**3. The early initiation of breastfeeding and breastfeeding practice by mothers with C-section delivery**

Several studies have shown the low practice of early initiation of breastfeeding and breastfeeding in mothers who give birth with C-section delivery [9, 11, 32–36]. In comparison to women who gave birth vaginally, mothers who underwent a C-section had reduced odds of timely initiation of breastfeeding (TIBF), according to the findings of a systematic review. This situation also occurs in studies conducted in Ethiopia, Nigeria, Turkey, Saudi Arabia, Lebanon, Brazil, and India [31]. Another study using data from the Ethiopian Demographic and Health Survey revealed that among mothers who had given birth to their last living child, the prevalence of delayed breastfeeding was 25.03% (95%CI, 20.5–32.2). C-section delivery was one of the important variables linked with delayed breastfeeding initiation [AOR = 4.06 (95%CI, 2.66–6.2)]. The likelihood of delayed initiation of breastfeeding is four times higher among women who had C-section deliveries as compared to women who delivered vaginally [11].

According to a study conducted in Alberta, Canada, more mothers who had planned C-sections had no intention of breastfeeding or did not initiate breastfeeding (7.4% and 4.3%, respectively) than mothers who had a vaginal delivery (3.4% and 1.8%, respectively) or emergency C-sections (2.7% and 2.5%, respectively) [9]. It is also supported by another study that women with vaginal birth are 4.57 (3.16, 6.61) compared to planned C-section deliveries 1.64 (1.09, 2.46) four times more likely to initiate early breastfeeding [37]. According to a meta-analysis of 17 research, the pooled estimate of timely breastfeeding initiation among C-section women in Ethiopia was 40.1% (95% CI 33.29, 46.92). When compared to vaginal birth, C-section was related to a 79% reduced chances of timely breastfeeding initiation (OR 0.21; 95% CI 0.16, 0.28) [38].

According to numerous research, C-section births are related to delays in breastfeeding initiation or perhaps no breastfeeding initiation at all. The duration of breastfeeding in the months that follow may be impacted by this condition. According to the study, women who underwent C-section deliveries had lower rates of both exclusive and general breastfeeding than women who gave birth vaginally. Additionally, consuming formula in the hospital and a delayed start to breastfeeding were associated with C-section birth. The duration of breastfeeding was also reduced after C-section birth (hazard ratio = 1.40, 95% confidence range [1.06, 1.84]) [32]. Another study also showed that Women who had a planned C-section were more likely (OR = 1.61; 95% CI: 1.14, 2.26; p = 0.014) to cease breastfeeding before 12 weeks [9]. Several of these studies show that the practice of early initiation of breastfeeding and breastfeeding by mothers with C-section delivery is still low. The strategy is needed to be able to improve the implementation of early breastfeeding initiation and breastfeeding practices in mothers who deliver by C-section.
