Quality Improvement Interventions in the Delivery Room to Improve the Early Initiation of Breastfeeding in Healthy Neonates: A Tertiary Hospital-Based Study

Abstract

Background: The low-middle income countries continue to contribute to a high proportion of neonatal and child mortality globally. The reduction in mortality rates requires low-cost interventions such as early initiation of breastfeeding (EIBF). The study objective was to improve the rate of EIBF in all the healthy term newborns born in our institute from a baseline rate of 10% to at least 70% over 3 months through a quality improvement (QI) approach. Methods: This study was conducted in the labor room and operation theatre of a tertiary care center in Uttar Pradesh. All the healthy term mother-newborn pairs born in the study period were included and the Point Of Care Quality Improvement model was followed. After the baseline assessment of the problem, a QI team was formed which did the root-cause analysis and generated the change ideas to be implemented by small Plan-Do-Study-Act (PDSA) cycles initially then systematically expanded to the larger level. Outcome Measure: The effect of a PDSA cycle was measured by the percentage of newborns breastfed within the first hour of birth at the end of each cycle. Results: The EIBF improved from the baseline rate of 10% to 70.5% at the end of 5 PDSA cycles and was maintained at 70.7% during the sustainability phase. Conclusion: The QI approach can be utilized to improve EIBF, while the sustainability depends on continuous efforts like education programs, counselling, and supportive supervision. The inclusion of simulation-based training for staff can build confidence and improve results.