**2. The importance of early breastfeeding initiation and breastfeeding practice**

Breastfeeding has been recognized as the most effective means of ensuring the health and survival of children. Breastfeeding for the first 6 months is crucial, so the World Health Organization (WHO) recommends related to breastfeeding, such as:


Early Breastfeeding Initiation is the process of giving breast milk to the mother to the baby within the first hour of birth. This is also a step towards ensuring the newborn receives colostrum [14, 15]. Early breastfeeding initiation benefits infants by providing newborn protection from infection and reducing newborn mortality [16]. This process also facilitates the emotional bond between mother and baby which has a positive impact on the duration of exclusive breastfeeding [17]. A mother who starts breastfeeding within an hour of giving birth will stimulate milk production. The milk produced in the first few days is yellow, called colostrum, a vital source of nutrition and immune protection for newborns [10].

In addition to providing protective benefits for the baby, early initiation of breastfeeding also provides an opportunity for skin-to-skin contact (SSC) between

#### *Breastfeeding by Mothers with Cesarean Section Delivery DOI: http://dx.doi.org/10.5772/intechopen.114014*

mother and baby. Skin-to-skin contact is defined as the practice of laying the baby on the mother's bare chest after the baby is dried and covered with a warm blanket and left for 1 hour after birth [18]. This contact stimulates the release of oxytocin in both mother and baby so it is associated with calm, bonding and reduction of stress, anxiety, and psychological distress [19, 20]. Full-body contact and the sound of a mother's heartbeat are thought to simulate the sensations a baby experiences before birth, further reducing stress. SSC has many benefits for postnatal neuro-physical adjustment [21]. Previous studies have shown that newborns who experience SSC with their mothers have better and more stable physiological functions than newborns who do not have SSC. This is related to newborns' temperature regulation, heart rate, respiration, and gastrointestinal adaption. Babies who experience SSC sleep better, cry less and have fewer painful reactions to routine hospital procedures [21, 22]. This is an important reason for early initiation of breastfeeding after delivery.

The implementation of early breastfeeding initiation is associated with success in continuing exclusive breastfeeding and beyond. Breastfeeding provides health benefits for children and mothers. The benefits of breastfeeding for mothers include helping to accelerate the postpartum involution process thereby reducing the risk of bleeding, reducing stress and accelerating the return of pre-pregnancy weight. Longterm benefits that can be obtained by breastfeeding mothers include reducing the risk of cardiovascular disease, type 2 diabetes, the risk of breast, ovarian and endometrial cancer [23, 24]. In addition to the benefits that mothers get, breastfeeding babies also provides benefits for optimal baby growth and development [25]. Breastfeeding also reduces the risk of infectious diseases in infancy but also reduces the risk of childhood obesity and later metabolic diseases [17, 26].

Exclusive breastfeeding is giving only breast milk for 6 months without any additional food and drinks [27]. However, globally the coverage of exclusive breastfeeding in infants still reaches 44% [28]. UNICEF global databases showed that South Asia achieved the highest exclusive breastfeeding coverage of 61%. Exclusive breastfeeding coverage Eastern and Southern Africa 55%, Latin America and the Caribbean 43%. Eastern Europe, Central Asia, East Asia and the Pacific are at 42% exclusive breastfeeding coverage. Meanwhile, in the West and Central Africa region it was at 38%, then the lowest was in the Middle East and North Africa at 32% [29]. Evidence from research results showed that breastfeeding practice is affected by a variety of sociodemographic (i.e., mother's age, marital status, level of education, employment status, income) and perinatal factors (i.e., parity, method of childbirth, early SSC practice, early initiation of breastfeeding, prenatal class, rooming-in practice) [17]. These factors can be optimized to become reinforcing factors to enable mothers to breastfeed from the first hour after birth.

The evidence about the risks of not breastfeeding for mothers and infants showed that non-breastfed newborns have a higher risk of infectious morbidities, such as an increased risk of childhood obesity, type 1 and type 2 diabetes, leukemia and sudden infant death syndrome (SIDS). Premature infants who are not breastfed are related to a higher risk of necrotizing enterocolitis (NEC). For mothers, failure to breastfeed has been linked with an increased prevalence of premenopausal breast cancer, ovarian cancer, persistent pregnancy weight gain, type 2 diabetes, and metabolic syndrome [30]. Psychologically, mothers who do not breastfeed their babies are reported to experience frustration and feel guilty due to not being able to breastfeed. They think they are not capable of breastfeeding, especially when the baby is crying [31]. This evidence shows that breastfeeding is important in the first hour after birth and continues for 6 months exclusively.
