University of Oulu

Mervi Hakala, Pirjo Kaakinen, Maria Kääriäinen, Risto Bloigu, Leena Hannula, Satu Elo, The realization of BFHI Step 4 in Finland – Initial breastfeeding and skin-to-skin contact according to mothers and midwives, In Midwifery, Volume 50, 2017, Pages 27-35, ISSN 0266-6138,

The realization of BFHI Step 4 in Finland : initial breastfeeding and skin-to-skin contact according to mothers and midwives

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Author: Hakala, Mervi1; Kaakinen, Pirjo2,3; Kääriäinen, Maria2,4;
Organizations: 1Northern Ostrobothnia Hospital District, Oulaskangas Hospital, Finland
2Research Unit of Nursing Science and Health Management, University of Oulu, Finland
3Medical Research Center (MRC) Oulu, Finland
4Northern Ostrobothnia Hospital District Medical Research Center, Oulu, Finland
5Medical Informatics and Statistics Research Group, University of Oulu, Oulu, Finland
6Metropolia University of Applied Sciences, Finland
7Oulu University Hospital, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.1 MB)
Persistent link:
Language: English
Published: Elsevier, 2017
Publish Date: 2018-03-22


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.

Design: 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.

Findings: On the basis of the results, initial breastfeeding succeeded well after vaginal birth. Initial breastfeeding began, on average, at 41 minutes of age and lasted for 51 minutes. 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.

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Series: Midwifery
ISSN: 0266-6138
ISSN-E: 1532-3099
ISSN-L: 0266-6138
Volume: 50
Pages: 27 - 35
DOI: 10.1016/j.midw.2017.03.010
Type of Publication: A1 Journal article – refereed
Field of Science: 316 Nursing
Copyright information: © 2017. This manuscript version is made available under the CC-BY-NC-ND 4.0 license