A trained Lactation management counselor visited the mothers daily in the postnatal ward and counseled them about art of breastfeeding and its advantages. Every mother, irrespective of mode of delivery, was helped by the counselor and the nursing students to initiate and sustain breastfeeding. Data acquisition was done by the counselor by interviewing the mothers. Mother and infant pairs were divided into 3 groups. Group A included those mothers who initiated breastfeeding within 1 hour, Group B initiated feeding between 1-4 hours and Group C included those beyond 4 hours.

There were a total of 1793 live singleton deliveries during this period. Among them 917 neonates were delivered by cesarean section and 876 neonates were delivered vaginally. Group A included 1169 (65.19%) neonates; among them 588 neonates were delivered by cesarean section and 581 neonates delivered vaginally. Group B consisted of 385 (21.47%) neonates. Among them 193 neonates delivered vaginally and 192 neonates by cesarean section. The reasons for delayed initiation of breastfeeding in Group B were that baby was given late to the mother (n=81, 21.0%), mother was tired (n=73, 19.0%), baby slept off (n=19, 4.9%), traditional belief (n=57, 14.8%), and mother thought milk is not coming (n=39, 10.12%). There were 239 (13.32%) neonates in Group C. Among them 137 were delivered by cesarean section and 102 were delivered vaginally. Main reasons for delayed initiation being that 197(89.94%) babies were shifted to NICU for various reasons, mother/baby slept (n=12, 5.1%) and traditional belief (n=5, 2.1%), or mother was in ICU (n=5, 2.1%).

In this study, initiation of breastfeeding within 1 hour among vaginally delivered neonates was 66.32% and by cesarean section was 64.12%. There was no significant difference between the two modes of delivery in early initiation of breastfeeding (P=0.35).

Most critical period for initiation of breastfeeding is first 1 hour after birth [1,2]. WHO has rated the percentages of breastfeeding initiation in the first hour as poor (0–29%), fair (30–49%), good (50–89%), and very good (90–100%) [3]. Early initiation of breastfeeding is good (65.56%) in this study. Often, mothers who have undergone cesarean section need extra help with breastfeeding. Otherwise, these mothers on an average initiate breastfeeding much later and terminate breastfeeding sooner [3,4]. We conclude that with the help of a trained lactation management counselor it is possible to initiate breastfeeding early even among mothers delivered by cesarean section.

1. Edmond KM,　Zandoh C,　Quigley MA,　Amenga-Etego S,　Owusu-Agyei S,　Kirkwood BR. Delayed breastfeeding initiation increases risk of neonatal mortality. Pediatrics.　2006;117:e380-6.

2. Evidence for the ten steps to successful breastfeeding. Geneva: World Health Organization;1998.

3. Infant and Young Child Feeding: A tool for assessing national practices, policies and programmes. Available from: http://whqlibdoc.who.int/publications/2003/9241562544.pdf. Accessed on 2012 October 17.