Initiation of breastfeeding among babies delivered by ceaserian Section in Kenyatta national hospital and Pumwani maternity Hospital.

Abstract

Introduction: Baby Friendly Hospital Initiative (BFHI) recommends that a newborn is breastfed within the first hour and should not be given food or drink other than breast milk unless medically indicated. Early initiation of breastfeeding increases the chances of achieving exclusive breastfeeding. Even among baby friendly hospitals, studies have shown that women who deliver through a caesarean section experience a significant delay in initiating breastfeeding compared with women giving birth vaginally. Overall, therefore, caesarean section delivery may be negatively associated with successful implementation of BFHI. It is therefore important to know the initiation of breastfeeding among mothers delivered by caesarean section so as to find out areas that may need improvement and how to improve them. Objective: To determine the time to initiation of breastfeeding and the prevalence of prelacteal feeding and type of prelacteal feeds(PLF) given to babies delivered through caesarean section in two major hospitals, Kenyatta National Hospital(KNH) and Pumwani Maternity hospital(PMH). Method; A cross sectional hospital based study was carried out in KNH and PMH using pretested structured questionnaires that were interviewer administered. Three eighty-five mothers were interviewed (192 from PMH and 193 from KNH).Consecutive sampling of mothers who had delivered through caesarean section between August 2014 and October 2014 was done in the two hospitals with the assistance of two research assistants in each hospital. Data were analysed using STATA 11.0. Results: The median age of the participants was 27 years, inter-quartile range (23-30). All the mothers interviewed were found to have had their caesarean section done under spinal anaesthesia. Two hundred and sixty one (68%) mothers were primiparous. Only 98 (25%) of the mothers had initiated VII breastfeeding within an hour. The median time to initiation of breastfeeding at KNH was 1.5 hours; inter-quartile range (1-2hours) compared to 6 hours inter-quartile range (4-9 hours) at PMH. The main reason for delay in initiation of breastfeeding was hospital factors- delays in transferring mother from theatre to the ward. There was a significant association between delayed initiation of breastfeeding and giving PLF (x2for trend p<0.0001). Thirty-four (8.9%) of mothers interviewed reported that their babies had been given prelacteal feeds. Conclusion: Only 25% of mothers had initiated breastfeeding within one hour .PLF prevalence was 8.9%.The main reason for delay in initiation of breastfeeding was hospital factors- delays in transferring mother from theatre to the ward. The delay in initiation of breastfeeding was the major risk factor for increased risk of PLF. Recommendation: Implementation of aggressive efforts to initiate breastfeeding in theatre while arrangements are being done to transfer mother and baby to the postnatal ward