**Question:** In normal delivery, breast feeding should be started –

A. immediately after birth
B. after placenta is delivered
C. after cord is clamped and cut
D. after baby is dried

**Core Concept:**

In normal delivery, initiation of breastfeeding is a crucial aspect of immediate newborn care as it promotes bonding between mother and baby, aids in lactation, and provides essential nutrients and protection to the infant.

**Why the Correct Answer is Right:**

A. **immediately after birth:** This is the ideal timing for breastfeeding initiation as it helps to establish the "latent phase" of lactation, where the baby gets used to suckling and milk ejection reflex (MER) is triggered. It also prevents hypothermia and helps in effective milk production.

B. **after placenta is delivered:** Initiating breastfeeding after the delivery of the placenta is not recommended as it may lead to delayed initiation of breastfeeding. Moreover, the baby might not be able to suckle effectively due to the mother's postpartum pain and bleeding.

C. **after cord is clamped and cut:** This option is incorrect because it delays breastfeeding initiation. Furthermore, it may lead to umbilical cord separation complications and impaired lactation.

D. **after baby is dried:** Drying the baby before breastfeeding initiation is not recommended as it can cause unnecessary stress and discomfort for the newborn, and may prolong the time for breastfeeding initiation.

**Why Each Wrong Option is Incorrect:**

C. **after cord is clamped and cut:** This is incorrect because clamping and cutting the umbilical cord before breastfeeding initiation may cause complications during cord separation and impair lactation.

D. **after baby is dried:** Drying the baby before breastfeeding initiation is not a recommended practice as it may cause unnecessary stress to the newborn and prolong the time for breastfeeding initiation. Drying the newborn may also cause discomfort and delay the establishment of effective breastfeeding.

**Clinical Pearls:**

1. Immediate breastfeeding initiation is vital for the mother's and baby's wellbeing. It promotes lactation, strengthens the mother-baby bond, and ensures the baby receives essential nutrients and protection.
2. Adequate preparation of the mother and newborn should precede breastfeeding initiation, such as ensuring maternal pain relief, stabilizing maternal blood loss, and ensuring proper positioning and latching techniques for effective milk extraction.

3. In case of multiple babies, the mother should prioritize the first baby for breastfeeding initiation, as it promotes lactation in the mother and strengthens the bond between the mother and the first baby.

4. In case of breech presentation, the baby should be turned into a head-down position to facilitate breastfeeding.

5. In case of caesarean section, breastfeeding initiation should ideally be done within 1-2 hours postpartum to optimize lactation and prevent postpartum hemorrhage. However, in case of complications like excessive bleeding, unstable maternal condition, or maternal pain, breastfeeding can be initiated when the mother is