Objective:

To identify the frequency and practice of the fourth step of the Baby Friendly Hospital Initiative in a reference maternity hospital in the southwest of Maranhão.

Method:

Documentary research, retrospective, quantitative approach, carried out between August and November 2019. For data collection, follow-up forms were used in the maternity center, information on skin-to-skin contact between mother and child, breastfeeding maternal in the first hour of life, as well as the sociodemographic, obstetric and delivery characteristics of the participants. The sample consisted of 254 records. The data were descriptively analyzed according to the absolute and relative frequencies of the variables.

Results:

Cesarean deliveries were 50.4% and 49.6% normal. 46.1% had immediate and uninterrupted skin-to-skin contact at birth and were breastfed in the first hour of life. The age of the parturients ranged from 13 to 46 years and the nurse was present in 96% of the deliveries.

Conclusion:

Less than half of the children studied performed the fourth step of the Baby Friendly Hospital Initiative, assuming that cesarean delivery was the main indication for noncompliance with this step and normal delivery was considered as a contributing factor for this performance. Therefore, it is suggested that there be supplementary support for postpartum women undergoing caesarean section to help them initiate early contact and breastfeeding as soon as possible.