Improvement of the first-hour breastfeeding rate following vaginal delivery: A point-of-care quality improvement study from the North Bastar Region of India.

Abstract

Background

Early initiation of breastfeeding (EIBF) within one hour of birth reduces neonatal morbidity and mortality, promotes bonding and supports exclusive breastfeeding, yet coverage after normal vaginal delivery remains suboptimal in many Indian public hospitals.

Objectives: To increase the EIBF rate after uncomplicated vaginal births in the labour room from 20% to 80% over six months using standard quality-improvement methods.

Methods

A point-of-care quality-improvement (POCQI) study from October 2022 to April 2023 in a tertiary-care teaching hospital. Root-cause analysis using fish-bone diagrams and process mapping identified gaps in staff awareness, role clarity, and documentation. A one-month baseline phase (October 2022) was followed by four Plan–Do–Study–Act (PDSA) cycles from November 2022 to February 2023 and a two-month sustenance phase (March–April 2023). Key change ideas were structured counselling of mothers during antenatal and intrapartum periods, initiation of EIBF in the labour room itself, clear assignment of responsibilities to staff on each shift, and creation of a monitoring, feedback, and reporting system.

Results

Overall, 483 eligible term mother–baby dyads with uncomplicated vaginal deliveries from a tertiary-care teaching hospital in the tribal North Bastar region were included. Baseline EIBF prevalence was 20%. After successive PDSA cycles, EIBF increased to 35%, 78%, 84% and 89%. During the sustenance phase, EIBF exceeded 90%, reaching 96% and 98% in the two subsequent months, indicating the effectiveness and stability of the intervention package.

Conclusion

Implementation of a structured QI approach, with active participation of nurses, obstetricians, paediatricians, and hospital managers, substantially improved EIBF rates and maintained high performance in a tertiary-care setting.

Recommendations

Similar low-cost POCQI interventions should be integrated into routine labour-room practice, supported by institutional policies, staff training, real-time data review, and periodic audits to ensure sustained high EIBF coverage and adaptation to other delivery settings.