Breastfeeding or breastfeeding is the most appropriate nutrient for newborns. The WHO recommends exclusive breastfeeding for the first six months of life, followed by continued breastfeeding until 2 years of age and beyond, with the addition of appropriate complementary solid foods at least during the first year and beyond
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According to the 2018 Turkey Demographic and Health Survey (TDHS) conducted in Turkey, 98% of all children born are breastfed at some point during the first six months of life, and the breastfeeding rate we obtained in our study (97.7%) is consistent with this rate. According to the TDHS report, the breastfeeding rate in the first hours after birth is 71%, while the breastfeeding rate on the first day after birth is 86% 13. During the postpartum period, it is important to breastfeed the baby within the first 30 minutes after birth to stimulate the sucking reflex of the baby, initiate lactation, and normalize her breast tissue. By starting to breastfeed the baby in the early period, colostrum with a high antibody content is transferred to the baby, thus encouraging breast milk production and supporting the formation of an emotional bond between the mother and the baby 19. Bostancı et al., reported that the percentage of mothers who started breastfeeding in the first hour was 88%. In a study conducted in Hong Kong, the rate of breastfeeding within 1 hour after birth was found to be 45.5% 20-21. In another study conducted in India, only 42.6% of new mothers started breastfeeding within 1 hour after delivery 22. The different results between the studies may be due to differences in the regions where the studies were conducted.
In our study, 93.4% of the mothers breastfed within the first hour, and 95.7% breastfed within the first 24 hours. In our study group, the breastfeeding rate within the first hour after birth was greater than expected. We think that this may have been because our hospital is a baby-friendly hospital and that there was a midwife or nurse who was trained in breastfeeding and supported mothers in breastfeeding.
Only four of the mothers who participated in our study reported that breastfeeding of the baby was delayed due to routine procedures applied to the baby and the mother after delivery (such as cleaning the baby, weight measurement, vaccinations, dressing, incision site pain due to cesarean section, repair process if the mother had episiotomy at birth).
There are many factors affecting breastfeeding. There are different findings on the effects of maternal education level on breastfeeding. For example, in a study conducted in Indonesia, breastfeeding rates increased with higher education levels of mothers 23. However, In another study conducted in 81 countries, it was found that breastfeeding duration decreased with an increase in mothers’ education level 24. Moreover, in the TDHS 2018 data, it was reported that the duration of breastfeeding decreased with increasing maternal education level 13. In our study, breastfeeding rates were quite high in our hospital regardless of education level. This is because breastfeeding education is given to every newborn baby within 1 hour of birth.
In our study, it was found that the majority of mothers applied breastfeeding techniques correctly. Tiruye et al., reported that 43.4% of mothers used breastfeeding techniques appropriately. These results are in parallel with our study results 25.
Although labor is a physiological process, cesarean section may be preferred in cases where the health of the mother and fetus is endangered. However, there has been a significant increase in cesarean section rates in recent years. According to the data from the Turkey Demographic and Health Survey, the rate of cesarean section was 48% in 2013 and increased to 52% in 2018 13.
Among the mothers in our study group, 62.4% gave birth by cesarean section, and 37.6% gave birth normally. Of the mothers who had cesarean sections, 96.3% were breastfeeding. In our study, we observed that vaginal delivery or cesarean section did not affect breastfeeding. When the relationship between the mode of delivery and breastfeeding time was examined, 99.3% of mothers who had a normal delivery breastfed within the first hour, while 89.8% of mothers who had a cesarean section breastfed within the same period. In the study conducted by Arruda et al. 26, 79.3% of mothers who delivered vaginally and 69.5% of mothers who delivered by cesarean section breastfed within the first hour of life. No significant difference was found between the number of pregnancies of the mothers and their breastfeeding behaviors or breastfeeding times. Fifty-one percent of the newborns were girls, and 49% were boys. Ninety-four percent of boys and 92.8% of girls were breastfed within the first hour. No significant correlation was found between the sex of the babies and breastfeeding duration. Similarly, in our study, Arruda et al. 26 found no significant difference between the time of initiation of breastfeeding and the gender of the babies. Only 31.1% of the mothers who participated in the study said that they received information about infant feeding and breastfeeding before delivery and 90.7% of them said that they received this information from midwives/nurses. It was found that mothers who received information about breastfeeding midwives/nurses fed their babies exclusively with breast milk for longer periods 27. In our study, 39.6% of the mothers stated that they planned to breastfeed as long as their newborns suckled, and 30.3% stated that they planned to breastfeed until the age of 2 years.
According to the latest data, the mean duration of breastfeeding in Turkey was 16.7 months, consistent with our study 13.
When the mothers were examined in terms of receiving information about breastfeeding after delivery, 98.7% of them received information. We believe that the high rate of receiving information about breastfeeding is because our hospital has received a baby-friendly title. Many mothers believe that breast milk is not sufficient and apply traditional methods during the breastfeeding process, which results in inadequate nutrition for infants and many health problems 28,29. The most commonly practiced traditional practice is giving sugar water after breastfeeding and giving water after each breastfeeding; the practice of giving breast milk after waiting for three adolescents was determined to be the least common practice. In one study, approximately one-third of mothers preferred the practice of providing sweetened water or water with ground am before breastfeeding 30.
Korğalı et al., reported a rate of 0.7%, and Arabacı et al., reported a rate of 1% for the practice of not breastfeeding newborn babies until after three prayer times 31-32. In our study, almost all of the mothers who participated in the survey were aware of traditional practices, but these practices were practiced at a low rate (2.3%). The most commonly practiced traditional practice in our study was providing sugar water after breastfeeding and water after each breastfeeding, with a rate of 7.6%. According to the TDHS 2018, the percentage of pre-lacted mothers (those who received food before breastfeeding) was 42% 13. In a study conducted by Cengizhan et al., 74.4% of mothers gave sugar water after birth 33. In our study, traditional method practices were found to be quite rare compared to those in the literature.
This may be due to the predominant cultural structure in the regions where the study was conducted and the fact that our hospital is a baby-friendly hospital. Mothers must use the time they spend in the hospital effectively, provide the training they need, and support them in practice to prevent mothers from obtaining misinformation by using other sources of information, such as spouses, friends, and relatives.
In conclusion, the promotion of breastfeeding is an important tool for mothers and their babies and is critical for improving the health of the fetus, boosting the immune system, and strengthening the mother-infant bond. This support can be provided during the prenatal, intrapartum, and postnatal periods. In the prenatal period, expectant mothers should be informed about breastfeeding and provided with training to prepare them for possible difficulties. During labor and delivery, health personnel should provide support and guidance to expectant mothers on the importance of breast milk and appropriate breastfeeding techniques. In the postpartum period, mothers should be offered resources such as breastfeeding counseling and support groups to encourage successful breastfeeding. It is also important to adopt breastfeeding-friendly policies in health facilities and to ensure that staff support breastfeeding. Breastfeeding contributes greatly to the health of both mothers and infants, improving the overall health of the population. Therefore, expanding policies and resources that support breastfeeding is an important step toward a healthy future.
Disclosure: The authors declare no conflict of interest.
Compliance with Ethical Statement Conflicts of Interest: The authors have no conflicts of interest relevant to this article to disclose
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