title: The realization of BFHI Step 4 in Finland - Initial breastfeeding and skin-to-skin contact according to mothers and midwives.
abstract: BACKGROUND
  Breastfeeding and skin-to-skin contact are the best start for infant life. Breastfeeding ensures the best trajectory for development and growth while preventing many diseases later in life. It is recommended that initial breastfeeding occur during the first hour and that generally exclusive breastfeeding is adopted during the first six months.
  
  
  OBJECTIVE
  The aim of this study is to describe how initial breastfeeding and skin-to-skin contact (Step 4 of the BFHI) is implemented in Finnish maternity hospitals as well as to explain the factors connected to it. The information can be used to develop maternity care during the immediate postpartum period.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  The data were collected from mothers who had given birth as well as their midwives via questionnaire during the spring of 2014 during one week at eight maternity hospitals in Finland. The response rate was 59% for the new mothers (n=111), while it was 57% for the midwives (n=272). The data were analysed statistically and the open-ended questions in the questionnaire using content specifications.
  
  
  RESULTS
  On the basis of the results, initial breastfeeding succeeded well after vaginal birth. Initial breastfeeding began, on average, at 41minutes of age and lasted for 51minutes. Of mothers, 87% regarded it a very positive experience. Initial breastfeeding was delayed mainly because of caesarean section and for reasons related to an infant's condition. Many background factors such as midwives' age, mothers' parity and the mode of childbirth were statistically significant in respect to the success of initial breastfeeding.
  
  
  CONCLUSIONS
  More attention should be placed on the initial breastfeeding of infants born by caesarean section and primiparous mothers.
authors.affiliation: Northern Ostrobothnia Hospital District, Oulaskangas Hospital, Finland. Electronic address: mervi.hakala@student.oulu.fi.
authors.forename: Mervi
authors.initials: M
authors.lastname: Hakala
authors.affiliation: Research Unit of Nursing Science and Health Management, University of Oulu, Finland; Medical Research Center (MRC) Oulu, Finland.
authors.forename: Pirjo
authors.initials: P
authors.lastname: Kaakinen
authors.affiliation: Research Unit of Nursing Science and Health Management, University of Oulu, Finland; Northern Ostrobothnia Hospital District Medical Research Center, Oulu, Finland.
authors.forename: Maria
authors.initials: M
authors.lastname: Kääriäinen
authors.affiliation: Medical Informatics and Statistics Research Group, University of Oulu, Oulu, Finland.
authors.forename: Risto
authors.initials: R
authors.lastname: Bloigu
authors.affiliation: Metropolia University of Applied Sciences, Finland.
authors.forename: Leena
authors.initials: L
authors.lastname: Hannula
authors.affiliation: Medical Research Center (MRC) Oulu, Finland; Research Unit of Nursing Science and Health Management, University of Oulu and Oulu University Hospital, Finland.
authors.forename: Satu
authors.initials: S
authors.lastname: Elo
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000379:methods / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D005387:Finland; D006801:Humans; D008875:Middle Aged; D009035:Mothers / Q000523:psychology*; D009721:Nurse Midwives / Q000523:psychology*; D011795:Surveys and Questionnaires; D014110:Touch
keywords: BFHI; Infant; Initial breastfeeding; Quantitative research/questionnaires; Step 4