Improving the First-hour Breastfeeding Rate in Cesarean Deliveries: A Quality Improvement Initiative

Introduction: Breastfeeding during the golden hour after birth is crucial for establishing successful long-term breastfeeding. Despite the World Health Organization recommendation, according to the National Family Health Survey-5, the first-hour breastfeeding rate in India following cesarean delivery is only 23.9%. We aimed to improve the first-hour breastfeeding rate in stable neonates born through cesarean delivery from the baseline of 9% to 80% within a period of 4 weeks. Methods: This quality improvement initiative was conducted in Southern India during 8 months (April 2022 to November 2022) by a multidisciplinary team comprising doctors and nurses. The baseline first-hour breastfeeding rate among inborn, stable neonates of 34 weeks’ gestation or greater delivered via cesarean section was assessed during a 10-week period. The Point Of Care Quality Improvement model (POCQI_learner_manual_ver 03_2020.pdf) was used to enhance the breastfeeding rate during 4 weeks. Successful change ideas were adopted, and their sustainability was evaluated during the 22-week sustenance period. Results: Out of the 592 neonates delivered by cesarean section at a gestational age of 34 weeks or older, 418 were eligible. The average gestational age and birth weight were 38 weeks (±1.4) and 2916 g (±489), respectively. The first-hour breastfeeding rate increased from a baseline of 9.6% to 100% at the conclusion of the intervention phase, and this was maintained at greater than 90% throughout the sustainability period. Conclusions: This quality improvement initiative enhances healthcare workers’ knowledge, competence, and confidence in immediate first-hour breastfeeding within the operating theater. Further research is required to assess the potential for generalization across diverse units.