the nursing team has a significant role in encouraging breastfeeding, in all phases of this follow-up, such as prenatal care, lectures, groups of pregnant women and maintenance in the puerperal period (19)(20)(21)(22) .
Guidelines for mothers with cleft babies are the same as for mothers with babies without malformation; however, the type of cleft must be taken into account.
When suction is not possible, it is recommended to express breast milk and offer using utensils, often associated with a milk formula to ensure adequate weight gain (2) .
When Providing such care, breastfeeding in children with cleft lip and palate may be seen in a lighter way. However, it is necessary for nurses to fulfill their function, being accessible to this mother and promoting the indispensable comfort for her to have a satisfactory experience.
As a limitation for this study, the reduced number of participants can be considered, which can delimit a regional reality.
Advances in Nursing and Health, Londrina, v. 3, p. 01-13, 2021 The experience of mothers of babies with cleft lip and palate regarding breastfeeding unveiled in this study permeates frustration and concern about their babies' health conditions for fear that they will be malnourished due to lack of breast milk, which results in emotional pain, with breastfeeding management identified asa health need to achieve comfort.
While for some, comfort is provided through physical comfort, for others, it is accomplished by the emotional aspect of breastfeeding. It is notorious to transfer mother comfort to baby comfort, which can configure the transcendence in this aspect, i.e., comfortable newborn, comfortable CONCLUSION 1 Identify mothers' desire for breastfeeding, as their feelings and decisions must be respected.

2
Instruct the correct baby positioning technique to prevent bronchoaspiration of the milk: semi-sitting or in an upright position, facing the mother's body or lying on a flat surface, with the head tilted towards the mother's lap, while mothers lean their body about it (2,4) . 3 Guide how to position the nipple inside the cleft palate in order to obstruct it, providing the oral pressure necessary for babies to be able to perform effective sucking (2,4) .

4
Assure mothers how significant it is that they are in a comfortable and adequate position at the time of breastfeeding so that the act is not harmful to their health (11,(13)(14)(15) .

5
Guide family members about the importance of privacy during breastfeeding (13) .

7
Advise to be calm during breastfeeding, as this will also calm the child, minimizing the turbulence of the moment and ensuring newborn satiety (11,(13)(14)(15) .

8
Encourage the removal of breast milk, if suction is not possible (12,17) .

9
Guiding mothers on the importance of keeping babies at the right weight and demonstrating other ways to satisfy their hunger (12,17) .

10
Encourage the bond between mother and baby even from other means of feeding.

11
Ensure that in any doubt, mothers can count on nursing professionals, who will attend to them and will help to resolve their doubts.
breastfeeding. It is notorious to transfer mother comfort to baby comfort, which can configure the transcendence in this aspect, i.e., comfortable newborn, comfortable mother.
Thus, it was evidenced that the