Improving First-hour Breastfeeding Initiation Rate After Cesarean Deliveries: A Quality Improvement Study.

Objective: To improve the rates of first hour initiation of breastfeeding in neonates born through cesarean section from 0 to 80% over 3 months through a quality improvement (QI) process.
Design: Quality improvement study.
Setting: Labor Room-Operation Theatre of a tertiary care hospital.
Participants: Stable newborns ≥35 weeks of gestation born by cesarean section under spinal anesthesia.
Procedure: A team of nurses, pediatricians, obstetricians and anesthetists analyzed possible reasons for delayed initiation of breastfeeding by Process flow mapping and Fish bone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act (PDSA) cycles.
Outcome Measure: Proportion of eligible babies breast fed within 1 hour of delivery.
Results: The rate of first-hour initiation of breastfeeding increased from 0% to 93% over the study period. The result was sustained even after the last PDSA cycle, without any additional resources.
Conclusion: A QI approach was able to accomplish sustained improvement in first-hour breastfeeding rates in cesarean deliveries.