**1. Introduction**

Cesarean section (C-section) is an intervention to overcome complications in labour by delivering the foetus to the uterine wall through the front abdominal wall. Currently, SC is much more performed because of the very development of the procedure [1]. A C-section must still be understood as an alternative to childbirth if a normal delivery cannot be done. Ninety per cent of the delivery processes are normal, while the rest might have complications. Prioritizing the safety of the mother and baby is essential to address the difficulty during labour process [2]. C-section is also associated with maternal and newborn survival, as it can be a life-saving intervention if appropriately indicated [3]. However, in recent decades, the rate of CS has increased in many countries to become more common than vaginal birth [3, 4].

C-section rates worldwide increased from 6.7% in 1990 to 19.1% in 2014 [5]. The increase in CS in various countries can be seen in the following graph (**Figure 1**).

A recent WHO report showed that C-section deliveries continue to rise worldwide, accounting for more than one-fifth (21%) of all deliveries. This figure is expected to rise further in the future decades, with almost one-third (29%) of all newborns predicted to be delivered *via* C-section by 2030 [4]. The trends (1990–2018) and projections (2030) in global, regional and subregional estimates of C-section rates.

By 2030, the C-section rate will be similar in more and less developed countries 36.6% (95% CI 31.7% to 41.4%) and 36.5% (95% CI 32.7% to 40.3%), respectively (**Figure 2**). The C-section rate in the least developed countries will be 11.8% (95% CI 9.7% to 13.8%). In Africa, the Northern sub-region will increase to 48.1% (95% CI 37.4% to 58.8%) CS rate in 2030, while the Sub-Saharan sub-region will remain at 7.1% (95% CI 6.4% to 7.9%). Eastern and Western Asia will reach the 50% mark by 2030, with C-section rates of 63.4% (95% CI 52.9% to 74.0%) and 50.2% (95% CI 47.4% to 52.9%) respectively. Central Asia, on the other hand, has the lowest prediction in this region with a C-section rate of 13.3% (95% CI 2.0% to 24.6%). According to projections for the Americas, 54.3% (95% CI 48.3% to 60.2%) of women in Latin America and the Caribbean will give birth by C-section in 2030, while Northern America will use C-section at a lower rate of 33.8% (95% CI 22.8% to 44.8%). According to projections for Europe, the highest C-section rates are expected in Southern Europe, at 47% (95% CI 38.8% to 53.3%), while C-section will be used in 27.6% (95% CI 16.2% to 39.1%) of births in Northern Europe, with little change over the next decade. In Australia and New Zealand, the use of C-section will rise to 45% (95% CI 38.1% to 52.0%) by 2030 [6]. In current conditions, C-section delivery is not only used as an emergency delivery but as a choice for mothers to give birth even without labour complications.

The trend of selecting C-section as the birth method chosen by mothers is influenced by several reasons, namely women's intense fear of pain and injuries to the mother and child during labour, unpredictability in vaginal delivery, and favorable attitudes or perceived advantages of C-section [7]. In line with the research of Suwanrath et al., [8] which states the results of a qualitative study of mother's reasons

**Figure 1.** *Global and regional trends in CS, 1990–2014 [5].*

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

#### **Figure 2.**

*Trends (1990–2018) and projections (2030) in global, regional and subregional estimates of C-section rates. The solid lines represent trend estimations, while the dotted lines represent predictions. (A) World; (B) Africa; (C) Asia; (D) Americas; (E) Europe; and (F) Oceania. Rates and projections for Melanesia, Micronesia, and Polynesia were not estimated due to the low coverage of data in this Oceania subregion [6].*

for C-section preference, such as fear of the birthing process, concerns about safety related to perceived risks that could disrupt health conditions, unpleasant experiences in previous births, positive views towards C-section, access to biased information and belief in auspicious date. Most women choose to give birth by C-section for more than one reason [8]. This increase in C-section delivery occurred globally in both developed and developing countries. This shows that C-section delivery is a global issue that needs special attention and follow-up to reduce it. In addition, this situation must be mindful of because it could have an impact on the health outcomes of mothers and babies.

Recent studies have related C-section delivery with an increased risk of several outcomes later in life, such as type 1 diabetes, asthma and obesity. Another study also stated that mothers who gave birth by C-section were less likely to breastfeed or to delay early initiation of breastfeeding [9]. In fact, early initiation of breastfeeding is one of the keys to the success of exclusive breastfeeding. In addition, early initiation of breastfeeding is important because it has many benefits, namely, it allows the release of colostrum as the baby's first immunity, contains many vitamins and other protective factors, can increase the bond between mother and baby and reduce the risk of postpartum hemorrhage [10]. Delay in early initiation of breastfeeding at C-section is associated with separation of mother and baby, reduced ability to breastfeed the baby, decreased acceptance of the baby, and lack of milk supply, which can result in shorter duration of breastfeeding [9]. The results of previous studies

showed that there was a negative correlation between delivery by C-section and the implementation of early initiation of breastfeeding [11]. This shows that C-section is one of the obstacles in early breastfeeding [12]. Therefore, health workers need to provide education to mothers and families if they can give birth spontaneously and do not have medical indications, then delivery can be done spontaneously. If indeed the mother needs a C-section delivery for medical reasons, healthcare professionals (obstetricians, midwives and nurses) also need to optimize the implementation of early initiation of breastfeeding for mothers with C-section delivery so that mothers and babies can still gain the experience of early initiation of breastfeeding and early bonding to the baby [9, 11]. According to the research, a variety of variables, including breastfeeding constraints brought on by the mother's physical discomfort and surgical incision pain, may impair breastfeeding following a C-section. Another study revealed that women who received C-sections experienced breastfeeding challenges. It was discovered through semi-structured interviews that the majority of the mothers had post-C-section nausea, vomiting, and exhaustion. In addition, these women's early postpartum limb numbness from the local anesthetic used during surgery limited their ability to move around and made it more difficult for them to interact with their infants. The majority of women frequently express breastfeeding issues, which are significantly influenced by incision discomfort. Most mothers who undergo a C-section in a South African exploratory study stated that the soreness following the procedure was excruciating [13].
