First Hour Initiation of Breastfeeding and Exclusive Breastfeeding at Six Weeks: Prevalence and Predictors in a Tertiary Care Setting

Abstract

Objective

To assess the prevalence of first hour breastfeeding initiation and exclusive breastfeeding at 6 wk and identify its barriers in healthy term babies born in a tertiary hospital setting.

Methods

A prospective observational cohort study was carried out in consecutively selected 400 mothers who delivered (normal, instrumental or cesarean) term healthy babies in a tertiary care hospital setting. All mother-infant dyads were enroled within 48 h of delivery.

Results

Breastfeeding was initiated within first hour in 255 out of 400, i.e., 64 % of babies. Cesarean delivery and male gender were strongest risk factors for delayed initiation of breastfeeding [OR (95 % CI) = 1.99 (1.14–3.48) and 34.17 (17.10–70.40) respectively]. Among the babies followed up till 6–8 wk, 83 % were exclusively breastfed. Breast milk substitutes were given in 172/400 (43 %) babies on day one, which emerged as an independent predictor of failure to continue exclusive breastfeeding at 6 wk (OR 2.96; 95 % CI 1.09–8.06). Odds of exclusive breastfeeding were two times higher in babies breastfed within first hour (n = 255/400, 64 %) when compared to babies initiated breastfeeds beyond first hour (n = 145/400, 36 %) (OR 2.01;05 % CI 1.12–3.61).

Conclusions

Cesarean section and male gender emerged as significant risk factors for delayed initiation (beyond first hour) of breastfeeding in the index study cohort. In addition, use of breast milk substitute emerged as the only predictor for failure to continue exclusive breastfeeding at six weeks in a tertiary care hospital.

Appendices

Appendix A: Questionnaire and Tool Performa

• 1. Serial no:

• 2. Date and time of interview:

  Baseline demographic data:

• 3. Mother’s CR No:

• 4. Gravidity:

• 5. Parity:

• 6. Baby’s CR No:

• 7. Sex :

• 8. Birth Order :

• 9. Number of siblings :

• 10. Date and Time of delivery:

• 11. Parent’s name

  Father:

  Mother:

• 12. Parent’s Age:

  Father:

  Mother:

• 13. Educational Status:

  (Illiterate/<10th/10th or 10+2/Graduate/Post Graduate)

  Father:

  Mother:

• 14. Occupation:

  Father:

  Mother:

• 15. Religion:

  Father:

  Mother:

• 16. Caste:

  Father:

  Mother:

• 17. Annual income of family:

  Father:

  Mother:

• 18. Socioeconomic status score:

• 19. Residential address :

• 20. Living environment: (Urban/Rural)

• 21. Phone Number:

  Other Details:

• 22. Booked/Unbooked:

• 23. Supervised/Unsupervised:

• 24. Birth Weight:

• 25. Gestation:

• 26. Reason for Referral to PGI:

• 27. Type of delivery (NVD/LSCS/Instrumental):

• 28. Date and time of Rooming in:

• 29. Whether received breastfeed within first hour or not:

• 30. Any illness in baby on day 1 :

• 31. Prelacteal feeds given/not:

• 32. Breast milk substitute given/not:

• 33. Any problem related to breastfeeding:

  Nipple retraction/Nipple soreness/Too little milk/Breast refusal/Breast engorgement

• 34. Any creams or ointments applied to nipple:

• 35. Father’s attitude (Positive/Negative)

• 36. Mother’s attitude (score=)

• 37. Paternal Grandmother’s attitude (Positive/Negative)

• 38. Aware of importance of colostrum/not:

• 39. Previous baby breastfed/not:

• 40. If yes, how long:

• 41. Received antenatal counseling from obstetrician/gynaecologist or not:

• 42. Received postnatal counseling from pediatrician or not:

• 43. Received postnatal counseling from nursing staff or not:

• 44. Received counseling from breastfeeding instructor or not:

• 45. Interval without sleep before delivery

• 46. Duration of labour Stage 1: Stage2:

• 47. Obstetric problems in mother:

• 48. Medical problems in mother:

• 49. Maternal drugs:

• 50. Latch Score:

  • a) Latch

  • b) Audible swallowing

  • c) Type of nipple

  • d) Comfort

  • e) Hold

  Total score =

  AT 6–8 weeks

• 1. Exclusively breastfed or not:

• 2. If not, when stopped:

• 3. Substitutes/Supplements given:

• 4. Type of feeding:

  (Predominantly breastfed/Complementary feeding/Bottle feeds)

• 5. Reason as per mother:

• 6. Any illness in baby (When? How long?)

• 7. Any illness in mother (When?)

• 8. Any problem related to breastfeeding:

  Nipple retraction/Nipple soreness/Too little milk/Breast refusal/Breast engorgement

• 9. Any help sought from PGI lactation team for breastfeeding (After discharge):

THANK YOU

Appendix B: LATCH scoring system

	0	1	2
L: Latch	Too sleepy or reluctant. No latch achieved	Repeated attempts, holds nipple in mouth, Stimulates suck	Grasps breast, tongue down, lips flanged, Rythmic sucking
A: Audible swallowing	None	A few with stimulation	Spontaneous and intermittent (<24 h), Spontaneous and frequent (>24 h)
T: Type of nipple	Inverted	Flat	Everted (after stimulation)
C: Comfort (Breast/Nipple)	Engorged, cracked/bleeding/large blisters or bruises, severe discomfort	Filling, reddened/small blisters or bruises, mild/moderate discomfort	Soft, non tender
H: Hold (Positioning)	Full assist (staff holds infant at breast)	Minimal assist. Teach one side, mother does other. Staff holds and mother takes over.	No assist from staff. Mother able to position or hold infant.

Appendix C: Infant feeding practices

Feeding practice	Requires that the infant receive	Allows the infant to receive	Does not allow the infant to receive
Exclusive breastfeeding	Breast milk (including milk expressed or from wet nurse)	ORS drops, syrups (vitamins, minerals, medicines)	Anything else
Predominant Breastfeeding	Breast milk (including milk expressed or from wet nurse) as the predominant source of nourishment	Certain liquids (water and water based drinks, fruit juice), ritual fluids and ORS, drops or syrups (vitamins, minerals, medicine)	Anything else (in particular non human milk, food based fluids)
Complementary feeding	Breast milk (including milk expressed or from wet nurse) and solid or semisolid foods	Anything else; any food or liquid including non human milk or formula	NA
Bottle feeding	Any liquid (including breast milk) or semi solid food from a bottle with nipple or teat	Anything else; any food or liquid including non human milk or formula	NA

1. Jensen D, Wallace S, Kelsay P. LATCH: A breastfeeding charting system and documentation tool. JOGNN. 1994;23:27–32