The Golden Hour: Early Initiation of Breastfeeding

Background: Breastfeeding in the first hour of life is recommended by the World Health Organization (WHO) and is listed as step four of the Baby-Friendly Hospital Initiative (BFHI). The United States Surgeon General has identified the steps listed in the BFHI as an approach that leads to better breastfeeding outcomes. Outdated hospital policies/protocols, lack of education for labor and delivery staff, and decreased knowledge on the World Health Organization Baby Friendly Standards are barriers to mother-child bonding and initiation of breastfeeding. The first hour of life is referred to as “The Golden Hour” and many hospitals recognize this period as a special time for bonding between parents and newborns. Through the Maternal-Child Health Nurse Leadership Academy (MCH) sponsored by Sigma Theta Tau International (STTI) and Johnson & Johnson, this scholar participated in a mentor-guided leadership program using Kouzes and Posner’s leadership practices. The triad team, consisting of a faculty mentor, leadership mentor and scholar, developed and implemented a quality improvement project using evidence-based practice to increase and improve the early initiation of breastfeeding while increasing nurse education and comfort with lactation support.

Purpose: The purpose of this project is to increase and improve the early initiation of breastfeeding while increasing nurse education and comfort with lactation support.

Methods: This project involves a cross-sectional survey of labor and delivery nurses within a midsize community hospital in Glendale, Arizona. The pre/post survey evaluates nurses’ knowledge regarding breast feeding support and internal or external barriers preventing initiation within the first hours of life. Early breastfeeding initiation rates were collected prior to staff education and will be re-evaluated at project completion. Staff education consisted of the empirical evidence supporting early initiation, patient education material and use of the Golden Hour Data sheet used by nurses at each delivery. Additional education was created for physician offices to distribute to patients.

Results: Results from the nurse survey demonstrated that 65% of nursing staff felt comfortable with assisting patients with breastfeeding. Sixty-eight percent of staff would like more education and training on latching and positioning infants. However, a sample of deliveries reviewed before implementation of the Golden hour revealed only 48% of mothers initiated breastfeeding within the first hour of life. Preliminary results (January through May) reveal 88% of mothers have initiated breastfeeding within the first hour of life. A post-assessment survey of nurses is scheduled for July 2015.

 Conclusions: Using the MCH Academy to implement a quality improvement project using evidence-based practice to increase and improve the early initiation of breastfeeding while increasing nurse education and comfort with lactation support has demonstrated promising results promoting the special bond between patients and newborns. Continued work is warranted to sustain the nursing practice change, as well as, future research evaluating patient response measuring neonatal stress and transition vital signs.