Indications of Cesarean Section and its Impact on Breastfeeding Initiation, Duration, Method of Feeding and Difficulties in the First 6 Months Postpartum in Rania City


  • Mahmood Arif Mahmood BSc, MSc, and PhD in Pediatric Nursing Science / University of Raparin / College of Nursing / Iraq
  • Kaify Jamil Qadir BSc, MSc, and PhD in Pediatric Nursing Science / Hawler Medical University / College of Nursing / Iraq
  • Gashbin Akram Najib BSc Nursing
  • Dlnya Kamaran Asad BSc Nursing
  • Zhina Salih Abdulls BSc Nursing


Timely initiation of breastfeeding, Exclusive breastfeeding, Cesarean section, Indications,, Postpartum


Background: Breastmilk is vital in attaining newborn health and optimum growth and
development. Early initiation of breastfeeding which is affected by way of delivery has great
importance for both mothers and newborns. The main aim of this study is to assess breastfeeding
barriers and difficulties among mothers undergo cesareans section.
Methodology: A cross sectional, descriptive study was conducted among a convenience
sample of 100 mothers having 6-24-month age children which were born through cesarean
section in Rania city. The data were collected using a questionnaire format with face to face
interviewing technique from 15th to 27th December 2021. Validity and reliability of the data
collection tool was attained (r.=0.73) and data were analyzed using SPSS.

More than half of mothers were at the age of 24-35 years old. The highest percentage of mothers
42% were at the highest level of education and the majority of them 82% were house wife. Most
of the mothers 79% were at barely sufficient monthly income. About half of the cesarean
deliveries 47% were emergency. Only 36% of the mother’s initiate feeding within first hour and
54% of them practiced exclusive breastfeeding for the first day following delivery. Highest
percentage of mothers mentioned pain as a main difficulty for breastfeeding within the first day
of life, while insufficient milk was the main difficulty following that period. There were no
significant association between breastfeeding history, difficulties of breastfeeding and
indications of cesarean section.
Cesarean delivery adversely affected timely initiation of breast feeding and continuing for the
age of six months. Different indications of cesarean delivery had no significant association with
the history of breastfeeding and its difficulties.


Chen, C., Yan, Y., Gao, X., Xiang, S., He, Q., Zeng, G., Liu, S., Sha, T. & Li, L. 2018.

Influences Of Cesarean Delivery On Breastfeeding Practices And Duration: A Prospective

Cohort Study. Journal Of Human Lactation, 34, 526-534.

Gedefaw, G., Goedert, M. H., Abebe, E. & Demis, A. 2020. Effect Of Cesarean Section On

Initiation Of Breast Feeding: Findings From 2016 Ethiopian Demographic And Health Survey.

Plos One, 15, E0244229.

Getaneh, T., Negesse, A., Dessie, G., Desta, M., Temesgen, H., Getu, T. & Gelaye, K. 2021.

Impact Of Cesarean Section On Timely Initiation Of Breastfeeding In Ethiopia: A Systematic

Review And Meta-Analysis. International Breastfeeding Journal, 16, 1-10.

Hobbs, A. J., Mannion, C. A., Mcdonald, S. W., Brockway, M. & Tough, S. C. 2016. The Impact

Of Caesarean Section On Breastfeeding Initiation, Duration And Difficulties In The First Four

Months Postpartum. Bmc Pregnancy And Childbirth, 16, 1-9.

Horta, B. L., Loret De Mola, C. & Victora, C. G. 2015. Long‐Term Consequences Of

Breastfeeding On Cholesterol, Obesity, Systolic Blood Pressure And Type 2 Diabetes: A

Systematic Review And Meta‐Analysis. Acta Paediatrica, 104, 30-37.

Mahmood, M. 2016. Assessment Of Some Associated Factors With Omitting Exclusive

Breastfeeding In Rania City. University Of Raparin, 3, 8.

Ochieng Arunda, M., Agardh, A. & Asamoah, B. O. 2020. Cesarean Delivery And Associated

Socioeconomic Factors And Neonatal Survival Outcome In Kenya And Tanzania: Analysis Of

National Survey Data. Global Health Action, 13, 1748403.

Organization, W. H. 2018. Who And Unicef Issue New Guidance To Promote Breastfeeding In

Health Facilities Globally.

Organization, W. H. & Unicef. 2003. Global Strategy For Infant And Young Child Feeding,

World Health Organization.

Paksoy Erbaydar, N. & Erbaydar, T. 2020. Relationship Between Caesarean Section And

Breastfeeding: Evidence From The 2013 Turkey Demographic And Health Survey. Bmc

Pregnancy And Childbirth, 20, 1-9.

Samdal, L. J., Steinsvik, K. R., Pun, P., Dani, P., Roald, B., Stray-Pedersen, B. & Bøhler, E.

Indications For Cesarean Sections In Rural Nepal. The Journal Of Obstetrics And

Gynecology Of India, 66, 284-288.

Sharifirad, G., Rezaeian, M., Soltani, R., Javaheri, S. & Mazaheri, M. A. 2013. A Survey On The

Effects Of Husbands’ Education Of Pregnant Women On Knowledge, Attitude, And Reducing

Elective Cesarean Section. Journal Of Education And Health Promotion, 2.

Smith, E. R., Locks, L. M., Manji, K. P., Mcdonald, C. M., Kupka, R., Kisenge, R., Aboud, S.,

Fawzi, W. W. & Duggan, C. P. 2017. Delayed Breastfeeding Initiation Is Associated With Infant

Morbidity. The Journal Of Pediatrics, 191, 57-62. E2.

Yisma, E., Mol, B. W., Lynch, J. W. & Smithers, L. G. 2019. Impact Of Caesarean Section On

Breastfeeding Indicators: Within-Country And Meta-Analyses Of Nationally Representative

Data From 33 Countries In Sub-Saharan Africa. Bmj Open, 9, E027497