Abstract / Summary
The WHO recommends breastfeeding within the first hour of delivery to prevent neonatal mortality and provide babies with colostrum. However, a significant proportion of mothers who deliver by cesarean section do not initiate breastfeeding in a timely manner. This study aimed to determine the prevalence and correlates of timely initiation of breastfeeding (TIBF) among post-cesarean mothers at Kawempe National Referral Hospital (KNRH), Uganda’s National Women and Children’s Referral Hospital. A cross-sectional, convergent mixed-methods study was conducted among 385 post-cesarean mothers. TIBF was defined as introduction of breastfeeding within the first hour of delivery. Eleven qualitative interviews, comprising four key informant (KIIs) and seven in-depth interviews (IDIs), were also conducted to understand experiences that influenced maternal attitudes towards TIBF following a cesarean section delivery. Multivariable modified Poisson regression analysis generated adjusted prevalence ratios (APRs). Significance was set at p < 0.05. Deductive and inductive thematic analysis approaches were used to triangulate the qualitative findings from the KIIs and IDIs. Interpretation of the results was presented in the discussion and included triangulation of the quantitative and qualitative findings for comprehensive and better contextual understanding of findings. The prevalence of TIBF among post-cesarean mothers was 33.5%. The determinants of TIBF included child birthweight of ≥ 2.5 kg (APR = 1.86[1.07–3.23]), no baby-mother separation (APR = 1.55[1.16–2.01]), no prenatal breastfeeding counselling (APR = 0.75[0.57–0.98]), emergency cesarean section (APR = 0.75[0.58–0.99]), no health worker support (APR = 0.72[0.55–0.95]), and no maternal knowledge on the benefits of TIBF (APR = 0.27[0.09–0.80]). Health worker guidance, family support, early skin-to-skin contact and rooming-in promoted positive maternal attitudes towards TIBF while post-operative pain, fear of inadequate milk production, pre-lacteal feeding negatively influenced mothers’ attitudes and delayed initiation of breastfeeding. The prevalence of TIBF among mothers who delivered by cesarean section at KNRH was sub-optimal. Low birth weight, emergency cesarean sections, baby-mother separation, lack of health worker breastfeeding support and prenatal breastfeeding counselling, and limited maternal knowledge on the benefits of TIBF were associated with low TIBF practice. Integrating breastfeeding messages in prenatal and antenatal health education, adequate post-operative and health worker breastfeeding support, and re-enforcing baby-friendly hospital initiatives could improve TIBF practice among mothers who deliver by cesarean section.