Initiation Rate of First-hour Breastfeeding in Healthy Term and Near Term Babies: Outcome Assessment After Quality Improvement Methods in Secondary Care District Hospital

Objective: To improve the rate of first-hour breastfeeding in term and near-term healthy neonates by a quality improvement (QI) study at Secondary Care District Hospital. Design: QI study. Setting: Labor room-operation theatre of a secondary care district hospital. Participants: Stable newborns ≥35 weeks of gestation born by normal vaginal delivery and by cesarean section under spinal anesthesia. Procedure: A team of nurses, pediatricians, obstetricians, and anesthetists analyzed possible reasons for delayed initiation of breastfeeding by flow chart and Fishbone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act cycles. Outcome measure: Proportion of eligible babies breastfed within 1 hour of delivery. Results: The rate of first-hour initiation of breastfeeding increased from 69% to 88% in normal vaginal deliveries and from 17% to 61% in the cesarian section over the study period, which were sustained up to 80% in normal vaginal deliveries (NVD) and 55% in lower segment cesarean section. Conclusions: A QI approach was able to accomplish sustained improvement in first-hour breastfeeding rates in normal and cesarean deliveries.