Breastfeeding at first hour: Individual x institutional factors

INTRODUCTION: According to step four of Baby Friendly Hospital Initiative (BFHI), the breastfeeding at first hour of life is recognizably important to promote mother-baby relationship and reduce neonatal mortality. The present study investigated the factors associated with breastfeeding at first hour in Rio de Janeiro’s maternities.

METHOD: A representative sample of mothers that delivered in maternities in Rio de Janeiro city was interviewed. Excluding newborns or mothers with restriction to breastfeeding resulted in a sample of 8397 subjects. The outcome was the breastfeeding at first hour of life. A random effects – at maternities level – binomial model was employed, in a hierarchical approach with three levels: distal, intermediary and proximal. Confidence intervals (CI) of 99% were adopted.

RESULTS: Only 16% of mothers breastfed at the first hour of life. Significant risk factors to this practice were: unnecessary practice of nursery care for newborns (OR=2,74; IC99%=2,35-3,14); neonates with intercurrences (OR=2,54; IC99%=2,22-2,85); not bring the newborn to his mother soon after delivery (OR=2,6; IC99%=2,29-2,91); cesarean section delivery (OR=3,78; IC99%=3,56-3,99); and delivery at private maternities (OR=34,94; IC99%=33,76-36,13 – compared with public maternities). One protective factor was found: mothers who do not wish to become pregnant (OR=0,81; IC99%=0,71-0,91). The maternities were responsible for 39,6% of residual variance.

CONCLUSION: At individual level, the breastfeeding within one hour of birth was prejudiced due to cesarean section delivery and by inappropriate practices in private maternities. Those practices should be reviewed to improve step 4 of BFHI in maternities, principally at private maternities. Poor mothers, with more children – represented by those mothers who do not wish to become pregnant – had breastfed more at first hour, probably due to their previous experience. A high cluster effects  at maternity level indicates that mothers have little autonomy to breastfeeding their babies at first hour.