Improving the rate of Early Initiation of breastfeeding in a busy Government Hospital of Central India–A Quality Improvement Study

Abstract

Background:Early Initiation of Breastfeeding (within 1^st hour)  will improve the success with latch/suckling in first days ,timely switch from colostrum to milk production , Improved milk volume at 4 days , 4 weeks, 4 months.Delayed initiation , results in failure to breastfeed leading to faulty IYCF practices and later in life leads to Severemalnutrition. The present rates of early initiation of breastfeeding is 21 % in our setup so there is a need of Quality improvement in this subject.Objectives: To Increase the rate of early initiation of breastfeeding in normal babies (i.e, babies with birthweight> 1800 grams with no perinatal complications)  in a very busy Government Hospital from existing 21% to 60% by 30 days.Design: Quality improvement study. Setting: Labor Room, Operation Theatre and PNWs and Post-Ceaserian wards of a very busy tertiary care Government hospital.Procedure: A team of Final year Post Graduate students of Obstetrics and Gynecology, Post-Graduate student of Pediatrics, 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 babiesbreast fed within 1 hour of delivery. Results: The rate of first-hour initiation of breastfeeding increased from 21% to 36.7% over the study period. The result was sustained even after the last PDSA cycle, without any additional resources. The study did not achieve the expected goal because of following reasons

• Time given was less and needed more time for PDSA cycle.
• Need more training of team members.
• Lack of communication among team members.
• Perinatology includes the team of Obstetricians, Pediatricians and Anesthetists coordinate and complementation needed.

Conclusion:Proper communication, training, Reinforcements with Posters and Counselling may help in increasing the Early Initiation of Breastfeeding in a busy Government Hospitals.

Keywords: Quality Improvement, Breast Feeding, Plan-Do-Study-Act cycle.