Efficacy of nurse-led breastfeeding supportive care (B-SUCA) on breastfeeding outcomes among mother-newborn dyads in a tertiary referral hospital of India: a randomized controlled trial

TL;DR

A nurse-led intervention combining breast crawl and skin-to-skin contact improved early breastfeeding and bonding in a hospital in India.

Contribution

Demonstrates the effectiveness of nurse-led B-SUCA in improving breastfeeding outcomes in a real-world hospital setting.

Findings

The intervention group had significantly faster breastfeeding initiation and better bonding outcomes.

Exclusive breastfeeding rates were higher in the intervention group at six months.

Newborn body temperature and perinatal outcomes were statistically better in the intervention group.

Abstract

Despite efforts to promote mother‒newborn skin‒to‒skin contact (SSC) following delivery, this is seldom practiced. World Health Organization (WHO) recommends SSC at least one hour following birth. This trial determined the efficacy of nurse-led Breastfeeding Supportive Care (B-SUCA), an integrated intervention combining breast crawl with SSC for early initiation of breastfeeding outcomes, perinatal outcomes and exclusive breastfeeding (EBF).

A randomized controlled trial was conducted between 2022 and 2024 at a tertiary referral hospital in India. Approximately 160 mother-newborn dyad’s were enrolled with an allocation ratio of 50:50, with 80 individuals randomly allocated each to intervention and control groups. The intervention group received the intervention in addition to routine standard care provided by the nurse-midwives, and control group received only standard care. Breastfeeding outcomes comprised time to initiation of breastfeeding, breastfeeding behaviors, perinatal outcomes assessed postintervention in the hospital and exclusive breastfeeding from birth to six months assessed by telephonic follow-up.

The median time (in minutes) to initiation of breastfeeding was 32.5 (IQR:25.0–41.0) in the intervention and 48.5(IOR: 44.0 – 54.3) in the control group, respectively. The majority of participants reported positive attachment response (p<0.002), emotional bonding (p<0.001) and swallowing behavior (p<0.002) between the groups. All participants had spontaneous deliveries, and the uterus contracted well following birth. The median time for placental separation in the intervention group was 14.0 (IQR: 11.00 – 15.00) and the control group was 11.0 (IQR: 10.00– 12.30) respectively (p value <0.001). The Apgar scores at 0 min were 6 – 8 (both groups) and at 5 mins (7 – 10) in intervention; (7 – 9) in control group respectively. The mean newborns’ body temperature (°F ) was 98.4 °F (SD = 0.475) intervention group and 98.1 °F (SD = 0.552) control group, with a statistically significant difference (p < 0.001). Sixty-seven (84%) and fifty-six (70%) participants exclusively breastfed up to 6 months in the intervention and control group respectively.

Findings provide critical evidence that nurse-led B-SUCA intervention was effective in improving breastfeeding outcomes. Its integration into routine care can empower nurse-midwives and enhance maternal-infant outcomes.

CTRI Reg. No. is CTRI/2022/03/040974, CTRI Reg. dated 10 March 2022.

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