Learnings from a quality improvement study for breastfeeding initiation within one hour of delivery during the past COVID-19 pandemic

Background: Breastfeeding initiation (BFI) within 1 h of delivery is a preventive strategy to decrease neonatal mortality, which was compromised during the COVID-19 pandemic. Objective: To implement BFI within 1 h of birth in all healthy neonates during the COVID-19 pandemic through multiple Plan-Do-Study-Act (PDSA) cycles over 2 months. Methodology: All neonates with gestation age ≥35 weeks delivered through vaginal delivery (VD) or cesarean section (CS) from asymptomatic mothers were enrolled and BFI within 1 h of delivery was observed. Quality improvement (QI) team assessed the BFI rates in the baseline period and barriers for it were analyzed with fishbone diagram. Various strategies were implemented through four PDSA cycles and continuation of the practice was monitored in the sustenance phase. Results: The demographic characteristics of mother-neonate dyads of 18 in baseline period and 130 in implementation phase were comparable. With the implementation of four PDSA cycles, BFI rates increased from 0% to 90% in CS and 8.3% to 95.2% in VD. The average (median) mean time of initiation decreased from 120 to 29.5 min in CS and 90–26.4 min in VD. During the sustenance phase, breastfeeding rates were 94.7% in CS deliveries and 95.8% in VD, with the timing of initiation being 26.7 minutes and 25.2 minutes, respectively. Conclusion: With QI initiative, BFI within 1 h of life could be successfully achieved at highest level in VD and CS during the COVID-19 pandemic and the strategies adopted might be helpful in future for similar public health crises.