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A Pioneering Effort by Both Mother and Caregiver Pays Dividend

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New milestone for feeding a new born is set at ten minutes

This blog is coauthored by Vishal Abhishek, Vivek Gupta and Vikrant Prabhakar of ACCESS Health India. They write about how the Niloufer Hospital demonstrates success through quality improvement. The Niloufer Hospital is part of the Safe Care, Saving Lives program.

Breast milk is free of cost and has an abundance of nutrients and immunity properties. It is established that a newborn should be exclusively breastfed, starting within an hour of birth and up to six months, but quoting various reasons, such as a high footfall of patients and lack of supporting structures to encourage breastfeeding, facilities do not always adhere to this best practice.

Breastfeeding advocates have been vocal about their support for breastfeeding for the nutritional and immunological advantages it provides to the newborn. Breastfeeding helps reduce the risk of infection, increases grey matter in the brain and thus contributes to Intelligence Quotient, and protects against a host of chronic ailments. Several research studies have shown that breastfeeding has long term benefits on the overall health of children. The Government of India promotes immediate and exclusive breast feeding as a recommended best practice under its reproductive maternal and child health strategy.

Breastfeeding adds to bond building between mother and baby

The advantages of breastfeeding extend beyond nutritional and immunological benefits though. It is well known that breastfeeding helps in creating a special bond between the new mother and the newborn. There is a direct correlation between the bonding between mother and baby and breastfeeding. Describing the way babies bond, Dr. Shailaja at Niloufer hospital in Hyderabad went on to elaborate about the various advantages of breastfeeding and equated it to nectar.

A newborn is expected to be given to its mother for breastfeeding within an hour of delivery; or after the delivery, the newborn is placed on the abdomen of the mother and the baby automatically finds its way to the teat of the mother. However, breastfeeding is usually delayed following a cesarean section.

Niloufer Hospital was concerned  with the number of mothers not initiating breastfeeding within an hour of delivery. They wanted to do something about it. They took this as their improvement project and decided to work on ensuring that the proportion of mothers initiating breastfeeding within one hour of delivery improved from nine percent to at least eighty percent within the next two months.

The team, comprising of Dr. Saraswati, Dr. Shailaja, Dr. Koustubha, and Sister Jhansi, decided to address the problem, receiving support from the ACCESS Health team and government recommendations and suggestions. They started with an orientation for facility staff on breastfeeding and its importance for both mother and child. This created a desire and will in the hospital staff to ensure that every baby is put to breast. They felt sure it could happen if they worked toward it.

Although the initial thoughts for ensuring breast feeding were more conventional, such as counseling the mothers, the quality team felt that “doing the same thing again and again and expecting different results is a sigh of insanity”, a thought promoted by the Safe Care, Saving Lives project. Hence, the team decided to adopt the Continuous Quality Improvement approach promoted by the Safe Care, Saving Lives project. The team also decided to run those ideas through the Plan Do Study Act cycles while ensuring that the Quality Improvement team and the nurses at the facility were not overwhelmed and felt under pressure. The Quality Improvement team wanted to make sure the nurses were involved in the journey of ensuring the welfare of the mother and the baby.

Together with the ACCESS Health team, they performed a brainstorming exercise. They mapped their delivery process and decided that the best way to initiate breast feeding within one hour was to ensure initiation of breastfeeding in the labor room itself. For their first idea, they informed the staff of the importance of breastfeeding. For the second idea, they decided to put the baby on the breast while on the labor table. They tested if a birth companion would be helpful in ensuring breastfeeding within one hour.  The staff also tried a review mechanism and regular monitoring by the head of the department of gynecology.

The attempts lead to significant results, and within three months, the proportion of feeding by mothers to their babies within one hour was ninety eight percent among audited cases in one shift. The team felt excited and confident with the success in normal deliveries in one shift and decided to extend this practice to all the normal deliveries happening in the facility. Little did a would be mother know that these efforts by the quality team would make her a trendsetter.

Those caregivers at Niloufer Hospital in Hyderabad have shown the way for many babies yet to be born. Besides all of these benefits, the most understated benefit is a healthy bond between the mother and her newborn baby.

What drives a mother to experiment with formula milk?

With changing lifestyles, nuclear families, and working mothers, there has been a change in the mindset of women towards breastfeeding. In some cases, a mother is obsessed that she is not producing enough breast milk and the baby is hungry, encouraging her to opt for formula milk. On the other hand, a mother is too busy to spend time breastfeeding. However, when the baby is on formula milk, it goes through nipple confusion. Due to the easy flow of milk from a bottle feed, a baby prefers that to breastfeeding. Owing to this phenomenon, the newborn does not put the same effort when it is breastfed again which results in reduced milk flow, which can also lead to failure in lactation among new mothers. There are various statistics on how the milk of a mother is considered the elixir of life, full of goodness and nutrition with no alternative.

An increasing number of millennials today are opting for nuclear homes and breastfeeding is becoming an important way to express love and communicate with the baby during this exclusive time. Bond between a mother and her new baby is irreplaceable.

The success is authored by Dr. Saraswati, Dr. Shailaja, Dr. Koustubha, and Sister Jhansi from Niloufer hospital, and supported by Vishal Abhishek, Dr. Vivek Gupta, Dr. Santhosh Kraleti and Dr. Tirumala of the Safe Care, Saving Lives Project.

Vishal Abhishek

Vishal Abhishek

Vishal Abhishek is part of the Quality and Process Improvement team of the Safe Care, Saving Lives program, working mainly as a quality improvement mentor in hospitals in Telangana.

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