Early initiation of breastfeeding refers to provision of mother’s breastmilk to infants within one hour of birth. This is an evidence-based high-impact intervention for improving neonatal survival, and for establishing breastfeeding over the long-term. According to World Health Organization, early and uninterrupted skin-to-skin contact between mothers and infants should be facilitated and all mothers should be supported to initiate breastfeeding as soon as possible after birth, within the first hour after delivery. Despite these established guidelines and benefits of early initiations of breastfeeding, only 41.6% of neonates in India are breastfed within one hour of birth [1]. Despite 80% of the deliveries are institutional, early initiation of breastfeeding is suboptimal in the country [2].

In resource-restricted settings with high delivery rates, the reasons for suboptimal early initiation practices include lack of manpower (dedicated lactation counsellors and staff nurses) and delay in procedures like episiotomy suturing and ward transfers. Ours is a tertiary care teaching Institute in Southern India with 1500 to 1600 intramural deliveries per month. The rate of early initiation of breastfeeding in this center was only 33% as observed in a previous study [3]. In this context, Bonding Angel Program was initiated in September 2018 to improve early initiations of feeding. All stakeholders, including Departments of Neonatology, Obstetrics and Gynecology and Nursing College, were involved. Among the nursing students posted in labor room, one female nursing student was designated as the dedicated Bonding Angel for the day, and an identifying badge was provided to her. It was her responsibility to bring the mother and baby together soon after delivery, and help them to initiate breastfeeding at the earliest. She would also ensure correct position and attachment during breastfeeding. This has the potential to prevent hypoglycemia in newborn, facilitate good uterine contraction in the mother and ensure bonding between mother and the baby. All the Bonding Angels received appreciation certificates at the end of their labor room posting. The impact of this quality initiative on early initiation of breastfeeding is yet to be quantified. National Health Mission has also incorporated early initiation of breastfeeding in Laqshya – Labor room quality improvement initiative [4].

1. National Family Health Survey - 4. 2017. Available from: http://rchiips.org/nfhs/pdf/NFHS4/India.pdf. Accessed March 3, 2019.

2. Dudeja S, Sikka P, Jain K, Suri V, Kumar P. Improving first-hour breastfeeding initiation rate after cesarean deliveries: A quality improvement study. Indian Pediatr. 2018;55:761-4.

3. Adhisivam B, Vishnu Bhat B, Poorna R, Thulasingam M, Pournami F, Joy R. Postnatal counseling on exclusive breastfeeding using video - experience from a tertiary care teaching hospital, South India. J Matern Fetal Neonatal Med. 2017;30:834-8.