Improving First-hour Breastfeeding Initiation Rate After Cesarean Deliveries: A Quality Improvement Study

ABSTRACT

Objective: To improve the rates of first hour initiation ofbreastfeeding in neonates born through cesarean section from 0to 80% over 3 months through a quality improvement (QI)process.Design: Quality improvement study.Setting: Labor Room-Operation Theatre of a tertiary carehospital.Participants: Stable newborns ?35 weeks of gestation born bycesarean section under spinal anesthesia.Procedure A team of nurses, pediatricians, obstetricians andanesthetists analyzed possible reasons for delayed initiation ofbreastfeeding by Process flow mapping and Fish bone analysis.Various change ideas were tested through sequential Plan-Do-Study-Act (PDSA) cycles.Outcome measure: Proportion of eligible babies breast fedwithin 1 hour of delivery.Results: The rate of first-hour initiation of breastfeeding increasedfrom 0% to 93% over the study period. The result was sustainedeven after the last PDSA cycle, without any additional resources.Conclusions: A QI approach was able to accomplish sustainedimprovement in first-hour breastfeeding rates in cesareandeliveries.