A Quality Improvement Initiative: Improving First-hour Breastfeeding Initiation Rate among Healthy Newborns

INTRODUCTION: “No matter where a newborn takes his or her first breath, the desire to give that baby the best start in life is universal.” The best gift a mother can give her baby is the gift of health. The gift of health can be given to the baby through early and adequate breastfeeding. Globally, only 2 out of 5 newborns are put to the breast within the first hour of life. Therefore, initiating breastfeeding is an evidence-based intervention for improving neonatal survival. METHODS: We aimed to improve the first-hour breastfeeding initiation rate from the existing 12%–80% over 3 months through a quality improvement (QI) process. The setting was antenatal, perinatal, and postnatal wards of the Maharishi Markandeshwar Institute of Medical Sciences And Research Hospital. The participants were postpartum mothers with stable newborns 35 weeks and older of gestation born by normal vaginal delivery. PROCEDURE FOR QI: A team of nurses and obstetricians was formed; we analyzed possible reasons for delayed initiation of breastfeeding by process cycle matrix chart and Fishbone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act cycles. The outcome measure is the proportion of eligible babies breastfed within 1 hour of delivery. RESULTS: After 3 months, the first-hour initiation of breastfeeding increased from 12% to 80%, without additional resources. CONCLUSIONS: A QI approach achieved an improvement in first-hour breastfeeding rates after normal vaginal delivery.