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Original article

Utilization of baby-friendly services in maternity wards in Serbia

Mirjana Živković Šulović1
  • Institute of Public Health of Serbia, Belgrade, Serbia

ABSTRACT

Introduction/aim: Breastfeeding, as a topic for health promotion and research, continues to be relevant due to numerous benefits for both the child (decreased mortality, strengthening of immunity, reduction of allergies, respiratory and digestive disorders, obesity and diabetes, increased IQ) and the mother (reduced risk of hypertension, diabetes, hyperlipidemia, cardiovascular diseases, breast and ovarian cancer). The study aims to propose effective and efficient health promotion activities directed towards increasing the percentage of exclusively breastfed newborns and infants up to six months of age, in Serbia.

Method: The study was conducted as a secondary analysis of data obtained in Multiple Indicator Cluster Survey 6 (MICS 6) for the national and the Roma ethnic group sample, in Serbia, in 2019. The association between the utilization of the following services: skin-to-skin contact, early breastfeeding, and full-time rooming-in for mother and baby, and the socio-demographic variables of mothers, were examined using univariate and multivariate logistic regression analysis. Statistical significance was determined at p < 0.05 (Student t-test, Pearson’s chisquare test, and Mann-Whitney U-test).

Results: The examined socio-economic characteristics of the mothers in both samples were not associated with the use of baby-friendly services. A significant statistical difference exists in relation to the type of delivery in both samples. Women who gave birth by caesarean section remain deprived of utilizing the procedures that have proven positive short-term and long-term effects on the health of both the child and mother. In both samples, there was a significant increase in rooming-in in the Belgrade region, where the maternity hospital leading the National Breastfeeding Support Program is located.

Conclusion: The most effective measures to improve breastfeeding are related to the adoption of breastfeeding support policies in health facilities and the obligation to train the entire staff who are in contact with mothers during their stay at the maternity hospital (20-hour WHO breastfeeding counseling training).


INTRODUCTION

Guided by the importance of breastfeeding for the longevity and health of newborns and infants, the World Health Organization (WHO) adopted an internationally agreed upon Code of Ethics (International Code of Marketing of Breast-Milk Substitutes) which explains to the public, health and marketing professionals, health systems and regulatory bodies in all countries of the world that breastfeeding is a natural diet that is the most appropriate and superior to any artificial feeding [1]. With this Code, the WHO and the United Nations International Children’s Emergency Fund (UNICEF) instruct countries that, as part of the efforts to prevent malnutrition and disease, priority should be given to the support and promotion of breastfeeding, legislative and social actions that accelerate the acceptance of the habit of breastfeeding among working mothers, the revival of breastfeeding practices in populations where it is declining, and the adoption of regulations related to the sanctioning of unacceptable promotion and sale of artificial food for newborns and infants as a substitute for breast-milk [1],[2].

Breastfeeding, as a topic for work and research in the areas of health and education, has not as yet ceased to be relevant, due to numerous short-term and long-term benefits for the child (decreased mortality, strengthening of immunity, reduction of allergies, respiratory and digestive disorders, obesity and diabetes, increased IQ) [3] and the mother (reduced risk of hypertension, diabetes, hyperlipidemia, cardiovascular diseases, breast and ovarian cancer) [4].

The aim of promoting breastfeeding is to influence decision-makers to adopt health legislation that would enable, within the framework of baby-friendly maternity hospitals, the early establishment of breastfeeding practice, which should enable skin-to-skin contact (STS) between mother and child and subsequent breastfeeding, in the first 60 minutes after delivery [2].

UNICEF and WHO joined the Baby-Friendly Hospital initiative aiming to motivate health authorities to provide health services oriented towards implementing the “Ten Steps to Successful Breastfeeding” guide, which consists of a set of legal documents and recommendations for implementing breastfeeding support procedures [5].

Early initiation of breastfeeding is considered one of the key interventions to reduce infant and child mortality and improve child survival. Skin-to-skin contact is defined as placing the newborn over the mother’s bare chest at the time of delivery for at least one hour, during which time breastfeeding can be started immediately [6],[7],[8].

Every year, due to the lack of protection, promotion, and support for breastfeeding, significant economic losses are recorded. Key findings of “Global Costs of Not Breastfeeding” show that breastfeeding, as recommended by the WHO, has the potential to prevent the following: (1) global losses of $574 billion (on average 0.7% of GDP); (2) more than 510,000 deaths; (3) 4.58 million cases of childhood obesity per year; (4) loss of 200 million IQ points per year. It can also save more than 10% of the family income that would be spent on purchasing formula milk [9].

The legal framework for breastfeeding support in Serbia is represented by the Regulation on the National Program for Breastfeeding Support and Developmental Care of a Newborn (2018) [10], which was adopted after the alarming data from the MICS 5 survey showing that, in 2014, in Serbia, only 12.4% of children exclusively breastfed for the first six months of life [11].

The study aims to investigate the association between the personal characteristics of the mothers giving birth and the use of baby-friendly services (STS, early breastfeeding, and rooming-in), in the general population and the population of Roma women from Roma settlements, as well as to propose appropriate measures to improve the use of baby-friendly services in maternity hospitals in Serbia, in keeping with the results obtained.

MATERIALS AND METHODS

The study was conducted as a secondary analysis of data obtained from the MICS 6 survey from 2019, which was conducted by the Statistical Office of the Republic of Serbia, with the technical and financial support of UNICEF, the European Union, the United Nations Fund for Population Activities (UNFPA), and the Government of the Republic of Serbia [12].

MICS (Multiple Indicator Cluster Survey) is a multipurpose international household survey program aimed at collecting internationally comparable data on a wide range of indicators of the position of women and children. The MICS survey measures key indicators that enable countries to generate data necessary for the development of policies, programs, and national development plans, as well as for monitoring progress in achieving the Sustainable Development Goals (SDG) [13]. MICS 6 included two nationally representative samples of the general (non-Roma) population and the Roma population living in Roma settlements in Serbia.

For the purpose of secondary analysis, the study used variables from two of the four questionnaires used in the MICS 6 survey for both populations: the Household Questionnaire for collecting data on the demographic and socioeconomic characteristics of the household and the Questionnaire for Individual Women Aged 15 – 49 (module: Maternal and Newborn Health). Both samples included women aged 15 – 49 who had given birth to a live-born child in the previous two years.

Based on the literature review, we structured the analysis, research variables, and regrouping within the variables. Statistical processing of eight socio-demographic characteristics for the respondents of both populations (age of pregnant women, level of education, employment status, household well-being index, place of residence/environment, region, and type of delivery) was performed in terms of their association with the use of baby-friendly and newborn care at birth services (STS, early breastfeeding and rooming-in), using univariate and multivariate logistic regression analysis. The following tests for statistical significance were used: t-test, chi-square test, and the U-test. Statistical significance was determined in relation to p < 0.05. The SPSS statistical software, Version 20.3, was used for statistical analysis.

The most important study results, presented graphically and tabularly, were interpreted and discussed in light of relevant literature. Based on the conducted research, a proposal of health education measures and activities aimed at increasing the volume of positive practices in maternity hospitals was conceived.

RESULTS

Demographic and socio-economic characteristics of the samples

The national sample included a total of 331 women (weighted), and the sample of Roma women from Roma settlements included 383 women. Table 1 shows the characteristics of both samples of respondents. Women in the Roma population were significantly younger (24 ± 5.3 : 31 ± 5.5), (p < 0.001). The proportion of mothers older than 30 years in the general population was significantly higher (53.3% : 11.7%), (p < 0.001). In the national sample, there were no respondents who did not complete school, while in the sample from Roma settlements, every eighth respondent had no education, and every sixth respondent had completed high school or above. There were significantly more working mothers in the general population (63% : 10.7%), (p < 0.001). Every other respondent in the national sample had a good index of household well-being, while this was true of less than one-third of the respondents from Roma settlements, which is a significant statistical difference (p < 0.001). No statistically significant difference between these two samples in terms of material deprivation was confirmed. Statistically significantly more respondents from the sample of Roma settlements lived in urban settlements. The largest number of respondents in the general population were from the region of Vojvodina, while the largest number of respondents from the Roma settlements were from the region of South and East Serbia, which is statistically significant (p < 0.001), but in keeping with the representative sample of the share of the Roma population in the regions. Every third respondent in the general population had a cesarean delivery, i.e., every fifth respondent from Roma settlements, which is statistically significant (p < 0.001).

Table 1. Characteristics of the mothers

Table 1. Characteristics of the mothers

The skin-to-skin procedure

In the national sample, immediate skin-to-skin contact after delivery by vaginal or cesarean section was performed in 31.7% of mothers, i.e., 37.4% of respondents in the sample of women from Roma settlements (Chart 1). There is no statistical significance in the use of this service in the two observed samples.

Figure 1. Utilization of baby friendly services in Serbia, MICS 6 (2019)

Figure 1. Utilization of baby friendly services in Serbia, MICS 6 (2019)

Table 2 presents the association of demographic and socioeconomic characteristics of both samples with the use of the skin-to-skin procedure immediately after delivery. Although there is a statistically significant difference between the respondents of the two samples in terms of all the examined characteristics, with the exception of material deprivation, within the samples themselves, there is no statistical difference in the use of the STS procedure.

Table 2. Demographic and socio-economic characteristics of mothers and the frequency of skin-to-skin contact procedures, in both samples

Table 2. Demographic and socio-economic characteristics of mothers and the frequency of skin-to-skin contact procedures, in both samples

Table 2. Demographic and socio-economic characteristics of mothers and the frequency of skin-to-skin contact procedures, in both samples

In both samples, only the type of delivery, i.e., the state of health of the respondent indicated for cesarean delivery, was statistically significantly associated with the use of the STS procedure (p < 0.001). In the national sample of respondents who gave birth by cesarean section, direct skin-to-skin contact was achieved in 17.1%, and in the sample of mothers from Roma settlements, it was achieved in 2.2% of mothers.

Early breastfeeding

In the national sample, the percentage of children who were breastfed for the first time within one hour of birth was 7.7%. (Graph 1). A total of 13.7% of children in the sample from Roma settlements received early breastfeeding, which is a statistically significant difference.

In both samples, age, education, employment status, environment and region of residence, the well-being index, and material deprivation did not show statistical significance regarding the frequency of early breastfeeding. In both samples, there is a significant statistical difference (p < 0.001) regarding the availability of early breastfeeding for women who had had a cesarean section. In the national sample, not a single baby born by cesarean section had early breastfeeding, while only three respondents from the sample of mothers from Roma settlements were able to provide early breastfeeding for their baby. Table 3 presents the demographic and socioeconomic characteristics of the mothers of both samples, the frequency of early breastfeeding, and their association.

Table 3. Demographic and socio-economic characteristics of the mothers and the frequency of early breastfeeding, in both samples

Table 3. Demographic and socio-economic characteristics of the mothers and the frequency of early breastfeeding, in both samples

Table 3. Demographic and socio-economic characteristics of the mothers and the frequency of early breastfeeding, in both samples

Rooming-in

Rooming-in occurred in 66.3% of respondents in the national sample and in 82.8% of the respondents of Roma nationality (Chart 1), which is a statistically significant difference (p < 0.001).

Age, education, employment status, environment, well-being index, and material deprivation of the respondents did not show statistical significance regarding the frequency of rooming-in, in both samples. In both samples, there is a statistically significant difference in relation to region. Among the respondents of the national sample, the rooming-in program was most prevalent in Belgrade and least prevalent in Vojvodina (p < 0.001). Among Roma respondents, the rooming-in program was also most prevalent in Belgrade and least prevalent in the region of Šumadija and West Serbia (p = 0.004). A cesarean section was performed on 17.8% of respondents in the national sample from the rooming-in program, and on 45.5% of those who did not stay in the same room with their newborn, which is a statistically significant difference (p < 0.001). The type of delivery and rooming-in, in the sample of respondents from Roma settlements, is not statistically significant. Table 4 shows the association of demographic and socioeconomic characteristics of both samples with the use of 24-hour shared accommodation for mother and child (rooming-in).

Table 4. Demographic and socio-economic characteristics of the mothers and the frequency of rooming-in, in both samples

Table 4. Demographic and socio-economic characteristics of the mothers and the frequency of rooming-in, in both samples

Table 4. Demographic and socio-economic characteristics of the mothers and the frequency of rooming-in, in both samples

DISCUSSION

A study conducted in 2019 showed that organized activities influence the promotion of exclusive breastfeeding (EBF); (an increase in the general population from 12.8% to 23.7%, between 2014 and 2019), but it was also alarming that among the Roma population, in those five years, there was a drop in exclusive breastfeeding from 13% (2014) to 8.0% (2019) [12]. Both values from the 2019 survey are far lower than the World Health Organization recommended goal of at least 50% of exclusively breastfed children under six months of age [13]. The subject of our study included the implementation of two of the “Ten Steps to Successful Breastfeeding”, i.e., Step 4. “Immediate Postnatal Care” (STS contact immediately after birth for at least 60 minutes and early breastfeeding within the first hour after birth) and Step 7. “Rooming-in”, as activities that have been proven to influence both the establishing of exclusive breastfeeding in the maternity ward [14] and the continuation of EBF [15].

The results of this study show that the STS procedure in the national sample of Serbia was applied in 31.7% of women giving birth. According to MICS research conducted in the region (2018 - 2020), this procedure was applied with similar results in Montenegro (33.9%), North Macedonia (32.8%), and Kosovo* (UNSCR 1244), (33.2 %). In parturient women from the Roma population in Serbia, 37.4% of mothers had STS, which is more than in the same population in Montenegro (29.1%), North Macedonia (26.9%), and in the sample of Ashkali and Egyptians in Roma settlements in Kosovo* (32%), (UNSCR 1244) [16],[17],[18]. A systematic review of the prevalence of STS after vaginal delivery in the world [19] included 35 studies (2007 – 2017) from 28 countries with representatives of all six regions of the World Health Organization, and with a total of 429,222 women. The prevalence of the STS procedure ranged from 1% to 98%, and was higher in countries with higher GDP and in studies that included only vaginal deliveries (Canada 81%, Finland 89%, Australia 93%, Denmark 95.6%, Croatia 97 .8%). In countries with low GDP [20],[21], there is a positive association of higher education and higher household income with a higher prevalence of STS. In the same study, there is also a statistically significant as sociation between the place of birth (maternity center versus home birth), region (urban versus rural), as well as the use of prenatal health care, which is also more common among women with a higher education level and with a higher household financial status.

In numerous studies, there is a negative association between cesarean section and STS contact [22],[23],[24]. The percentage of cesarean sections in Serbia is high (every third birth) [25] which is indicative of the medical system. In the general population, cesarean births are much more common among women from households with above-average financial means, women from urban settlements, and women with a higher level of education [12]. In newborns born by cesarean section, the rate of breastfeeding is usually lower compared to babies born by vaginal delivery, which has been confirmed by studies examining data obtained at discharge from the maternity ward [22],[23],[24]. Direct STS contact after cesarean section with the use of spinal or epidural anesthesia is possible because the mother remains awake. However, after general anesthesia, the newborn should be placed skin-to-skin to the mother as soon as she is awake and responsive [24].

Early initiation of breastfeeding in Serbia, in the national sample (7.7%) is lower than in neighboring countries: 24.1% in Montenegro, 9.5% in North Macedonia, and 32.1% in Kosovo* (UNSCR 1244) [16],[17],[18]. The early initiation of breastfeeding in Serbia in samples from the Roma population amounting to 13.7% is also lower than in the surrounding area: in Montenegro 40.9%, in North Macedonia 15.7%, and in Kosovo* 54.9% (UNSCR 1244) [16],[17],[18].

In studies on the prevalence of early breastfeeding in low-GDP countries, diverse influences of sociodemographic variables on early initiation of breastfeeding have been shown: in the northern region of Tanzania, socioeconomic characteristics of the mother (age, education, marital status, occupation, income) were not associated with the initiation of early breastfeeding [26]. In a study analyzing the association of factors for early initiation of breastfeeding in a rural area of Ethiopia, mothers with higher education were 3.2 times more likely to initiate early breastfeeding than mothers with no formal education [27]. Research on the association between determinants and early breastfeeding in Papua New Guinea showed an association with the age of the mother (lowest in the 15 – 19 age group, as compared to women aged 20 – 29 and 30 and above), as well as with the region [28]. In all studies, the type of delivery influenced the initiation of early breastfeeding – women who gave birth by cesarean section had a significantly lower chance (up to 93%) of early breastfeeding [26],[27],[28].

The practice of rooming-in, according to the definition by the World Health Organization and UNICEF, is “a hospital practice in which postpartum mothers and a healthy term newborn stay together in the same room 24 hours a day from the moment they arrive in their room (rooming-in) [29]. Putting mother and infant together in the same room makes breastfeeding easier as the mother can learn to recognize and respond to signs that the infant is hungry, and it also allows the mother to practice caring for her infant as well as to breastfeed it in a safe environment when the infant requests it. It has been shown that mothers who are placed in a room together with their child are more sensitive towards their child and respond to their needs with love and tenderness (mothers and babies sleep better and experience less anxiety). In addition, STS contact, which is easy to apply when the mother and baby are staying in the same room, has been shown to reduce postpartum depression and physiological stress of the mother [30],[31].

In our study, the statistically significantly lower percentage of rooming-in, in the national sample in Serbia (66.5%), as compared to the sample from Roma settlements (82.8%), is the result of significantly more frequent cesarean births in the national sample (32.3% : 18.5%). In both samples, rooming-in is significantly more common in Belgrade, which is home to the largest maternity hospital in the Balkans and host of the National Breastfeeding Support Program in Serbia.

Very important messages regarding the importance of the mother’s continuous stay with the newborn arise from a study conducted in Finland. Namely, after the drastic reduction of exclusive breastfeeding of babies until the age of six months to only 1% (in 2012), the BFHI (Baby Friendly Hospital Initiative) “Ten Steps to Successful Breastfeeding” program was intensified in Finland. After five years, the percentage of mothers sharing a room with their newborns was 91%. A Finnish study showed that maternity wards in their hospitals implement rooming-in to a satisfactory extent, as a significant number of mother-child pairs are together during the postpartum period. This study supports the increased use of Step 7 of the BFHI program in women who have had a cesarean delivery. The main recommendation is that the entire staff of the maternity ward clearly understand the importance of rooming-in and their own role in implementing this practice, with the ultimate goal of making exclusive breastfeeding long-term. A key part of this is that all staff members have completed 20 hours of World Health Organization breastfeeding counseling training, as staff who have completed this training are more likely to room-in mother and infant than staff who do not have this training [32].

In the latest BFHI report for the European Region, wherein 31 countries participated, including Serbia, 21.4% (6) of the countries met the recommended BFHI standard for the application of the STS procedure (five minutes after delivery for at least 60 minutes) in over 80 % woman; 42.8% (12) of countries met the recommended BFHI standard of implementing early breastfeeding (within one hour after delivery) in over 80% of women; 14.3% (4) of countries met the new recommended BFHI standard defined in Step 7 –in 80% of women, mother-infant separation should not last longer than one hour [33].

During health education work, and in keeping with the findings of this study, important guidelines for the training of all stakeholders have emerged. Key health-educational messages should relate to early breastfeeding and contact. Early breastfeeding stimulates the production of breast milk, accelerates lactogenesis, and reduces the risk of infant death [3],[4],[6]. Immediate and continuous skin-to-skin contact facilitates the newborn’s natural sucking reflex, helps establish the newborn’s microbiome, and prevents hypothermia. These two processes usually happen as one event and have an impact on the emotional connection between mother and child. All three of the aforementioned practices of baby-friendly maternity hospitals are founded on evidence-based medicine, i.e., literature data that speak in favor of health benefits for the mother and the child [19],[20],[21],[22],[23],[24],[30],[31],[32].

CONCLUSION

The results of this study have shown that, in maternity hospitals in our country, baby-friendly services for the promotion of breastfeeding are not implemented in accordance with the goals of the National Program for Breastfeeding Support and Developmental Care of a Newborn. The biggest obstacle to achieving the goals of the National Program is the high percentage of cesarean deliveries in Serbia (33%), as well as the low percentage of deliveries with epidural anesthesia, after which Steps 3 and 7 of the “Ten Steps to Successful Breastfeeding” Guide can be safely applied.

The experiences of countries or health institutions that have met the recommended standards of the BFHI program – coverage of more than 80% of mothers in maternity hospitals by applying Step 4 and Step 7 of the Guide, show that the prerequisite for this is the fulfillment of Step 1 and Step 2 of the Guide, which refer to the adoption of support policies for breastfeeding in the health institution and the obligation of continuous education of the entire staff who are in contact with mothers during their stay at the maternity hospital (twenty-hour training of the World Health Organization for counseling on breastfeeding).

Within the domain of the selection of successful health educational interventions that promote breastfeeding with the aim of achieving the global goal is spreading knowledge and awareness about the importance of breastfeeding, primarily among policymakers, program coordinators, health workers, and within the community. It is necessary to encourage positive attitudes towards breastfeeding, primarily among the target group of pregnant women, but also among health workers who have direct contact with women during pregnancy at the primary and secondary levels of health care.

List of abbreviations and acronyms

WHO – World Health Organization
UNICEF – United Nations International Children’s Emergency Fund
GDP – Gross domestic product
IQ – intelligence quotient
STS – skin-to-skin contact
MICS – Multiple Indicator Cluster Survey
EBF – exclusive breastfeeding
BFHI – Baby-Friendly Hospital Initiative

  • Conflict of interest:
    None declared.

Informations

March 2024

Pages 27-43
  • Keywords:
    exclusive breastfeeding, baby-friendly services, training
  • Received:
    04 March 2024
  • Revised:
    14 March 2024
  • Accepted:
    18 March 2024
  • Online first:
    25 March 2024
  • DOI:
  • Cite this article:
    Živković Šulović M. Utilization of baby-friendly services in maternity wards in Serbia. Serbian Journal of the Medical Chamber. 2024;5(1):27-43. doi: 10.5937/smclk5-49641
Corresponding author

Mirjana Živković Šulović
Institute of Public Health of Serbia Dr Milan Jovanović Batut
5 Dr Subotića Street, 11000 Belgrade, Serbia
E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.


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20. Ekholuenetale M, Barrow A, Benebo FO, Idebolo AF. Coverage and factors associated with mother and newborn skin-to-skin contact in Nigeria: a multilevel analysis. BMC Pregnancy Childbirth. 2021 Sep 4;21(1):603. doi: 10.1186/s12884-021-04079-8. [Internet]. / [CROSSREF]

21. Ekholuenetale M, Onikan A, Ekholuenetale C.E. Prevalence and determinants of mother and newborn skin-to-skin contact in The Gambia: a secondary data analysis. J. Egypt. Public. Health. Assoc. 95, 18 (2020). doi.org/10.1186/ s42506-020-00050-1. [CROSSREF]

22. Zanardo V, Pigozzo A, Wainer G, Marchesoni D, Gasparoni A, Di Fabio S, et al. Early lactation failure and formula adoption after elective caesarean delivery: cohort study. Archives of Disease in Childhood. 2013;98(1):F37–F41. doi: 10.1136/archdischild-2011-301218. [CROSSREF]

23. Guala A, Boscardini L, Visentin R, Angellotti P, Grugni L, Barbaglia M, et al. Skin-to-Skin Contact in Cesarean Birth and Duration of Breastfeeding: A Cohort Study. ScientificWorldJournal. 2017;2017:1940756. doi: 10.1155/2017/1940756. [CROSSREF]

24. Gouchon S, Gregori D, Picotto A, Patrucco G, Nangeroni M, Di Giulio P. Skinto-skin contact after cesarean delivery: an experimental study. Nurs Res. 2010 Mar-Apr;59(2):78-84. doi: 10.1097/NNR.0b013e3181d1a8bc. [CROSSREF]

25. Horozović V, Živković-Šulović M, Dukić D, Ljubičić M, Atanasijević D, Brcanski J, et al. Izveštaj o unapređenju kvaliteta rada u zdravstvenim ustanovama u Republici Srbiji 2018. godine. Pokazatelji kvaliteta rada odeljenja ginekologije i akušerstva u bolnicama, Srbija, 2018. (tabela 4, str. 142). [Internet]. Dostupno na: https://www.batut.org.rs/download/izvestaji/Izvestaj%20 kvalitet%202018.pdf

26. Lyellu HY, Hussein TH, Wandel M. Stray-Pedersen B, Mgongo M, Msuya SE. Prevalence and factors associated with early initiation of breastfeeding among women in Moshi municipal, northern Tanzania. BMC Pregnancy Childbirth 20, 285 (2020). https://doi.org/10.1186/s12884-020-02966-0. [CROSSREF]

27. Gebremeskel SG, Gebru TT, Gebrehiwot BG, Meles HN, Tafere BB, Gebreslassie GW, et al. Early initiation of breastfeeding and associated factors among mothers of aged less than 12 months children in rural eastern zone, Tigray, Ethiopia: cross-sectional study.  BMC Res Notes  12, 671 (2019). https://doi. org/10.1186/s13104-019-4718-x [CROSSREF]

28. Seidu AA, Ahinkorah BO, Agbaglo E, Dadzie LK, Tetteh JK, Ameyaw EK, et al. Determinants of early initiation of breastfeeding in Papua New Guinea: a population-based study using the 2016-2018 demographic and health survey data. Arch Public Health 78, 124 (2020). https://doi.org/10.1186/s13690-020-00506-y [CROSSREF]

29. World Health Organization. Implementation guidance: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services – the revised Baby-friendly Hospital Initiative. Geneva: World Health Organization; 2018. [HTTP]

30. Crenshaw JT. Healthy Birth Practice #6: Keep Mother and Baby Together- It’s Best for Mother, Baby, and Breastfeeding. J Perinat Educ. 2014 Fall;23(4):211- 7. doi: 10.1891/1058-1243.23.4.211./ [CROSSREF]

31. Bigelow A, Power M, MacLellan-Peters J, Alex M, McDonald C. Effect of mother/infant skin-to-skin contact on postpartum depressive symptoms and maternal physiological stress.  JOGNN - Journal of Obstetric, Gynecologic, & Neonatal Nursing.  2012;41(3):369–382. doi:  10.1111/j.1552- 6909.2012.01396_1.x. [CROSSREF]

32. Hakala M, Kaakinen P, Kääriäinen M, Bloigu R, Hannula L, Elo S. Implementation of Step 7 of the Baby-Friendly Hospital Initiative (BFHI) in Finland: Rooming-in according to mothers and maternity-ward staff. Eur J Midwifery. 2018 Aug 23;2:9. doi: 10.18332/ejm/93771. [CROSSREF]

33. 2022 BFHI Status country Report Summary, Maite Herndez Aguilar BFHI Network. 2022. [Internet]. [Citirano 13. mart 2024.]. Dostupno na: https:// www.ihan.es/wp-content/uploads/2022-BFHI-Status-Country-Report-summary.pdf [HTTP]


REFERENCES

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2. Jama A, Gebreyesus H, Wubayehu T, Gebregyorgis T, Teweldemedhin M, Berhe T, et al. Exclusive breastfeeding for the first six months of life and its associated factors among children aged 6-24 months in Burao district, Somaliland. Int Breastfeed J. 2020 Jan 30;15(1):5. doi: 10.1186/s13006-020-0252-7. [CROSSREF]

3. Binns C, Lee M, Low WY. The Long-Term Public Health Benefits of Breastfeeding. Asia Pac J Public Health. 2016 Jan;28(1):7-14. doi: 10.1177/1010539515624964. [CROSSREF]

4. Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, et al.; Lancet Breastfeeding Series Group. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016 Jan 30;387(10017):475- 90. doi: 10.1016/S0140-6736(15)01024-7. [CROSSREF]

5. Bagci Bosi AT, Eriksen KG, Sobko T, Wijnhoven TM, Breda J. Breastfeeding practices and policies in WHO European Region Member States. Public Health Nutr. 2016 Mar;19(4):753-64. doi: 10.1017/S1368980015001767. [Internet]. [Citirano 13. mart 2024.]. Dostupno na: https://pubmed.ncbi.nlm.nih.gov/26096540/ [CROSSREF]

6. NEOVITA Study Group. Timing of initiation, patterns of breastfeeding, and infant survival: prospective analysis of pooled data from three randomised trials. Lancet Glob Health. 2016;4(4): e266–75. doi:10.1016/ S2214-109X (16)00040-1. [CROSSREF]

7. WHO and UNICEF. Capture the Moment – Early initiation of breastfeeding: The best start for every newborn. New York. 2018. [Internet]. [Citirano 13. mart 2024.]. Dostupno na: https://www.unicef.org/eca/media/4256/file/Capture-the-moment-EIBF-report.pdf [HTTP]

8. Smith ER, Hurt L, Chowdhury R, Sinha B, Fawzi W, Edmond KM; Neovita Study Group. Delayed breastfeeding initiation and infant survival: A systematic review and meta-analysis. PLoS One. 2017 Jul 26;12(7):e0180722. doi: 10.1371/ journal.pone.0180722. [CROSSREF]

9. Sameen A, Sakshi J, Walters D. The Global Cost of Not Breastfeeding. Nutrition International, August 2022. [Internet]. Dostupno na: https://www.aliveandthrive.org/sites/default/files/2022-07/CONBF%20Global%20 Brief-v6%20%281%29.pdf [HTTP]

10. Uredba o Nacionalnom programu podrške dojenju, porodičnoj i razvojnoj nezi novorođenčeta: 53/2018-3 [Internet]. [Citirano 25. jul 2022.]. Dostupno na: https://www.pravno-informacioni-sistem.rs/SlGlasnikPortal/eli/rep/sgrs/vlada/uredba/2018/53/1/reg [HTTP]

11. Republički zavod za statistiku i UNICEF, 2014. Istraživanje višestrukih pokazatelja položaja žena i dece u Srbiji 2014, i Istraživanje višestrukih pokazatelja položaja žena i dece u romskim naseljima u Srbiji 2014, Konačni rezultati. Beograd, Srbija: Republički zavod za statistiku i UNICEF. [Internet]. [Citirano 12. mart 2024.]. Dostupno na:https://www.unicef.org/serbia/media/6496/file/Istra%C5%BEivanje%20vi%C5%A1estrukih%20pokazatelja%202014.%20-%20rezime.pdf [HTTP]

12. MICS Srbija-Istraživanje višestrukih pokazatelja 2019 i Srbija-romska naselja. Istraživanje višestrukih pokazatelja 2019. [Internet]. [Citirano 12. mart 2024.]. Dostupno na: https://www.unicef.org/serbia/media/16726/file/MICS%206%20Multiple%20Indicator%20Cluster%20Survey%20for%202019.pdf [HTTP]

13. WHO. Global targets 2025. To improve maternal, infant and young child nutrition. [Internet]. Dostupno na: https://www.who.int/publications/i/item/WHO-NMH-NHD-14.2 [HTTP]

14. Jaafar S, Ho JJ, Lee K. Rooming-in for new mother and infant versus separate care for increasing the duration of breastfeeding. Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD006641. DOI: 10.1002/14651858.CD006641.pub3 [CROSSREF]

15. Potgieter KL, Adams F. The influence of mother-infant skin-to-skin contact on bonding and touch. S. Afr. j. occup. ther.  2019  Aug. http://dx.doi. org/10.17159/2310-3833/2019/vol49n2a3. [CROSSREF]

16. Montenegro and Montenegro Roma Settlements Multiple Indicator Cluster Survey 2018 Survey Findings Report December 2019. [Internet]. Dostupno na: https://mics-surveys prod.s3.amazonaws.com/MICS6/Europe%20and%20Central%20Asia/Montenegro%20%28Roma%20Settlements%29/2018/ Survey%20findings/Montenegro%20%28National%20and%20Roma%20 Settlements%29%202018%20MICS%20SFR_v4_English.pdf [HTTP]

17. North Macedonia and North Macedonia Roma Settlements Multiple Indicator Cluster Surveys 2018-2019 Survey Findings Reports. May, 2020.  [Internet]. Dostupno na: https://mics-surveys-prod.s3.amazonaws.com/MICS6/Europe%20and%20Central%20Asia/North%20Macedonia%2C%20 Republic%20of%20%28Roma%20Settlements%29/2018-2019/Survey%20 findings/North%20Macedonia%20and%20North%20Macedonia%20 Roma%20Settlements%20MICS%202018-19%20SFR_English.pdf [HTTP]

18. Kosovo* (UNSCR 1244) Multiple Indicator Cluster Survey 2019–2020 and Roma, Ashkali and Egyptian Communities in Kosovo Multiple Indicator Cluster Survey 2019–2020 Survey Findings Report November, 2020. [Internet]. Dostupno na: https://mics-surveys-prod.s3.amazonaws.com/MICS6/Europe%20and%20Central%20Asia/Kosovo%20under%20UNSC%20 res.%201244%20%28Roma%2C%20Ashkali%2C%20and%20Egyptian%20 Communities%29/2019-2020/Survey%20findings/Kosovo%20%28UNSCR%201244%29%20%28National%20and%20Roma%2C%20Ashkali%20 and%20Egyptian%20Communities%29%202019-20%20MICS-SFR_English.pdfhttps://mics-surveys

19. Abdulghani N, Edvardsson K, Amir LH. Worldwide prevalence of mother-infant skin-to-skin contact after vaginal birth: A systematic review. PLoS One. 2018 Oct 31;13(10):e0205696. doi: 10.1371/journal.pone.0205696. [CROSSREF]

20. Ekholuenetale M, Barrow A, Benebo FO, Idebolo AF. Coverage and factors associated with mother and newborn skin-to-skin contact in Nigeria: a multilevel analysis. BMC Pregnancy Childbirth. 2021 Sep 4;21(1):603. doi: 10.1186/s12884-021-04079-8. [Internet]. / [CROSSREF]

21. Ekholuenetale M, Onikan A, Ekholuenetale C.E. Prevalence and determinants of mother and newborn skin-to-skin contact in The Gambia: a secondary data analysis. J. Egypt. Public. Health. Assoc. 95, 18 (2020). doi.org/10.1186/ s42506-020-00050-1. [CROSSREF]

22. Zanardo V, Pigozzo A, Wainer G, Marchesoni D, Gasparoni A, Di Fabio S, et al. Early lactation failure and formula adoption after elective caesarean delivery: cohort study. Archives of Disease in Childhood. 2013;98(1):F37–F41. doi: 10.1136/archdischild-2011-301218. [CROSSREF]

23. Guala A, Boscardini L, Visentin R, Angellotti P, Grugni L, Barbaglia M, et al. Skin-to-Skin Contact in Cesarean Birth and Duration of Breastfeeding: A Cohort Study. ScientificWorldJournal. 2017;2017:1940756. doi: 10.1155/2017/1940756. [CROSSREF]

24. Gouchon S, Gregori D, Picotto A, Patrucco G, Nangeroni M, Di Giulio P. Skinto-skin contact after cesarean delivery: an experimental study. Nurs Res. 2010 Mar-Apr;59(2):78-84. doi: 10.1097/NNR.0b013e3181d1a8bc. [CROSSREF]

25. Horozović V, Živković-Šulović M, Dukić D, Ljubičić M, Atanasijević D, Brcanski J, et al. Izveštaj o unapređenju kvaliteta rada u zdravstvenim ustanovama u Republici Srbiji 2018. godine. Pokazatelji kvaliteta rada odeljenja ginekologije i akušerstva u bolnicama, Srbija, 2018. (tabela 4, str. 142). [Internet]. Dostupno na: https://www.batut.org.rs/download/izvestaji/Izvestaj%20 kvalitet%202018.pdf

26. Lyellu HY, Hussein TH, Wandel M. Stray-Pedersen B, Mgongo M, Msuya SE. Prevalence and factors associated with early initiation of breastfeeding among women in Moshi municipal, northern Tanzania. BMC Pregnancy Childbirth 20, 285 (2020). https://doi.org/10.1186/s12884-020-02966-0. [CROSSREF]

27. Gebremeskel SG, Gebru TT, Gebrehiwot BG, Meles HN, Tafere BB, Gebreslassie GW, et al. Early initiation of breastfeeding and associated factors among mothers of aged less than 12 months children in rural eastern zone, Tigray, Ethiopia: cross-sectional study.  BMC Res Notes  12, 671 (2019). https://doi. org/10.1186/s13104-019-4718-x [CROSSREF]

28. Seidu AA, Ahinkorah BO, Agbaglo E, Dadzie LK, Tetteh JK, Ameyaw EK, et al. Determinants of early initiation of breastfeeding in Papua New Guinea: a population-based study using the 2016-2018 demographic and health survey data. Arch Public Health 78, 124 (2020). https://doi.org/10.1186/s13690-020-00506-y [CROSSREF]

29. World Health Organization. Implementation guidance: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services – the revised Baby-friendly Hospital Initiative. Geneva: World Health Organization; 2018. [HTTP]

30. Crenshaw JT. Healthy Birth Practice #6: Keep Mother and Baby Together- It’s Best for Mother, Baby, and Breastfeeding. J Perinat Educ. 2014 Fall;23(4):211- 7. doi: 10.1891/1058-1243.23.4.211./ [CROSSREF]

31. Bigelow A, Power M, MacLellan-Peters J, Alex M, McDonald C. Effect of mother/infant skin-to-skin contact on postpartum depressive symptoms and maternal physiological stress.  JOGNN - Journal of Obstetric, Gynecologic, & Neonatal Nursing.  2012;41(3):369–382. doi:  10.1111/j.1552- 6909.2012.01396_1.x. [CROSSREF]

32. Hakala M, Kaakinen P, Kääriäinen M, Bloigu R, Hannula L, Elo S. Implementation of Step 7 of the Baby-Friendly Hospital Initiative (BFHI) in Finland: Rooming-in according to mothers and maternity-ward staff. Eur J Midwifery. 2018 Aug 23;2:9. doi: 10.18332/ejm/93771. [CROSSREF]

33. 2022 BFHI Status country Report Summary, Maite Herndez Aguilar BFHI Network. 2022. [Internet]. [Citirano 13. mart 2024.]. Dostupno na: https:// www.ihan.es/wp-content/uploads/2022-BFHI-Status-Country-Report-summary.pdf [HTTP]

1. World Health Organization. International Code of Marketing of Breast-Milk Substitutes. Geneva: World Health Organization 1981). [Internet]. [Citirano 13. mart 2024.]. Dostupno na: https://iris.who.int/bitstream/handle/10665/40382/9241541601.pdf?sequence=1 [HTTP]

2. Jama A, Gebreyesus H, Wubayehu T, Gebregyorgis T, Teweldemedhin M, Berhe T, et al. Exclusive breastfeeding for the first six months of life and its associated factors among children aged 6-24 months in Burao district, Somaliland. Int Breastfeed J. 2020 Jan 30;15(1):5. doi: 10.1186/s13006-020-0252-7. [CROSSREF]

3. Binns C, Lee M, Low WY. The Long-Term Public Health Benefits of Breastfeeding. Asia Pac J Public Health. 2016 Jan;28(1):7-14. doi: 10.1177/1010539515624964. [CROSSREF]

4. Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, et al.; Lancet Breastfeeding Series Group. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016 Jan 30;387(10017):475- 90. doi: 10.1016/S0140-6736(15)01024-7. [CROSSREF]

5. Bagci Bosi AT, Eriksen KG, Sobko T, Wijnhoven TM, Breda J. Breastfeeding practices and policies in WHO European Region Member States. Public Health Nutr. 2016 Mar;19(4):753-64. doi: 10.1017/S1368980015001767. [Internet]. [Citirano 13. mart 2024.]. Dostupno na: https://pubmed.ncbi.nlm.nih.gov/26096540/ [CROSSREF]

6. NEOVITA Study Group. Timing of initiation, patterns of breastfeeding, and infant survival: prospective analysis of pooled data from three randomised trials. Lancet Glob Health. 2016;4(4): e266–75. doi:10.1016/ S2214-109X (16)00040-1. [CROSSREF]

7. WHO and UNICEF. Capture the Moment – Early initiation of breastfeeding: The best start for every newborn. New York. 2018. [Internet]. [Citirano 13. mart 2024.]. Dostupno na: https://www.unicef.org/eca/media/4256/file/Capture-the-moment-EIBF-report.pdf [HTTP]

8. Smith ER, Hurt L, Chowdhury R, Sinha B, Fawzi W, Edmond KM; Neovita Study Group. Delayed breastfeeding initiation and infant survival: A systematic review and meta-analysis. PLoS One. 2017 Jul 26;12(7):e0180722. doi: 10.1371/ journal.pone.0180722. [CROSSREF]

9. Sameen A, Sakshi J, Walters D. The Global Cost of Not Breastfeeding. Nutrition International, August 2022. [Internet]. Dostupno na: https://www.aliveandthrive.org/sites/default/files/2022-07/CONBF%20Global%20 Brief-v6%20%281%29.pdf [HTTP]

10. Uredba o Nacionalnom programu podrške dojenju, porodičnoj i razvojnoj nezi novorođenčeta: 53/2018-3 [Internet]. [Citirano 25. jul 2022.]. Dostupno na: https://www.pravno-informacioni-sistem.rs/SlGlasnikPortal/eli/rep/sgrs/vlada/uredba/2018/53/1/reg [HTTP]

11. Republički zavod za statistiku i UNICEF, 2014. Istraživanje višestrukih pokazatelja položaja žena i dece u Srbiji 2014, i Istraživanje višestrukih pokazatelja položaja žena i dece u romskim naseljima u Srbiji 2014, Konačni rezultati. Beograd, Srbija: Republički zavod za statistiku i UNICEF. [Internet]. [Citirano 12. mart 2024.]. Dostupno na:https://www.unicef.org/serbia/media/6496/file/Istra%C5%BEivanje%20vi%C5%A1estrukih%20pokazatelja%202014.%20-%20rezime.pdf [HTTP]

12. MICS Srbija-Istraživanje višestrukih pokazatelja 2019 i Srbija-romska naselja. Istraživanje višestrukih pokazatelja 2019. [Internet]. [Citirano 12. mart 2024.]. Dostupno na: https://www.unicef.org/serbia/media/16726/file/MICS%206%20Multiple%20Indicator%20Cluster%20Survey%20for%202019.pdf [HTTP]

13. WHO. Global targets 2025. To improve maternal, infant and young child nutrition. [Internet]. Dostupno na: https://www.who.int/publications/i/item/WHO-NMH-NHD-14.2 [HTTP]

14. Jaafar S, Ho JJ, Lee K. Rooming-in for new mother and infant versus separate care for increasing the duration of breastfeeding. Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD006641. DOI: 10.1002/14651858.CD006641.pub3 [CROSSREF]

15. Potgieter KL, Adams F. The influence of mother-infant skin-to-skin contact on bonding and touch. S. Afr. j. occup. ther.  2019  Aug. http://dx.doi. org/10.17159/2310-3833/2019/vol49n2a3. [CROSSREF]

16. Montenegro and Montenegro Roma Settlements Multiple Indicator Cluster Survey 2018 Survey Findings Report December 2019. [Internet]. Dostupno na: https://mics-surveys prod.s3.amazonaws.com/MICS6/Europe%20and%20Central%20Asia/Montenegro%20%28Roma%20Settlements%29/2018/ Survey%20findings/Montenegro%20%28National%20and%20Roma%20 Settlements%29%202018%20MICS%20SFR_v4_English.pdf [HTTP]

17. North Macedonia and North Macedonia Roma Settlements Multiple Indicator Cluster Surveys 2018-2019 Survey Findings Reports. May, 2020.  [Internet]. Dostupno na: https://mics-surveys-prod.s3.amazonaws.com/MICS6/Europe%20and%20Central%20Asia/North%20Macedonia%2C%20 Republic%20of%20%28Roma%20Settlements%29/2018-2019/Survey%20 findings/North%20Macedonia%20and%20North%20Macedonia%20 Roma%20Settlements%20MICS%202018-19%20SFR_English.pdf [HTTP]

18. Kosovo* (UNSCR 1244) Multiple Indicator Cluster Survey 2019–2020 and Roma, Ashkali and Egyptian Communities in Kosovo Multiple Indicator Cluster Survey 2019–2020 Survey Findings Report November, 2020. [Internet]. Dostupno na: https://mics-surveys-prod.s3.amazonaws.com/MICS6/Europe%20and%20Central%20Asia/Kosovo%20under%20UNSC%20 res.%201244%20%28Roma%2C%20Ashkali%2C%20and%20Egyptian%20 Communities%29/2019-2020/Survey%20findings/Kosovo%20%28UNSCR%201244%29%20%28National%20and%20Roma%2C%20Ashkali%20 and%20Egyptian%20Communities%29%202019-20%20MICS-SFR_English.pdfhttps://mics-surveys

19. Abdulghani N, Edvardsson K, Amir LH. Worldwide prevalence of mother-infant skin-to-skin contact after vaginal birth: A systematic review. PLoS One. 2018 Oct 31;13(10):e0205696. doi: 10.1371/journal.pone.0205696. [CROSSREF]

20. Ekholuenetale M, Barrow A, Benebo FO, Idebolo AF. Coverage and factors associated with mother and newborn skin-to-skin contact in Nigeria: a multilevel analysis. BMC Pregnancy Childbirth. 2021 Sep 4;21(1):603. doi: 10.1186/s12884-021-04079-8. [Internet]. / [CROSSREF]

21. Ekholuenetale M, Onikan A, Ekholuenetale C.E. Prevalence and determinants of mother and newborn skin-to-skin contact in The Gambia: a secondary data analysis. J. Egypt. Public. Health. Assoc. 95, 18 (2020). doi.org/10.1186/ s42506-020-00050-1. [CROSSREF]

22. Zanardo V, Pigozzo A, Wainer G, Marchesoni D, Gasparoni A, Di Fabio S, et al. Early lactation failure and formula adoption after elective caesarean delivery: cohort study. Archives of Disease in Childhood. 2013;98(1):F37–F41. doi: 10.1136/archdischild-2011-301218. [CROSSREF]

23. Guala A, Boscardini L, Visentin R, Angellotti P, Grugni L, Barbaglia M, et al. Skin-to-Skin Contact in Cesarean Birth and Duration of Breastfeeding: A Cohort Study. ScientificWorldJournal. 2017;2017:1940756. doi: 10.1155/2017/1940756. [CROSSREF]

24. Gouchon S, Gregori D, Picotto A, Patrucco G, Nangeroni M, Di Giulio P. Skinto-skin contact after cesarean delivery: an experimental study. Nurs Res. 2010 Mar-Apr;59(2):78-84. doi: 10.1097/NNR.0b013e3181d1a8bc. [CROSSREF]

25. Horozović V, Živković-Šulović M, Dukić D, Ljubičić M, Atanasijević D, Brcanski J, et al. Izveštaj o unapređenju kvaliteta rada u zdravstvenim ustanovama u Republici Srbiji 2018. godine. Pokazatelji kvaliteta rada odeljenja ginekologije i akušerstva u bolnicama, Srbija, 2018. (tabela 4, str. 142). [Internet]. Dostupno na: https://www.batut.org.rs/download/izvestaji/Izvestaj%20 kvalitet%202018.pdf

26. Lyellu HY, Hussein TH, Wandel M. Stray-Pedersen B, Mgongo M, Msuya SE. Prevalence and factors associated with early initiation of breastfeeding among women in Moshi municipal, northern Tanzania. BMC Pregnancy Childbirth 20, 285 (2020). https://doi.org/10.1186/s12884-020-02966-0. [CROSSREF]

27. Gebremeskel SG, Gebru TT, Gebrehiwot BG, Meles HN, Tafere BB, Gebreslassie GW, et al. Early initiation of breastfeeding and associated factors among mothers of aged less than 12 months children in rural eastern zone, Tigray, Ethiopia: cross-sectional study.  BMC Res Notes  12, 671 (2019). https://doi. org/10.1186/s13104-019-4718-x [CROSSREF]

28. Seidu AA, Ahinkorah BO, Agbaglo E, Dadzie LK, Tetteh JK, Ameyaw EK, et al. Determinants of early initiation of breastfeeding in Papua New Guinea: a population-based study using the 2016-2018 demographic and health survey data. Arch Public Health 78, 124 (2020). https://doi.org/10.1186/s13690-020-00506-y [CROSSREF]

29. World Health Organization. Implementation guidance: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services – the revised Baby-friendly Hospital Initiative. Geneva: World Health Organization; 2018. [HTTP]

30. Crenshaw JT. Healthy Birth Practice #6: Keep Mother and Baby Together- It’s Best for Mother, Baby, and Breastfeeding. J Perinat Educ. 2014 Fall;23(4):211- 7. doi: 10.1891/1058-1243.23.4.211./ [CROSSREF]

31. Bigelow A, Power M, MacLellan-Peters J, Alex M, McDonald C. Effect of mother/infant skin-to-skin contact on postpartum depressive symptoms and maternal physiological stress.  JOGNN - Journal of Obstetric, Gynecologic, & Neonatal Nursing.  2012;41(3):369–382. doi:  10.1111/j.1552- 6909.2012.01396_1.x. [CROSSREF]

32. Hakala M, Kaakinen P, Kääriäinen M, Bloigu R, Hannula L, Elo S. Implementation of Step 7 of the Baby-Friendly Hospital Initiative (BFHI) in Finland: Rooming-in according to mothers and maternity-ward staff. Eur J Midwifery. 2018 Aug 23;2:9. doi: 10.18332/ejm/93771. [CROSSREF]

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