Barriers to timely initiation of breastfeeding among mothers of healthy full-term babies who deliver at the University of Port Harcourt Teaching Hospital

Objectives: (1) To determine the barriers to timely initiation of breastfeeding in mothers who Hospital. (2). To determine if there is any statistical association between the time of initiation of breastfeeding and certain socio-demographic, obstetric, psychosocial and environmental factors in the mother-baby pairs. Methodological: A prospective, hospital- based study of 500 consecutive health mother- infant pairs delivered at UPTH (both vaginally and by Caesarian section). Information was obtained using a structured questionnaire, medical record review and direct observation. Early initiation, i.e. mothers who initiated breastfeeding within 30 minutes of delivery (in the case of the vaginally delivered (VD) mothers) or within 30 minutes of recovery of post- operative consciousness (in the case of those delivered by Caesarian section) were compared with those who initiated breastfeeding after 30 minutes (Late initiator) in the VD and C/S groups. The association between time of breastfeeding initiation and factors under consideration were determine using the x 2 test. Results: Approximately 34% of the VD mother initiated breastfeeding early while no mother with Caesarean section had early initiation of breastfeeding. The mean time of breastfeeding initiation was 3. 35± 2. 6 hours in mother who had vaginal delivery, 6. 50± 3. 4 hours and 5. 9± 1.9 hours in those who had Caesarean section with general or spinal anaesthesia respectively. Among those with vaginal delivery, mothers younger than 25 years and of high socio- economic class were found to practice early breastfeeding initiation. Delay in the time of repair of episiotomy and labour duration less than 12 hours were associated with early breastfeeding initiation. Early contact between baby and mother, help received on the delivery table and the presence of more than one delivery assistant also positively influenced breastfeeding initiation. Similarly, the presence of a breastfeeding- trained delivery assistant enhanced the mother' practice of early initiation of breastfeeding. Observation of routine labour ward practices such as cleaning of the newborn and weight/ length measurement had negative impact on the practice of early initiation of breastfeeding. Early contact between the mother and her newborn on the delivery table with assistance to initate breastfeeding was the most important predictor of early breastfeeding initiation. Parity, attendance at the antenatal clinic, receipt of breastfeeding information and use of analgesics during labour did not show any statistical association with time of initiation of breastfeeding. Conclusion/ Recommendation: There was a low prevalence of early initiation of breastfeeding in mothers delivered at the University of Port Harcourt Teaching Hospital. This low prevalence was due to delay in helping the newly delivered mother, especially those with Caesarean delivery. Routine labour ward practices interfere with the time of breastfeeding initiation. Routine labour ward and delivery table, specific assignment to the staff in the delivery/ labour rooms help newly delivered mothers initiate breastfeeding early, and empowering the to request for babies are recommended. Keywords: breastfeeding, initiation, barriers Nigerian Journal of Clinical Practice Vol. 9(1) 2006: 57-6