A 21-year-old gravida 2, para 1001 female at 39 weeks and 4/7 days gestation was admitted to the labor and birth unit in active labor. She moved to the United States from Pakistan during the last 2 months of her pregnancy. She is a practicing Muslim. Her sister-in-law accompanied her. She had an uncomplicated antenatal course, except for iron deficiency anemia (at admission, her hemoglobin was 9.40 g/dl and hematocrit was 29.1%). She had an epidural anesthetic for pain relief. Her first stage of labor was 9 hours, her second stage was 5 minutes, and her third stage was 15 minutes. The baby was born over an intact perineum with Apgar scores of 9 and 9, respectively, and weighed 3,095 g. The baby was placed on the mother's abdomen, and once cleaned and wrapped in a blanket on the infant warmer, the baby was held by the mother. When asked her infant feeding preferences, the mother expressed eagerness to breastfeed. However, before initiation of breastfeeding, the sister-in-law asked the midwife permission to feed the baby a sweet (a drop of brown sugar). The sister-in-law explained that it was customary in Muslim families that “the first thing to touch the baby's mouth should be something sweet.” After the midwife agreed, the sister-in-law said a prayer. As requested by the mother, the baby was fed the drop of sweet. Breastfeeding was initiated within an hour postpartum. She reported exclusively breastfeeding from her birth until her 6-week postpartum visit.
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