**5. The facilitators to optimize breastfeeding by mothers with C-section Delivery**

### **5.1 Optimizing promotion of breastfeeding during antenatal care**

Health services for pregnant women are continuous with delivery, postpartum and newborn health services. Through antenatal care (ANC), promotion and education related to breastfeeding can be conveyed to mothers and their families. Education that needs to be conveyed includes the importance of breastfeeding, the implementation of early initiation breastfeeding and early contact, the right technique to breastfeed, to maintaining breastfeeding until the child is 2 years old can be given to mothers. This aims to prepare pregnant women so they have good knowledge regarding breastfeeding, readiness to breastfeed and self-efficacy for being able to breastfeed after birth [43]. Previous studies suggest that women who learn breastfeeding techniques and have high breastfeeding self-efficacy are more likely to be successful in breastfeeding their babies [44]. Enhancing and investing in healthcare facility ability to facilitate breastfeeding with continuity from prenatal care, early initiation breastfeeding advice, follow-up until hospital discharge, and postpartum care visits might improve exclusive breastfeeding [35].

#### **5.2 Education on normal childbirth for mothers without complications**

One of the main goals of every medical team dealing with childbirth is to have a safe delivery [3]. In accordance with the competence of midwives in facilitating clean, safe deliveries and providing a positive experience of the delivery process [45]. C-section was initially introduced to save the condition of the mother and fetus who were in an emergency. However, currently, there is a paradigm shift that C-section is considered an escape from labour pain. In addition, women also have the wrong assumption that C-section is considered painless, safer and healthier than vaginal delivery. In fact, more than half of women voluntarily choose C-section as the preferred mode of delivery [3]. Health education about normal delivery is important and crucial for health workers to restore the perception in women that normal delivery is a physiological process and has less risk than C-section delivery. Women need to be educated that C-sections are only performed in emergency situations in an effort to save the mother and baby. A cross-sectional study among 150 women in India showed that the most common reason for a voluntary C-section was a previous one, which happened 29 times (33%). Besides these, fetal distress (17%), mal-presentations (13%), and maternal request (9%), there were other signs. Most emergency C-sections were done because the baby was in fetal distress (39, or 62%), or because the woman had C-section history in previous labour (12, or 19%) [46]. Another study said that the indication of C-section could come from maternal side, uterine/ anatomic side and from fetal side [1].

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

According to a Norwegian study, primiparous women, those who have had several pregnancies, CS in the past, are older, have a higher gestational age, and have health issues related to pregnancy are less likely to deliver vaginally (gestational diabetes, low-lying placenta, high blood pressure). A model of care with a more natural birth philosophy, not restricting the woman's freedom of movement and position throughout labour and delivery, and continuity of care providers during labour are a few factors that can increase the likelihood of having a normal birth [47]. Raising knowledge of this link and including mothers in decision-making are crucial steps in achieving normal birth [13]. Promotion of normal delivery is achieved with a personalized strategy, encouraging the mother about her capacity, strength and confidence that the mother has to face the normal delivery process. It is important for the mother to feel empowered in the face of labour so that she can achieve a normal delivery and a positive birth experience [48]. Awareness of the mother's ability in the delivery process is expected to increase the mother's self-confidence to undergo a normal delivery process and not choose C-section delivery.
