Published: 2020-01-23

A quality improvement study on breastfeeding initiation rate within 1 hour of life in inborn neonates in a tertiary care centre

C. Renuka Devi, Nalini A., N. S. Raghupathy


Background: Breastfeeding is a well-established key of success to improve the outcome in neonates. Early initiation of breastfeeding in neonates refers to the provision of mother’s milk to their own babies as early as possible after delivery. Despite the established benefits of breastfeeding, early initiation of breastfeeding is found to be suboptimal in our country. Early initiation of breastfeeding has many challenges like no bedding in, availability of lactation counsellors and staff nurses, procedural delay (episiotomy, skin suture) and shifting from the recovery room. Objective of the study was to improve the rate of initiation of breastfeeding stable term and preterm neonates within 1 hour of life in both normal vaginal delivery and caesarean section conducted in our hospital from baseline to 95% over 3 months period by Quality improvement approach.

Methods: Eligible inborn mother-infant dyads were enrolled in this study. A team formed, baseline data and rate of early initiation of breastfeeding collected and factors for delayed initiation analysed by Flowchart process, Fishbone analysis and 5 why’s, 3 PDSA cycles were done.

Results: Total 50 mother-infant dyads assessed. Rate of early initiation of breastfeeding within 1 hour of life increased from 25% to 100% over 3 months.

Conclusions: This quality improvement study was able to accomplish sustained improvement in the rate of breastfeeding the neonates in the first hour of life.


Breastfeeding, Early initiation, Neonates, Plan-do-study-act cycle, Quality improvement

Full Text:



WHO. Early initiation of breastfeeding. Available at: Https://Www.Who.Int/Elena/Titles/Commentary/Early_Breastfeeding/En/. Accessed 9 December 2019.

Khan J, Vesel L, Bahl R, Martines JC. Timing of breastfeeding initiation and exclusivity of breastfeeding during the first month of life: effects on neonatal mortality and morbidity--a systematic review and meta-analysis. Matern Child Health J. 2015 Mar;19(3):468-79.

Edmond K, Newton S, Hurt L, Shannon C, Kirkwood B, Mazumder S, et al. Timing of initiation, patterns of breastfeeding, and infant survival: prospective analysis of pooled data from three randomised trials. Lancet Glob Health. 2016 Jan 1;4.

WHO. Planning guide for national implementation of the Global strategy for infant and young child feeding. Available at: Accessed 9 December 2019.

Breastfeeding | Nutrition | UNICEF. Available at: Accessed 9 December 2019.

National Family Health Survey. Available at: Accessed 9 December 2019.

Rowe-Murray HJ, Fisher JRW. Baby friendly hospital practices: cesarean section is a persistent barrier to early initiation of breastfeeding. Birth Berkeley Calif. 2002 Jun;29(2):124-31.

Mikiel-Kostyra K, Mazur J, Wojdan-Godek E. Factors affecting exclusive breastfeeding in Poland: cross-sectional survey of population-based samples. Soz Praventivmed. 2005;50(1):52-9.

Hobbs AJ, Mannion CA, McDonald SW, Brockway M, Tough SC. The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum. BMC Pregnancy Childbirth. 2016 Dec;16(1):90.

Tawiah-Agyemang C, Kirkwood BR, Edmond K, Bazzano A, Hill Z. Early initiation of breast-feeding in Ghana: barriers and facilitators. J Perinatol Off J Calif Perinat Assoc. 2008 Dec;28 Suppl 2:S46-52.

Bhandari S, Thorne-Lyman AL, Shrestha B, Neupane S, Nonyane BAS, Manohar S, et al. Determinants of infant breastfeeding practices in Nepal: a national study. Int Breastfeed J. 2019 Apr 3;14(1):14.

Sharma S, Sharma C, Kumar D. Improving the Breastfeeding Practices in Healthy Neonates During Hospital Stay Using Quality Improvement Methodology. Indian Pediatr. 2018 Sep 1;55(9):757-60.

Dudeja S, Sikka P, Jain K, Suri V, Kumar P. Improving First-hour Breastfeeding Initiation Rate After Cesarean Deliveries: A Quality Improvement Study. Indian Pediatr. 2018 Sep 1;55(9):761-4.