Breastfeeding practices after caesarean section (C-section) at the Essos Hospital Center

Abstract

Background: Exclusive breastfeeding is the gold standard for infant feeding; combined with early breastfeeding, it becomes very beneficial for the child and his mother. However, caesarean section can affect its practice. Objective: To evaluate breastfeeding practices after caesarean section in the maternity ward of the Essos Hospital Center. Material and methods: Our retrospective and analytical cross-sectional study went from January 2020 to July 2020. Included in our sample were women who gave live-births by caesarean section at the Essos Hospital Center, whose children were alive. Interviews used a pre-established and pre-tested questionnaire, Data were collected using CSPro software version 7.3.1. The odds ratio with its 95% confidence interval was used to assess the association between the different variables. Any difference was considered statistically significant when the p-value <0.05. Results: We recruited 70 caesarized women, all the mother-child pairs had been separated, and none of the mothers had breastfed early. Furthermore, 42.9% of lactating women had given the breast between 1 and 24 hours after birth, and 52.9% twenty-four hours later. A statistically significant association existed between the duration of separation and the delay in breastfeeding initiation (duration of separation 24h (OR= 0.07; IC= 0.00-0.42; p=0.016); 48h (OR=0, 02; CI=0.00=0.18; p=0.002); 48h-72h (OR=0.03; CI=0.00-0.28; p=0.007)). Conclusion: In this population, caesarean section and mother-child separation played a major negative role by delaying the initiation of breastfeeding.

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Introduction
Breastfeeding (BF) is dened as the feeding of newborns and infants
with breastmilk. Exclusive breastfeeding is the gold standard for
infant feeding during the rst months of life. The WHO recommends
“exclusive breastfeeding for the rst six months of life, and continued
breastfeeding until the age of two years, or even beyond, according to
the desires of the mothers”.1–3 However, it is important to note that,
in the developing world, only 38% of children under six months are
exclusively breastfed; and that in Cameroon, the rate is just as low,
according to the latest DHS Cameroon 2018 report, of 40% between
0-5months.4 A study conducted in Ghana shows that breastfeeding
babies within an hour of birth prevent 22% of neonatal deaths; and
children who are breastfed for the rst few months are at least six
times more likely to survive than children who are not breastfed.5 The
correlation between breastfeeding, health and well-being is becoming
clear. In 2017 globally, an estimated 78 million newborns waited more
than an hour before being put to the breast.
This means that only about two in ve children (42%), mostly born
in low and middle-income countries, were breastfed within one hour
of birth. In West and Central Africa.6 Despite such benets, caesarean
section negatively affects the practice of breastfeeding. In a study
entitled “Birth by cesarean section and the start of breastfeeding”
carried out in 2015 in France, by Sylvie Bouvarel, the start of
breastfeeding presented more difculties in the case of cesarean
section than in the case of vaginal delivery birth; but there was also
is a signicant increase in the rst latching time after csection.7
Besides the time of initiation which is delayed, the duration of the
period of exclusive breastfeeding can be shortened. In addition, some
authors have reported even more negative effects in the event of a
planned cesarean compared to an emergency cesarean.8,9 These data
are of utmost importance to consider with the increase of C-section
rates even in regions with limited resources.10 Within this context we
designed this monocentric study with the objective to analyze the
practices of breastfeeding after C-section as well as the factors that
inuence it.
Materials and methods
We conducted a retrospective and analytical cross-sectional study
over a period from January 2020 to July 2020. It took place in the
maternity ward of the Essos Hospital Center, a tertiary level care
structure in the city of Yaoundé. Were included in our sample, women
who gave birth less than 2 months ago by C-section at term of living
newborns of at least 36 weeks of amenorrhea.
After consulting their medical records, they were contacted by
telephone, and the study was clearly presented to them, with its
objectives and informed consent. The main variables collected during
the interview concerned socio-demographic characteristics, duration
of the stay in the maternity ward, length of separation after C-section
and breastfeeding practices. Interviews used a pre-established and
pre-tested questionnaire which was validated.
Data were entered and recorded using CSPro version 7.3.1
software. All statistical analyzes were performed using R version
3.6.2 software. At the univariate level, the frequency distributions
were used for the categorical variables the Chi 2 test was used to
perform the test of independence between the dependent variable
and the independent variables, the Fisher ’s Exact test was used
alternatively when the conditions of applicability of the Chi 2 test
were not satised, in addition the unadjusted ORs were estimated.
At the multivariate level, logistic regression was used to estimate the
adjusted ORs and their 95% CI to nd factors associated with early
breastfeeding.
J Pediatr Neonatal Care. 2023;13(2):82‒85. 82
©2023 Ludovic et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and build upon your work non-commercially.
Breastfeeding practices after caesarean section
(C-section) at the Essos Hospital Center
Volume 13 Issue 2 - 2023
Ludovic Nguessa,1 Arsene Sandie,2 Anne
Esther Njom Nlend1,3,4
1Higher Institute of Medical Technology, Cameroon
2African Population and Health Research Center, Sénégal
3Health Ebene Consulting, Research Department, Cameroon
4Essos Hospital Center, Cameroon
Correspondence: Prof. AE Njom Nlend, Higher Institute
of Medical Technology, Health Ebene Consulting, Research
Department, Essos Hospital Center, Yaoundé, Cameroon,
Email
Received: April 07, 2023 | Published: May 10, 2023
Summary
Background: Exclusive breastfeeding is the gold standard for infant feeding; combined
with early breastfeeding, it becomes very benecial for the child and his mother. However,
caesarean section can affect its practice.
Objective: To evaluate breastfeeding practices after caesarean section in the maternity
ward of the Essos Hospital Center.
Material and methods: Our retrospective and analytical cross-sectional study went from
January 2020 to July 2020. Included in our sample were women who gave live-births by
caesarean section at the Essos Hospital Center, whose children were alive. Interviews used
a pre-established and pre-tested questionnaire, Data were collected using CSPro software
version 7.3.1. The odds ratio with its 95% condence interval was used to assess the
association between the different variables. Any difference was considered statistically
signicant when the p-value <0.05.
Results: We recruited 70 caesarized women, all the mother-child pairs had been separated,
and none of the mothers had breastfed early. Furthermore, 42.9% of lactating women had
given the breast between 1 and 24 hours after birth, and 52.9% twenty-four hours later. A
statistically signicant association existed between the duration of separation and the delay
in breastfeeding initiation (duration of separation 24h (OR= 0.07; IC= 0.00-0.42; p=0.016);
48h (OR=0, 02; CI=0.00=0.18; p=0.002); 48h-72h (OR=0.03; CI=0.00-0.28; p=0.007)).
Conclusion: In this population, caesarean section and mother-child separation played a
major negative role by delaying the initiation of breastfeeding.
Keywords: breastfeeding, caesarean section, post-partum
Journal of Pediatrics & Neonatal Care
Research Article Open Access

Breastfeeding practices after caesarean section (C-section) at the Essos Hospital Center 83
Copyright:
©2023 Nguessa et al.
Citation: Nguessa L, Sandie A, Nlend AEN. Breastfeeding practices after caesarean section (C-section) at the Essos Hospital Center. J Pediatr Neonatal Care.
2023;13(2):82‒85. DOI: 10.15406/jpnc.2023.13.00496
Ethical considerations
Ethical clearances and administrative authorization for carrying
out our study were issued by the administrative management of the
Essos Hospital Center under reference number 29/20/DCHE/DA/
CE-CHE/CNPS and by the Ethics and Institutional Committee of the
University of Douala.
Results
The mothers contacted numbered 123. Twenty-six of them were
unreachable, and 25 refused to participate in the study and two were
excluded (due to incomplete collection sheets). A total of 70 mothers
were recruited (see Figure 1).
Figure 1 ow chart of recruitment.
Sociodemographic and biodemographic
characteristics
The mothers who participated in this study were aged between 20
and 41, of whom 77.1% were aged between 21 and 34; the average
age was 30.5 years (see Table 1 & 2).
Table 1 Characteristics of the population
N %
Age years
21-34 54 77.1
≥35 16 22.9
Total 70 100
Employment
No 30 42.9
Yes 40 57.1
Total 70 100
Marital status
Single 17 24.3
Married 53 75.7
Total 70 100
Antenatal Follow-up
Yes 70 100
No 0 0
Total 70 100
Table 2 Feeding mode
N %
Articial Bottle feeding 6 8.6
Exclusive breast feeding (EBF) 30 42.8
Mixed feeding 34 48.6
Total 70 100.0
Feeding practices
• Initiation and feeding option
None of the mothers reported giving the breast within one hour
of birth. During the rst two months, less than half of the mothers
practiced EBF (see Table 3).
Table 3 Mother-child separation
N %
Duration of separation
<24h 12 17.1
24h 28 40.0
48h 19 27.1
>48h 11 15.7
Total 70 100.0
Admission in neonatology unit:
Yes 66 92.9
No 4 7.1
Total 70 100.0
Reason of transfer in neonatology
Surveillance 36 54.5
Special care 30 45.5
Total 66 100.0
Mother in recovery room
Yes 66 94.3
No 4 5.7
Total 70 100.0
Admission of mother in intensive unit:
Yes 5 7.1
No 65 92.9
Total 70 100.0
• Factors inuencing early breastfeeding Mother-child
separation and early breastfeeding
All the mothers had been separated from their children at birth,
40% of them for 24 hours. Sixty-ve newborns had been admitted
in neonatology. Considering the duration of mother-child separation
<24h, it appears that the mothers in this category breastfed earlier
(delay 1h-24h) than those in the other categories, namely 24h, 48h
and 48-72h; statistically signicant between the duration of mother-
child separation and the initial breastfeeding delay (p= 0.016; 0.002
and 0.007). With the adjusted odds ratios, we observe a signicant
difference between the duration of mother-child separation (24 hours
(p=0.026) and 48h(p=0.004)) and the time to breastfeed (Table 4 & 5).

Breastfeeding practices after caesarean section (C-section) at the Essos Hospital Center 84
Copyright:
©2023 Nguessa et al.
Citation: Nguessa L, Sandie A, Nlend AEN. Breastfeeding practices after caesarean section (C-section) at the Essos Hospital Center. J Pediatr Neonatal Care.
2023;13(2):82‒85. DOI: 10.15406/jpnc.2023.13.00496
Table 4 Reasons for separation from Mother and delay in breast feeding and unadjusted odds ratio
Birth-rst latch time 1h-24h >24 h Unadjusted OR (95%CI, p)
Separation time (hours) <24h 11 (36.7) 1 (2.5) -
24h 12 (40.0) 16 (40.0) 0.07 (0.00-0.42, p=0.016)
48h 4 (13.3) 15 (37.5) 0.02 (0.00-0.18, p=0.002)
>48h 3 (10.0) 8 (20.0) 0.03 (0.00-0.28, p=0.007)
Mother in recovery room Yes 29 (96.7) 37 (92.5) -
No 1 (3.3) 3 (7.5) 0.43 (0.02-3.52, p=0.469)
Mother admitted in
intensive care unit Yes 0 (0.0) 5 (12.5) p=0.992
No 30 (100.0) 35 (87.5) -
Admission in neonatalogy Ye s 28 (93.3) 37 (92.5) -
No 2 (6.7) 3 (7.5) 0.88 (0.11-5.66, p=0.893)
Reason of admission in
neonatalogy Surveillance 18 (64.3) 18 (47.4) -
Special care 10 (35.7) 20 (52.6) 0.50 (0.18-1.34, p=0.175)
Table 5 Multivariate distribution of factors associated with delay in breastfeeding after caesarean section
Birth-rst latch time Adjusted OR (95% CI, p)
Separation time (hours)
<24h -
24h 0.04 (0.00-0.47, p=0.026)
48h 0.01 (0.00-0.16, p=0.004)
Reason for admission in
Neonatology
>48h 0.07 (0.00-1.39, p=0.107)
Surveillance -
Special care 0.36 (0.04-2.77, p=0.335)
Mother in recovery room Yes -
No 1.42 (0.03-64.79, p=0.844)
Age 21-34 years -
≥35 years 0.20 (0.02-1.38, p=0.125)
Level of education
Primary -
Secondary 0.20 (0.00-5.46, p=0.363)
Higher 0.11 (0.00-1.47, p=0.131)
Employment No -
Yes 1.83 (0.37-10.90, p=0.473)
Marital status Single -
Married 0.17 (0.01-1.31, p=0.115)
Parity Primiparous -
Multiparous 1.64 (0.23-15.28, p=0.638)
Type de pregnancy Single -
Multiple 7.60 (0.72-104.09, p=0.103)
Term
Preterm -
Normal term 0.21 (0.02-1.69, p=0.161)
post-Term 0.74 (0.07-7.94, p=0.806)
• Difculties during breastfeeding
We also found that 60.9% of breastfeeding mothers had encountered
difculties, and that the main one was the presence of cracks on the
nipples (30.8%), followed by insufcient secretion of milk (20.5%).
Discussion
We aimed to evaluate the practices of breastfeeding after caesarean
section in the maternity ward of the Essos Hospital Center. The
main result is a delay in the start of breastfeeding, partly caused by
the separation of the mother and the baby. However, the exclusive
breastfeeding rate is similar to that recorded in the general population.4
We know that the earlier breastfeeding is started, the longer it lasts and
that caesarean section signicantly affects the rate of EBF by delaying
the latching time.11 The breastfeeding rate observed in our series is
slightly lower than that observed in the study by Wu et al in China,
which showed a prevalence of 52.4% for EBF.12

Breastfeeding practices after caesarean section (C-section) at the Essos Hospital Center 85
Copyright:
©2023 Nguessa et al.
Citation: Nguessa L, Sandie A, Nlend AEN. Breastfeeding practices after caesarean section (C-section) at the Essos Hospital Center. J Pediatr Neonatal Care.
2023;13(2):82‒85. DOI: 10.15406/jpnc.2023.13.00496
• Factors inuencing early latch on after caesarean section
All of the mothers interviewed had been separated from their
newborns at birth. This prolonged separation at birth negatively
inuenced early breastfeeding. The results obtained by Albokhary and
James in 2014 in Saudi Arabia, on a population of 60 births, including
30 caesareans, are similar to our results. Their results show that none
of the caesarized mothers had breastfed early; 60% had breastfed
during the 24 hours following birth and 40% more than 24 hours after
birth.13 The data from this site conrms a delay in the initiation of
breastfeeding in these caesarized women after 24 hours, while 48% of
mothers put their baby to the breast within one hour of birth according
to the latest demographic health survey.4
• Problems during breastfeeding
We also found that 60.9% of breastfeeding mothers had encountered
difculties, and that the main one was the presence of cracks on the
nipples (30.8%), followed by insufcient secretion of milk (20.5%).
Our result is close to that of Saeed et al, but quite different from that
of Hobbs et al.9,14
Limitations of the study and
recommendations
Among the limitations of the study, we note: the small size of the
sample, which is due to the non-availability and massive refusals
to participate; the context of the Covid-19 pandemic which made it
impossible to meet the patients; the failure to take into account the
type of anesthesia in this retrospective study including the type of
C-section; elective or emergency caesarean section.15
In addition, the monocentric nature of this recruitment in a tertiary
health facility may have overestimated the transfer rate and the
duration of separation of the newborn from its mother.
Also, on the basis of this preliminary study and in view of the
previously stated limits, we suggest a broader study based on data
from demographic and health surveys to understand the impact of
caesarean section on the initiation and continuation of breastfeeding
in our context.16,17 In addition, building the capacity of staff on this
site, for the essential care of the newborn after caesarean section, in
particular early breastfeeding is strongly recommended, as well as the
practice of skin to skin in women after caesarean especially in case of
locoregional anesthesia.18,19
Conclusion
In this site, after caesarean section, the almost automatic mother-
child separation greatly contributed to lengthening the time to
initiate breastfeeding, with moderate effects recorded on the rate of
breastfeeding during the rst two months of life.
Acknowledgements
We would like to express our gratitude to all the mothers who
participated in our study, as well as to the staff of the maternity and
neonatal departments.
Funding
None
Conicts of interest
The authors declare that they have no competing interests.
References
1. World Health Organization. Guideline: protecting, promoting and
supporting breastfeeding in facilities providing maternity and newborn
services. World Health Organization. 2017.
2. Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding.
Cochrane Pregnancy and Childbirth Group. Cochrane Database Syst
Rev. 2012.
3. Couto GR, Dias V, de Jesus Oliveira I. Benets of exclusive breastfeeding:
An integrative review. Nursing Practice Today. 2020;7(4):245–254.
4. Institut National de la Statistique (INS) et ICF. Enquête Démographique
et de Santé du Cameroun 2018. Yaoundé, Cameroun et Rockville,
Maryland, USA : INS et ICF. 2020.
5. Allaitement | Nutrition | UNICEF [Internet].
6. UNICEF, OMS. Saisir le moment – La mise au sein précoce : le meilleur
point de départ pour chaque nouveau-né. New York, UNICEF. 2018.
7. Sylvie Bouvarel. Démarrage de l’allaitement maternel et reprise de
poids des nouveau-nés en cas de césarienne : étude d’observation à la
maternité de l’Hôpital privé Drôme Ardèche. 2015.
8. Li L, Wan W, Zhu C. Breastfeeding after a cesarean section: A literature
review. Midwifery. 2021;103:103117.
9. Hobbs AJ, Mannion CA, McDonald SW, et al. The impact of caesarean
section on breastfeeding initiation, duration and difculties in the rst
four months postpartum. BMC pregnancy and childbirth. 2016;16(1):1–
9.
10. Betrán AP, Ye J, Moller AB, et al. The increasing trend in caesarean
section rates: global, regional and national estimates: 1990-2014. PloS
one. 2016;11(2):e0148343.
11. Zanardo V, Svegliado G, Cavallin F, et al. Elective cesarean delivery:
does it have a negative effect on breastfeeding? Birth. 2010;37(4):275–
279.
12. Wu Y, Wang Y, Huang J, et al. The association between caesarean
delivery and the initiation and duration of breastfeeding: a prospective
cohort study in China. Eur J Clin Nutr. 2018;72(12):1644–1654.
13. Albokhary AA, James JP. Does cesarean section have an impact on the
successful initiation of breastfeeding in Saudi Arabia? Saudi Med J.
2014;35(11):1400–1403.
14. Saeed G, Fakhar S, Imran T, et al. The Effect of Modes of Delivery on
Infants’ Feeding Practices. Iran J Med Sci. 2011;36(2):128–132.
15. Wen J, Yu G, Kong Y, et al. An exploration of the breastfeeding
behaviors of women after cesarean section: A qualitative study. Int J
Nurs Sci. 2020;7(4):419–426.
16. Gedefaw G, Goedert MH, Abebe E, et al. Effect of cesarean section on
initiation of breast feeding: Findings from 2016 Ethiopian Demographic
and Health Survey. PloS one. 2020;15(12):e0244229.
17. Paksoy Erbaydar N, Erbaydar T. Relationship between caesarean section
and breastfeeding: evidence from the 2013 Turkey demographic and
health survey. BMC pregnancy and childbirth. 2020;20:1–9.
18. Dudeja S, Sikka P, Jain K, et al. Improving rst-hour breastfeeding
initiation rate after cesarean deliveries: a quality improvement study.
Indian Pediatr. 2018;55(9):761–764.
19. Kollmann M, Aldrian L, Scheuchenegger A, et al. Early skin-to-skin
contact after cesarean section: A randomized clinical pilot study. PloS
one. 2017;12(2):e0168783.