In this study we found that an unacceptably high proportion of women delayed the initiation of breastfeeding after birth. The rates of EIBF vary between and within countries ranging from 30–83% [7, 8, 20, 9, 10, 12–15, 18, 19]. Reasons for these findings also vary across contexts. More than half of the women in this cohort underwent caesarean section delivery. Several studies explain that this mode of delivery is associated with delayed initiation of breastfeeding as explained in the following paragraph. This could possibly explain the high rate of delayed initiation of breastfeeding among women in our study cohort. A considerable number of women in this study also had some form of labour difficulty. A number of infants in this study also had a health issue after birth. Health complications that arise during delivery among women and their infants also affect early initiation of breastfeeding and could have contributed to the high rate of non-EIBF in this study.
Consistent with studies done elsewhere [7, 8, 22, 23, 9, 10, 13, 14, 18–21], our study found that delivery by caesarean section increased the odds of delayed initiation of breastfeeding. Along with caesarean delivery, comes exhaustion arising from the procedure itself and the effects of anaesthesia which may impede the early initiation of breastfeeding. A caesarean section birth takes a lot of time involving the repair of surgical incisions and recovery which may contribute to late breastfeeding initiation. Also many of the infants in this study that had a health issue at birth were actually delivered by caesarean delivery. These infants are likely to have difficulty in sucking. The combination of a caesarean delivery and the baby having a health issue at birth may further contribute to the risk of late breastfeeding initiation. Mothers who had undergone caesarean section may be less likely to introduce their new born infants (who may also have difficulty sucking) to breastfeeding within the recommended one hour after birth.
We found that infants that had a health issue at birth were more likely to delay to start breastfeeding after birth. This finding is consistent with evidence found in other studies [24, 25]. These health issues included difficulty in breathing, fever, diarrhoea and the infant being too weak. Infants with health issues at birth may cause the infant to have difficulty in suckling due to weak breastfeeding reflexes, poor coordination and lack of ability to swallow. This may contribute to the delayed initiation of breastfeeding. In addition, the majority of the infants that had a health issue at birth had actually been born by caesarean delivery. This mode of delivery could have contributed to the delay in the initiation of breastfeeding as explained earlier.
Women who had received antenatal care less than 3 times while they were pregnant were less likely to initiate breastfeeding within 1 hour after birth. This association has been demonstrated in other studies [8, 12, 22, 24, 26]. During antenatal care, the benefits of EIBF are always emphasized in health education talks in MRRH. The more the antenatal care visits the women have, the more the interface they make with these health education talks. In this way, these women become more conversant with these counselling messages and are therefore more likely to support their infants in initiating breastfeeding within 1 hour after birth.
Women who had a difficult labour were more likely to delay the initiation of breastfeeding. This finding is consistent with evidence found elsewhere [8, 23, 27]. Difficult labour in our study included prolonged labour, body weakness, experiencing a lot of pain, prolonged bleeding and having received an episiotomy. Most of the women that had a difficult labour actually ended up giving birth by caesarean section. This mode of delivery could have contributed to the delay in EIBF as explained in earlier paragraphs. In addition, maternal and foetal indications for caesarean delivery and postoperative care disrupt bonding and mother-infant interaction and delay initiation of breastfeeding.
It is surprising that in our study, women who were single were more likely to practice EIBF. Other studies [13, 24] have found contrary evidence to ours. We recommend that a qualitative study can be conducted on this subject matter to best understand the occurrence of this association in our context.