Challenges of exclusive breast feeding for new born, a problem-solving approach to improve percentage during hospital stay: A quality improvement perspective

Abstract

Exclusive breast feeding for six months is the intended target for every newborn, but even after decades of efforts by WHO, UNICEF, UN, it still stands at 44% globally. Ground reality was no different in our set up. NICU admission was the major reason. But heathy newborn roomed in with mother were also found to be not exclusively breast fed. Individualized reasons always cropped up for giving formula milk and situation was not changing in spite of exclusive breast-feeding policy in place. Task was taken up with a quality improvement perspective. Magnitude of problem was studied, Root cause analysis done. Two reasons were found, issue of non protactile /retracted nipples in mother creating a latching issue. Late interference or unsuccessful interference resulted in formula feeds to baby. Other was complain of non production of milk/colostrum in early postpartum period by mother. Three interventions were adopted, i.e., nipple examination by pediatric team in labor room, 20 cc inverted syringe pump at outset, traditional nutrition supplement of galactogogues addressing three different issues. As a result, we were able to improve our exclusive breast-feeding rates during hospital stay of newborn from 66 % to 100 % when both baby and mothers’ condition was considered. When only infants’ heath was considered as prerequisite it improved to 95%. We concluded that simple process of reassignment of job, anticipation and redecided remedial measures as standard operating procedure, led to quick rise in exclusive breast-feeding rates in our setup and they may be easily adopted at other places also.