Lokeesan Laavanya, Martin Elizabeth, Byrne Rebecca, Miller Yvette D
Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia.
Wesley Research Institute, Auchenflower, QLD, 4066, Australia.
BMC Pregnancy Childbirth. 2025 Jan 17;25(1):37. doi: 10.1186/s12884-025-07135-9.
In Sri Lanka, there is some evidence that the likelihood of breastfeeding initiation varies by exposure to Baby-Friendly Hospital Initiative [BFHI]-compliant care and mode of birth. Globally, there is some evidence that exposure to mother-baby skin-to-skin contact (BFHI Step 4) is lower in caesarean section births. Therefore, we aimed to determine how breastfeeding initiation varies by mode of birth in Sri Lanka, and the extent to which women's exposure to BFHI practices explains any associations found.
A cross-sectional survey was conducted with women with a live baby across four government hospitals in Sri Lanka. Quantitative data were collected through participant interviews and extraction from medical records. Associations between BFHI practices, breastfeeding initiation, mode of birth, and women's characteristics were assessed using binary logistic regression analysis applied in mediation and moderated mediation models.
Women who received care compliant with Steps 4 and 6 of BFHI, regardless of their mode of birth, were more likely to initiate breastfeeding within the first hour after birth. BFHI Step 4 partially and completely mediated the effect of planned caesarean section and emergency caesarean section, respectively, on breastfeeding initiation within one hour of birth. Further, exposure to BFHI Step 6 partially mediated the effect of emergency caesarean section on breastfeeding initiation within one hour of birth. Women's age, pre-pregnancy BMI, parity status, and ethnic group significantly influenced the relationship between planned or emergency caesarean section, exposure to Step 4 or Step 6 of BFHI, and breastfeeding initiation within one hour of birth. Specifically, being primiparous strengthened the likelihood that having a planned caesarean section decreased women's exposure to BFHI Step 4; and having a pre-pregnancy BMI of 23-27.49 kg/m weakened the likelihood that planned caesarean section decreased exposure to BFHI Step 4.
Improving compliance with mother-baby skin-to-skin contact (BFHI Step 4) and no supplementation (BFHI Step 6) is critical for Sri Lankan health services to support all women to establish breastfeeding initiation within one hour of birth, as these practices attenuate the negative effect of caesarean section on breastfeeding initiation.
在斯里兰卡，有证据表明，开始母乳喂养的可能性因是否接受符合爱婴医院倡议（BFHI）的护理以及分娩方式而异。在全球范围内，有证据表明剖宫产分娩中母婴皮肤接触（BFHI第4步）的发生率较低。因此，我们旨在确定在斯里兰卡开始母乳喂养的情况如何因分娩方式而异，以及女性接受BFHI措施的程度对所发现的任何关联的解释程度。
对斯里兰卡四家政府医院中有活产婴儿的女性进行了横断面调查。通过参与者访谈和从医疗记录中提取来收集定量数据。使用二元逻辑回归分析，应用于中介和调节中介模型，评估BFHI措施、开始母乳喂养、分娩方式和女性特征之间的关联。
无论分娩方式如何，接受符合BFHI第4步和第6步护理的女性在出生后一小时内开始母乳喂养的可能性更大。BFHI第4步分别部分和完全介导了计划剖宫产和紧急剖宫产对出生后一小时内开始母乳喂养的影响。此外，接受BFHI第6步部分介导了紧急剖宫产对出生后一小时内开始母乳喂养的影响。女性的年龄、孕前体重指数、产次状况和种族显著影响计划或紧急剖宫产、接触BFHI第4步或第6步与出生后一小时内开始母乳喂养之间的关系。具体而言，初产增加了计划剖宫产降低女性接触BFHI第4步的可能性；孕前体重指数为23 - 27.49 kg/m²减弱了计划剖宫产降低接触BFHI第4步的可能性。
提高对母婴皮肤接触（BFHI第4步）和不补充喂养（BFHI第6步）的依从性对于斯里兰卡卫生服务支持所有女性在出生后一小时内开始母乳喂养至关重要，因为这些措施减弱了剖宫产对开始母乳喂养的负面影响。
