Early initiation of breastfeeding and perinatal conditions among mothers in southern Ecuador: a descriptive cross-sectional study.

Background: Early initiation of breastfeeding within the first hour of life is a key indicator of newborn care quality and is recommended because of its relevance for neonatal health, survival, and the successful establishment of breastfeeding. However, its implementation varies across healthcare settings, and local evidence remains important for understanding the perinatal circumstances in which breastfeeding initiation occurs. Objective: To describe breastfeeding practices during the first hour of life and selected perinatal conditions reported by adult mothers (≥18 years) recruited from four public primary healthcare centers in southern Ecuador. Methods: A descriptive cross-sectional study was conducted between February and October 2025. Adult mothers (≥18 years) who had given birth within the previous two years were recruited while attending pediatric or gynecological consultations. Data were collected using a structured self-administered questionnaire assessing sociodemographic characteristics, obstetric history, perinatal conditions, and breastfeeding practices during the first hour after birth. Descriptive statistics, including frequencies, percentages, and 95% confidence intervals, were calculated. Results: A total of 343 mothers participated. Early initiation of breastfeeding was reported by 56.0% of participants, whereas 44.0% reported initiation after the first hour of life. Immediate skin-to-skin contact was reported by 77.8% of mothers, and 33.5% experienced difficulties initiating breastfeeding. Cesarean delivery accounted for 48.1% of births, maternal complications were reported by 21.0% of participants, and neonatal complications by 12.2%. Descriptive stratification showed notable differences in breastfeeding initiation across perinatal conditions. Early initiation was reported by 82.0% of mothers after vaginal delivery compared with 28.0% after cesarean delivery. Similarly, 67.0% of mothers reporting immediate skin-to-skin contact initiated breastfeeding within the first hour, compared with 11.8% of those whose contact occurred after 1 h. Conclusion: More than four out of every ten mothers in this cohort reported delayed breastfeeding initiation despite the high frequency of immediate skin-to-skin contact. Breastfeeding initiation occurred within a perinatal context characterized by substantial cesarean delivery rates, maternal-reported breastfeeding difficulties, and the presence of maternal and neonatal complications. These findings provide contemporary descriptive evidence on breastfeeding practices in southern Ecuador and support continued monitoring of early breastfeeding initiation as an indicator of maternal and newborn care quality.