title: Factors associated with breastfeeding in the first hour of life.
abstract: OBJECTIVE
  To identify factors associated with breastfeeding in the first hour of life (Step 4 of the Baby-Friendly Hospital Initiative).
  
  
  METHODS
  A cross-sectional study was conducted with a representative sample of mothers who gave birth in maternity wards in the city of Rio de Janeiro, Southeastern Brazil, between 1999 and 2001. Newborns or mothers with restriction to breastfeeding were excluded, resulting in a sample of 8,397 pairs. A random effect--at maternity hospital level--Poisson model was employed in a hierarchical approach with three levels: distal, intermediate and proximal for characteristics of the mother, of the newborn, and of prenatal and hospital assistance.
  
  
  RESULTS
  Only 16% of the mothers breastfed in the first hour of life. Breastfeeding in this period was less prevalent among neonates with immediate intercurrences after birth (PR = 0.47; CI99% 0.15;0.80); among mothers who did not have contact with their newborns in the delivery room (PR = 0.62; CI99% 0.29;0.95); among mothers submitted to cesarean section delivery (PR = 0.48; CI99% 0.24;0.72); and among mothers who gave birth at private maternity hospitals (PR = 0.06; CI99% 0.01;0.19) or at maternity hospitals contracted out to National Health System (SUS) (PR = 0.16; CI99% 0.01;0.30). The context effect of maternity wards was statistically significant.
  
  
  CONCLUSIONS
  At an individual level, breastfeeding within one hour after birth was constrained by inappropriate practices in private or SUS-contracted maternity hospitals. The group effect of maternity hospitals and the absence of individual maternal-related factors that explain the outcome suggest that mothers have little or no autonomy to breastfeed their babies within the first hour of life, and depend on the institutional practices that prevail at the maternity hospitals.
authors.affiliation: Programa de Pós-Graduação em Epidemiologia em Saúde Pública, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil. cristianoboccolini@yahoo.com.br
authors.forename: Cristiano Siqueira
authors.initials: CS
authors.lastname: Boccolini
authors.forename: Márcia Lazaro de
authors.initials: ML
authors.lastname: Carvalho
authors.forename: Maria Inês Couto de
authors.initials: MI
authors.lastname: Oliveira
authors.forename: Ana Glória Godoi
authors.initials: AG
authors.lastname: Vasconcellos
mesh_terms: D000328:Adult; D000367:Age Factors; D001942:Breast Feeding / Q000706:statistics & numerical data*; D004812:Epidemiologic Methods; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods / Q000592:standards*; D006771:Hospitals, Maternity / Q000592:standards; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009035:Mothers / Q000706:statistics & numerical data; D018743:Perinatal Care / Q000592:standards; D011247:Pregnancy; D012307:Risk Factors; D013997:Time Factors; D014944:World Health Organization; D055815:Young Adult