**5.3 Policy for implementing C-section delivery procedures according to indications**

Taking into account the trend of cases of C-section deliveries that continue to increase, the current policy of C-section deliveries at health care providers needs to be reviewed. The factors that influence the increase in C-section deliveries need to be re-examined to reduce unnecessary C-sections. Health care professionals really need to make strict policies on the implementation of C-section deliveries. This procedure is done if it is to save the mother and baby. It is only recommended when the life of the mother or fetus is threatened [3]. If the mothers do not experience any complications at the end of the pregnancy, C-sections should not be implemented for them [5]. It should be made apparent that a C-section will actually cause complications for the mother and baby.

### **5.4 Facilitating the mothers with C-sections for early initiation of breastfeeding**

Likewise, mothers who give birth vaginally, mothers with C-section delivery also need early contact and early initiation of breastfeeding. A study of women planning an elective C-section birth at a public hospital in New South Wales, Australia found that mothers who had skin-to-skin contact (SSC) during a C-section had positive experiences with better bonding. Mothers also reported lower anxiety and depression than prior C-sections. Chi-square analysis in the intervention group also showed that there was a significant relationship between having SSC and exclusive breastfeeding, p < 0.005. According to the odds ratio, newborns (n = 51) were twice (OR: 2.24; 95% CI 1.79–2.82) more likely to breastfeed exclusively if they were in the intervention group. A recent study provides evidence of the benefits of skin-to-skin contact during C-section [49].

Studies have shown that skin-to-skin contact after birth enhances innate behavior and the release of maternal oxytocin and can benefit breastfeeding outcomes and early attachment of the mother's baby. Although obstacles were found associated with skin-to-skin contact during C-section. This can be overcome by educating operating room staff about the benefits of SSC so that it can facilitate mothers and babies to do SSC and early initiation of breastfeeding. That study confirms previous findings that new mothers need skilled support and accompaniment after birth [39].

According to the findings of a different study, mothers who underwent an emergency C-section were more likely to have tried breastfeeding their child unsuccessfully before, be unable to do so for the first 24 hours after giving birth, and be unable to do so after leaving the hospital. This is consistent with recent research that found that mothers who gave birth through emergency C-section had a higher likelihood of being unable to breastfeed their child at either the time of delivery or upon discharge. It has been established that early postpartum breastfeeding difficulties and early discontinuation may be related to the mother and fetal stress response associated with delivery issues, particularly those related to C-section. Abdominal surgery's insult in both intended and emergency C-section may equally affect the lacto genesis process, although the notion of an emergency may invoke a greater or prolonged maternal stress response [9]. In these emergency conditions, facilitation for contact as early as possible between mother and baby still needs to be pursued while still paying attention to the condition of the mother and baby.

Research by Zavala-Soto et al. by observing mothers giving birth with C-section who had SSC showed satisfaction felt by the mother, exclusive breastfeeding and continued breastfeeding. The majority of participants in this study group were considered high risk due to previous C-section (39%), abnormal presentation, twins or premature babies, exacerbated diseases such as hypertension and diabetes, or complications during labour (42%). Nevertheless, since the mother's and infant's condition were stable, a pro-breastfeeding C-section was conducted, which included emotional and physical support, a warm environment, woman-centred care and skin-to-skin contact, particularly without interruption with supervised initial feeding at the breast. It was observed that the majority of these women exclusively breastfed for 6 months, including twins and six of eight premature babies (75%) [50]. This shows that optimal facilitation by health care professionals in women giving birth with C-sections can help implement SSC and increase the achievement of exclusive breastfeeding and the continuation of breastfeeding.

#### **5.5 Support of health care professionals, husband and family and community**

When mothers are supported at the institution, in the community, or in their families, breastfeeding practices have been found to improve [12, 14, 15].

Offering breastfeeding assistance to women was linked to a 12% lower risk of discontinuing exclusive breastfeeding before the age of 6 months, according to a Cochrane analysis (RR 0.88, 95% CI 0.85–0.92, 46 studies) [14]. Another study discovered that the most successful intervention to increase breastfeeding rates was hospital support that was Baby Friendly Hospital Initiative (BFI), which was linked to a 49% increase in exclusive breastfeeding (RR 1.49, 95% CI 1.33–1.68) and a 20% increase in early breastfeeding initiation (RR 1.20, 95% CI 1.11–1.28) [35]. In line with other study showed that several participants stated that they received positive support from the midwife, especially regarding their breastfeeding problems. The participants felt empowered and developed better relationships with their babies because of the support they received [40].

Difficulties encountered in the early stages of breastfeeding could lead to misperceptions about inadequate milk secretion [13]. This perception can affect the success of breastfeeding postpartum mothers in the future. The comfort of breastfeeding is one of the important factors in stimulating milk secretion, which is a reflex elicited by the baby's sucking. This type of suction can stimulate the secretion of prolactin which is secreted from the anterior lobe of the pituitary gland. However, the pain

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

from a C-section and anxiety suppresses both prolactin and milk secretion because pain stimulates the release of catecholamine neurotransmitters. The results of previous studies show that 2–5 days after delivery, the secretion of breast milk in women with C-sections is less than in women with vaginal birth. Furthermore, psychological adjustment after C-section interferes with the mother's learning about maternal and infant care skills and makes her feel incompetent in breastfeeding [13]. Therefore, C-section is a significant obstacle to early initiation of breastfeeding [51]. This condition indicates that mothers with C-sections really need support to be able to breastfeed their babies. There is evidence to suggest that professional support or the support of trained and experienced health workers supports the continuation of breastfeeding [35]. Women undergoing C-section need more specialized resources that can provide mental and physical support for breastfeeding, especially in the early postpartum period. It is also critical to promote optimal postpartum nursing positions, such as "biological nurturing." Breast milk volume and maternal self-efficacy could be improved by maintaining a comfortable breastfeeding position and hastening postoperative recovery [42].
