# Prevalence of Delayed Initiation of Breastfeeding and Its Associated Factors Among Mothers Who Gave Birth by Cesarean Section in Gamo and Gofa Zones, Southern Ethiopia: A Multicenter Cross-Sectional Study

## TL;DR

This study finds that over half of mothers who had cesarean births in Ethiopia started breastfeeding late, with lack of support and counseling being key factors.

## Contribution

The study identifies specific factors linked to delayed breastfeeding initiation after cesarean births in a region with limited prior research.

## Key findings

- 53.4% of mothers who had cesarean births initiated breastfeeding late.
- Lack of professional assistance and skin-to-skin contact were strongly associated with delayed breastfeeding.
- Postcesarean counseling significantly influenced early breastfeeding initiation.

## Abstract

Background: Delayed initiation of breastfeeding after birth can negatively impact maternal and newborn health, significantly increasing neonatal mortality. Due to the rising number of cesarean deliveries, the risk of delayed breastfeeding initiation is imminent. However, there is limited evidence on delayed initiation of breastfeeding among mothers who gave birth by cesarean section in Ethiopia. Thus, this study aims to assess factors associated with delayed initiation of breastfeeding among mothers who gave birth by cesarean section in public health facilities of Gamo and Gofa zones, south Ethiopia.

Methods: This multicenter, facility-based, cross-sectional study was conducted across five hospitals in the Gamo and Gofa zones that offer cesarean delivery services. A consecutive sampling technique, which involves selecting every eligible subject until the desired sample size is reached, was employed to include 416 mothers who underwent cesarean sections between March 20 and May 21, 2023. Data collection was performed through an interviewer-administered questionnaire and chart reviews. The collected data were entered into Epi-Data Version 4.6 and subsequently exported to the Statistical Package for Social Sciences (SPSS) Version 26 for analysis. To identify factors associated with delayed initiation of breastfeeding, a logistic regression model was fitted, with statistical significance determined at a p value of less than 0.05.

Results: The prevalence of delayed initiation of breast feeding was 53.4% with 95% CI: (48.5, 58.2). Being primiparous (AOR = 1.9, 95% CI: 1.1, 3.5), a lack of assistance from a health professional for early initiation breastfeeding (AOR = 5.1, 95% CI: 3.0, 8.6), not applying early skin-to-skin contact (AOR = 3.3, 95% CI: 1.7, 6.4), and not receiving postcesarean counseling about early initiation of breastfeeding (AOR = 2.0, 95% CI: 1.6, 3.8) were significantly associated with delayed initiation of breastfeeding.

Conclusions: This study found a high prevalence of delayed breastfeeding initiation among mothers who had cesarean sections, with significant factors including primiparity, a lack of professional assistance, the absence of early skin-to-skin contact, and inadequate postcesarean counseling. To address this, targeted interventions are essential, including enhancing antenatal care services, providing comprehensive breastfeeding counseling, promoting immediate skin-to-skin contact, and ensuring professional support for mothers postdelivery.