Feeding of a baby soon after the birth is a natural phenomenon; however, many of the mothers are unable to do so due to certain circumstances. It is well known that breastfeeding is the best source of nutrition for infants, as it provides all the essential nutrients required for their growth and development. Unfortunately, some mothers are still unaware of the benefits of breastfeeding. According to the UNICEF Levels and Trends in Child Mortality Report (2023), approximately 2.6 million infants die within the first 28 days of life worldwide, with around 7,000 newborn deaths occurring every day. In India, as reported by the National Family Health Survey (NFHS-5, 2019–21) and the Sample Registration System (2020), the neonatal mortality rate is 25.4 deaths per 1,000 live births nationally, 10 per 1,000 in Kerala and Goa, and 44 per 1,000 in Uttarakhand. If a woman breastfeeds her baby within the first hour of life, it can significantly reduce the risk of infections in the newborn. Studies have shown that breastfed babies experience fewer infections and hospitalizations than formula-fed infants. During breastfeeding, antibodies and other germ-fighting factors are transferred from the mother to the baby, thereby strengthening the infant’s immune system and lowering the risk of various infections. Several studies have demonstrated that breastfed infants have fewer infections, lower hospitalization rates, and better immune responses compared to formula-fed infants. During breastfeeding, essential antibodies, immunoglobulins, and other protective bioactive factors are transferred from the mother to the infant, strengthening the newborn’s immune system. This transfer of maternal immunity helps protect the baby from respiratory infections, diarrheal diseases, ear infections, and other common neonatal illnesses. A study conducted by Tiwari V. reported that the breast crawl technique helps newborns achieve feeding skills more quickly and effectively, and also plays a significant role in preventing hypothermia by maintaining body warmth through continuous skin-to-skin contact. Similarly, research by Linthoi K. found that newborns who experienced the breast crawl established breastfeeding earlier than those who were conventionally assisted. These findings strongly support the inclusion of the breast crawl in routine delivery room protocols, as it promotes early and successful breastfeeding initiation, enhances neonatal physiological stability, and strengthens maternal-infant bonding.

A quasi-experimental, two-group post-test only research design was adopted to determine the effectiveness of the breast crawl on the bio-physiological parameters of neonates and breastfeeding outcomes. The study was conducted in the labor room of a selected hospital in Uttarakhand. Ethical approval was obtained from the Institutional Ethics Committee, and written informed consent was secured from each participant prior to data collection. Participants were assured of anonymity and confidentiality throughout the study. A total of sixty-two mothers with their neonates were enrolled using a purposive sampling technique, with 32 participants in the experimental group and 30 in the control group. Participants were screened according to inclusion criteria and were considered eligible if they were expected to have a spontaneous vaginal delivery, had no pre-existing medical illness, and experienced no complications during labor. Only neonates with an Apgar score of 7 or above were included in the study.No randomization was performed. Initially, thirty eligible mothers were enrolled in the control group, who received routine care provided by the labor room nurses. One hour after delivery, the bio-physiological parameters of the neonates heart rate, SpO₂, temperature, and weight were measured using selected instruments. In the experimental group, the breast crawl was implemented as an intervention immediately after delivery. Newborns who cried immediately after birth and had an Apgar score of 7 or above were placed in a prone position on their mother’s abdomen. The infants were gently dried with a soft cotton cloth, leaving the hands and feet unwashed to preserve the natural odor that guides them to the breast. Both the mother’s chest and the baby’s body were kept bare to allow direct skin-to-skin contact. The pair was then covered with a cloth to maintain warmth and prevent hypothermia during the intervention.

The newborns were observed for their natural responses and allowed to crawl toward the breast to initiate their first feed with minimal assistance. This process typically took 45 to 60 minutes, during which the babies reached the breast and consumed the highly nutritious colostrum. One hour after delivery, the bio-physiological parameters of the neonates were again measured using the same instruments in the labor room. Breastfeeding outcomes were subsequently assessed using the LATCH Breastfeeding Assessment Tool.

Analysis and Interpretation

Table no. 1: Frequency and Percentage distribution and Homogeneity test of Socio-demographic variables of mothers                                                                                                                                                          [ n=62]

       df₁= 3.84 at p< 0.05 level of significance

     The above table shows the groups are homogeneous in terms of age, educational status, occupation, type of family,

     family income and place of residence with p>0.05

Table no. 1.2: Frequency and Percentage distribution and homogeneity test of mothers clinical data                                                                                                                                                                                    [n=62]

   df₁= 3.84 at p< 0.05 level of significance   * significant

The above table shows that both the groups are homogenous in terms of gravida, gestational age,  history of illness, history of medication at p>0.5  except expulsion of placenta p< 0.001.

Table no. 1.3: Frequency and Percentage distribution and test of homogeneity of selected birth related data of neonates                                                                                                                                                             [n=62]

     df₁= 3.84 at p< 0.05 level of significance * significant

The above table shows majority of the neonates were male with birth weight of 2.5-3.0 Kg, APGAR score shows majority of the baby 81.3% in experimental group were scored a range of 9-10 whereas 96.7% in control group were 7-8. Homogeneity test was done and found that there was no significant difference found in  gender, birth weight at p>0.05 except Apgar score with p< 0.001.

Table No. 2.1 Comparison of Biophysiological parameters in terms of Weight, Heartrate, Spo2 and Temperature of neonates in both groups.                                                                                                          [n=62]

       p<0.05 level of significance **highly significant

The above table shows that mean and SD of weight of the neonates on third day was 2.92± .348 in experimental and 2.89±.240 in control group. Similarly, the mean heart rate was 139.0±8.28 in experimental group and 124.0±11.0 in control group. Mean SPO2 was 96.06±1.69 in experimental group and 95.9±1.09 in control group and the mean temperature was 98.0±0.51 in experimental group and 97.2 ±0.71 in control group. The ‘t’ test computed and established no significant difference in weights of neonates in both the groups but significant difference found in heart rates, SPO₂, temperature of neonates. Thus, it was concluded that breast crawl was effective in the stability of the heart rate, Spo2 and temperature maintenance of neonates.

Table No. 3.1 Comparison of LATCH breast-feeding Score of third day in experimental and control group.

                                                                                                                                                                          [n=62]

       Min score: 0 and Max score: 10 t₆₁= 2.00 at 0.05 level of significance **highly significant

The above table shows the mean and SD LATCH Score was 8.47±0.50 in control group whereas 9.69±0.47 in experimental group. The obtained ‘t’ value was 9.42 at p <0.0001. The ‘t’ test revealed that there was significant difference between breastfeeding outcomes in both groups. So, the breast crawl was effective in improving breast feeding outcomes.

Table no. 3.2 Frequency and Percentage distribution of Passage of urine & stool frequency of neonates for 3 days                                                                    

                                                                                                                                                                   [n=62]

The above table shows there was no single neonates passed urine 5-8 times a day in control group whereas 34.4% neonates in experimental group passed urine 5-8 times on the very first day itself. On the second day 24.1% in control and 43.8 % in experimental group of neonates passed urine 5-8 times a day. On the third day 26.7% in non-intervention and 81.3 % in intervention group of neonates passed urine 5-8 times a day. Simultaneously there was 12.5 % neonates passed stool 5-8 times a day in intervention group but no single neonates in other group on the very first day. On the second day more neonates passed stools 5-8 times a day 31.3 % in experimental group of neonates passed stools 10 % in control and. On the third day 16.7% in control and 62.5 % in experimental group of neonates passed stools 5-8 times a day.

The present study demonstrated that neonates in the experimental group exhibited greater stability in heart rate, SpO₂, and body temperature compared to those in the control group, although no significant difference was observed in neonatal weight between the two groups. These findings align with the study by Mulupuru S. et al. (2019), which reported that the breast crawl positively influences newborn weight. Similarly, Thomas S., Mohanty N., and Dasila P.K. (2018) found a statistically significant difference in initial weight loss by the third day postpartum in neonates who experienced early initiation of breastfeeding.

In the current study, the mean ± SD of neonatal temperature in the experimental group was 98.0 ± 0.51°F, compared to 97.2 ± 0.71°F in the control group on the third day after birth. Mean ± SD values for weight were 2.92 ± 0.34 kg in the experimental group and 2.89 ± 0.24 kg in the control group. Heart rate averaged 139.0 ± 8.28 bpm in the experimental group versus 124.0 ± 11.0 bpm in the control group, and SpO₂ levels were 96.06 ± 1.69% and 95.9 ± 1.09%, respectively. These results indicate that the bio-physiological parameters of neonates in the experimental group were more stable than those in the control group. This is consistent with Varsha (2015), who reported that neonates undergoing breast crawl maintained better body temperature than those who did not, and Srivastava S. et al. (2009), who found that skin-to-skin contact improved axillary temperatures in new-borns. Breastfeeding outcomes were also superior in the experimental group. The study concluded that the breast crawl method effectively enhanced breastfeeding success and positively influenced neonatal elimination patterns, including the frequency of urine and stool passage. Dr. Lily Podder (2017) similarly reported that the breast crawl positively impacts breastfeeding initiation and outcomes. In the present study, the Modified Infant Breastfeeding Assessment Tool (IBFAT) scores in the interventional group were 28.6 on day one and 28.8 on day two, compared to 25.6 and 26.2 in the routine care group, with t-values of 5.3 and 4.3, respectively, indicating a significant improvement in breastfeeding outcomes. Additional studies support these findings. Christena P. (2018) reported that breast crawl reduces maternal blood loss, shortens the duration of placental separation, and facilitates early initiation of breastfeeding. Mulupuru S. et al. (2019) observed higher breastfeeding rates in the experimental group (94.8%) compared to the control group (95.7%). Thomas S. (2018) reported a significant reduction in the time taken to initiate breastfeeding among neonates who underwent the breast crawl. Furthermore, Khosla P., Tripathy P., and Moharana M. (2017) found that smearing breast milk during the breast crawl enhanced neonatal responsiveness. Overall, these findings highlight the effectiveness of the breast crawl in stabilizing neonatal bio-physiological parameters and improving breastfeeding outcomes, reinforcing the importance of incorporating this practice into routine postnatal care. Another study ne Rawat G et.al. found that the breast crawl intervention significantly improved neonatal temperature at 1 h post‑birth, shortened placental expulsion time, reduced episiotomy pain perception, and improved uterine involution. Shah A et.al. reported that a higher proportion of new-borns achieved good latching (60%) after breast crawl in experimental group as compared to controls (5%), and maternal episiotomy pain intensity was lower in the intervention group. Mahmoud NSA et.al. also reported that breast crawl significantly shortened the third stage of labour (placental separation), reduced maternal blood loss, and improved early initiation of breastfeeding relative to a control group.

This study employed a quantitative, post-test only, two-group design, allowing a clear comparison between the control and experimental groups while minimizing contamination bias. Reliable and standardized instruments, including digital thermometers, NIBP monitors, baby weighing scales, and the LATCH Breastfeeding Assessment Tool, were used to ensure accuracy and objectivity in data collection. However, the study had certain limitations. It was conducted in a single setting, which may limit the generalizability of the findings to broader populations or different healthcare contexts. Additionally, long-term follow-up was not included, restricting the ability to assess whether the benefits of breast crawl persist in sustained breastfeeding success or long-term neonatal growth and development. In conclusion, this study establishes that the breast crawl technique positively affects the bio-physiological parameters of neonates and improves breastfeeding outcomes. The intervention facilitates early initiation of breastfeeding and contributes to neonatal stability. This study implies that incorporating the breast crawl technique into postnatal care can enhance neonatal physiological stability and breastfeeding success. It also emphasizes the role of nurses in educating and supporting mothers to adopt evidence-based breastfeeding practices.

Source of Funding: NiL

Conflict of Interest: NiL

Ethical Approval: Ethical Approval was obtained from Ethics Committee of SRHU    

(SRHU/HIMS/ETHICS/2020/108)

Informed Consent: Informed written consent was obtained from the participants

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