AN EXPLORATION OF THE BREASTFEEDING BEHAVIORS OF WOMEN AFTER CESAREAN SECTION IN NIGERIA

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

The practice of performing caesarean sections has increasingly gained prevalence as a method of delivery globally in recent years. In Western nations, such as the United States, approximately 31.9%, or nearly one-third, of births occur via caesarean section (Centres for Disease Control and Prevention, 2020); in East Asia, this rate is even more pronounced (Zhang et al., 2019). Caesarean sections play a crucial role in preserving the lives of women in labour and their newborns during specific emergencies, including dystocia. Nonetheless, caesarean sections present certain challenges, one of which pertains to the practice of breastfeeding. Women who experience caesarean sections exhibit a reduced rate of early-initiation breastfeeding and a shorter duration of breastfeeding (Zhang et al., 2019; John et al., 2016).

Breastfeeding is acknowledged as a critical component for the health and development of infants, delivering vital nutrients and antibodies that bolster the immune system and promote the overall growth of the newborn. The World Health Organisation (WHO) advocates for exclusive breastfeeding during the initial six months of life, subsequently endorsing continued breastfeeding in conjunction with suitable complementary foods until the age of two years or longer (WHO, 2020). Nonetheless, numerous elements can affect the commencement and continuation of breastfeeding, especially in the context of a caesarean delivery. This surgical intervention, frequently necessitated by medical complications arising during childbirth, may pose distinct challenges for women in relation to breastfeeding practices. In Nigeria, there has been a notable rise in caesarean section rates, attributed to both medical necessity and elective choices (Agboeze et al., 2018).

Following a caesarean section, the initiation of breastfeeding can be hindered by factors such as post-operative discomfort, physical constraints, and a delay in the onset of milk production (Prior et al., 2018). Mothers who experience C-sections frequently find themselves apart from their newborns for extended durations after delivery, in contrast to those who have vaginal births. This separation can hinder the initiation of early skin-to-skin contact and the successful establishment of breastfeeding. Research indicates that commencing breastfeeding promptly, ideally within the initial hour post-delivery, greatly enhances the likelihood of successful breastfeeding and diminishes neonatal mortality rates (Debes et al., 2017). In instances of caesarean deliveries, the opportunity to commence breastfeeding during this vital period is frequently overlooked, potentially leading to negative implications for long-term breastfeeding success.

In Nigeria, caesarean sections are conducted in both public and private hospitals; however, significant disparities exist in access to healthcare services. This is particularly evident in rural areas, where numerous women may lack sufficient maternal care. Cultural beliefs and socioeconomic factors significantly influence breastfeeding practices (Ogunniyi et al., 2020). Certain conventional beliefs hinder women from initiating breastfeeding right after childbirth, stemming from misconceptions regarding colostrum, the initial milk secreted by the mother. This milk is extremely advantageous for the newborn, yet it is frequently misinterpreted in various communities (Ogunlesi & Dedeke, 2018). Furthermore, individuals who have experienced C-sections may encounter heightened expectations from relatives or societal standards that affect their choices regarding the duration and method of breastfeeding.

Physical discomfort and pain serve as significant obstacles to breastfeeding for women who have undergone caesarean deliveries. Post-surgical discomfort may restrict a mother's capacity to hold her infant in a suitable manner for breastfeeding. The administration of analgesics post-surgery may elicit apprehensions among mothers regarding the safety of breastfeeding during medication use (Zhu et al., 2017). In these circumstances, it is common for mothers to turn to formula feeding, especially when they do not have sufficient support or knowledge regarding breastfeeding after a caesarean section. Studies indicate that effective pain management and nursing assistance are vital in motivating mothers to start and maintain breastfeeding, even when faced with the difficulties associated with a caesarean section (Karlström et al., 2019).

The presence of healthcare support, especially regarding counselling and education on breastfeeding, constitutes a crucial element that impacts breastfeeding practices following a caesarean section. In numerous healthcare institutions throughout Nigeria, maternity nurses and midwives are pivotal in delivering information and support to new mothers, aiding them in the initiation of breastfeeding and presenting strategies to navigate prevalent challenges (Nwogu-Ikojo et al., 2020). Nonetheless, insufficient staffing, inadequate training, and overwhelmed healthcare systems may hinder the efficacy of breastfeeding support in numerous hospitals (Oladokun et al., 2015). In the absence of adequate support and encouragement, mothers who experience caesarean sections may face challenges in successfully initiating breastfeeding or sustaining exclusive breastfeeding for the advised duration.

Socioeconomic factors, such as educational attainment, income levels, and healthcare accessibility, play a significant role in influencing breastfeeding practices in Nigeria. Individuals possessing advanced educational attainment tend to exhibit a greater awareness of the advantages associated with breastfeeding and are more inclined to commence breastfeeding, even following a caesarean delivery (Iloh et al., 2015). In contrast, women hailing from lower socioeconomic backgrounds, who may encounter restricted access to healthcare services or confront cultural obstacles, frequently find themselves at an elevated risk of not engaging in breastfeeding. Furthermore, women residing in urban environments often enjoy enhanced access to healthcare services and postpartum assistance in contrast to their rural counterparts, which further exacerbates the differences in breastfeeding practices (Agho et al., 2017).

Furthermore, psychological elements, such as maternal assurance and emotional health, may impact breastfeeding practices following a caesarean delivery. The process of undergoing surgery, along with the subsequent physical recovery and the responsibilities of caring for a newborn, can contribute to feelings of anxiety or depression in certain mothers, potentially obstructing their capacity to establish an effective breastfeeding routine (Tully & Ball, 2018). Postpartum depression is notably linked to reduced rates of breastfeeding initiation and duration. Furthermore, mothers who have experienced caesarean sections may face an increased risk of developing postpartum depression in comparison to those who have had vaginal deliveries (Dennis & McQueen, 2019).

Recent studies have documented the occurrence of breastfeeding and the biological factors linked to breastfeeding among women following caesarean deliveries. Nonetheless, there exists a deficiency in qualitative research concerning the elements that affect women's breastfeeding practices following caesarean deliveries. To comprehend the factors that influence women's behaviours, such as the decision to breastfeed or not following caesarean sections, it is essential to delve into their actions and grasp the intricacies of the decision-making process. The aim of this study is to investigate the elements that affect women's breastfeeding practices following caesarean deliveries.

1.2 Statement of the Problem

Breastfeeding serves as an essential element of infant nutrition and maternal well-being, providing a multitude of advantages for both mothers and their infants. In Nigeria, breastfeeding practices continue to be inadequate, especially among women who have experienced caesarean deliveries. Caesarean deliveries, representing around 30% of all births in Nigeria, have the potential to greatly influence maternal and infant health outcomes (Nwogu-Ikojo et al., 2020). Although caesarean sections may be required for medical reasons, they frequently present a range of challenges that can negatively influence the initiation and practice of breastfeeding.

Studies suggest that individuals who undergo caesarean deliveries may encounter elevated levels of pain, extended recovery periods, and increased anxiety, factors that can hinder their capacity and willingness to commence and maintain breastfeeding (Adeleye et al., 2021). The absence of immediate skin-to-skin contact with the infant presents significant challenges, as this interaction is essential for the successful initiation of early breastfeeding (Musa et al., 2021). Research indicates that disruptions in the bonding process may result in postponements in the commencement of breastfeeding, a matter of particular concern due to the critical role of early colostrum consumption for the health of newborns (Adesiyun et al., 2022).

Furthermore, the influence of cultural factors and societal norms in Nigeria is crucial in determining breastfeeding practices. A significant number of women encounter societal expectations to adhere to conventional practices that often do not emphasise the importance of breastfeeding, especially after surgical deliveries (Ogunniyi et al., 2020). Moreover, the presence of assistance from healthcare professionals, relatives, and community groups plays a vital role in fostering effective breastfeeding practices; however, this support frequently proves to be irregular or insufficient (Ogunyemi et al., 2019). As a result, numerous women may encounter challenges in initiating and sustaining breastfeeding, which can lead to a greater dependence on formula feeding or alternative options that might not adequately meet the nutritional needs of infants.

The existing body of work highlights a notable deficiency in comprehending the particular breastfeeding practices of women following caesarean deliveries in Nigeria. Current research primarily emphasises standard breastfeeding practices (Adeleye et al., 2021; Musa et al., 2021), overlooking the specific difficulties encountered by this particular group of mothers. The absence of focused research hinders the advancement of effective strategies that could assist women who have experienced caesarean deliveries in their breastfeeding endeavours.

Moreover, the consequences of inadequate breastfeeding practices reach beyond personal health, influencing public health results and leading to increased rates of infant morbidity and mortality (Nwogu-Ikojo et al., 2020). Consequently, it is essential to investigate the complexities of breastfeeding practices among mothers who have undergone caesarean delivery in Nigeria. Comprehending the obstacles and enablers that affect these behaviours can guide the development of specific interventions and policies designed to elevate breastfeeding rates, improve maternal and child health outcomes, and ultimately cultivate a nurturing environment for new mothers following caesarean delivery. Thus, the necessity for this investigation arises.

1.3 Objectives of the study

The primary objective of this study is to critically explore the breastfeeding behaviors of women after cesarean section in Nigeria. Specific objectives of this study are to:

1. To explore the factors that influences breastfeeding behavior of women after cesarean section in Nigeria

2. To determine the challenges faced by cesarean delivery mothers in initiating and sustaining breastfeeding in Nigeria

3. To determine the consequences of positive breastfeeding behavior on mother and child health after cesarean section in Nigeria

4. To propose strategies to improve breastfeeding practices among women after cesarean sections in Nigeria

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

1. 1. 1. What are the factors that influences breastfeeding behavior of women after cesarean section in Nigeria?

      2. What are the challenges faced by cesarean delivery mothers in initiating and sustaining breastfeeding in Nigeria?

      3. What are the consequences of positive breastfeeding behavior on mother and child health after cesarean section in Nigeria?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: There are no significant factors that influences breastfeeding behavior of women after cesarean section in Nigeria

Ha: There are significant factors that influences breastfeeding behavior of women after cesarean section in Nigeria

1.6 Significance of the study

This research holds the promise of impacting a diverse array of stakeholders, such as healthcare professionals, policymakers, community organisations, researchers, and mothers themselves. The knowledge acquired will aid in developing a deeper comprehension of breastfeeding practices related to caesarean deliveries, promoting better strategies and regulations that support the health and welfare of mothers and infants in Nigeria.

The insights derived from this study will be of great significance to healthcare providers, such as obstetricians, paediatricians, and lactation consultants. Comprehending the distinct obstacles to breastfeeding encountered by mothers who have undergone caesarean deliveries can assist these professionals in formulating customised strategies that cater to their requirements. This understanding can foster advancements in clinical practices and guidelines that encourage the early initiation and continued support of breastfeeding, ultimately improving health outcomes for both mothers and infants.

The results will be of significant importance to those in positions of authority and public health administration. By recognising the elements that affect breastfeeding practices among mothers who have undergone caesarean deliveries, decision-makers can develop focused programs and policies that enhance breastfeeding efforts. This initiative can significantly enhance the overarching objective of advancing maternal and child health in Nigeria, in accordance with both national health priorities and international health guidelines.

The findings of this study will also provide valuable insights for community health workers and organisations dedicated to maternal health. Understanding the difficulties encountered by mothers who have undergone caesarean sections can guide the development of community outreach initiatives and educational efforts aimed at promoting breastfeeding support. These organisations have the capacity to create resources that equip mothers with essential knowledge regarding breastfeeding techniques and the significance of early initiation, thereby cultivating a nurturing environment for new mothers.

Furthermore, the research is of considerable importance for mothers who have experienced caesarean deliveries. By emphasising their experiences and challenges, the study can foster increased awareness among healthcare providers and support systems. A heightened awareness of these challenges can foster greater emotional and practical support for mothers, thereby enriching their breastfeeding experiences.

Scholarly researchers and academic institutions will acquire a more profound insight into breastfeeding practices within this particular demographic. This research provides a basis for additional enquiries into maternal health concerns, the support of breastfeeding, and the effects of caesarean births on family relationships. This contribution to the academic discourse has the potential to foster new research and partnerships focused on enhancing maternal and child health.

1.7 Scope of the study

Broadly, this study focus is to critically explore the breastfeeding behaviors of women after cesarean section in Nigeria. Empirically, the study will discuss the factors that influences breastfeeding behavior of women after cesarean section in Nigeria, the challenges faced by cesarean delivery mothers in initiating and sustaining breastfeeding in Nigeria and the consequences of positive breastfeeding behavior on mother and child health after cesarean section in Nigeria.

Geographically, the study will be carried out in National Hospital, Abuja.

1.8 Limitations of the study

During the examination, the researchers carefully examined the inherent limitations that are present in all human behaviours. One of the main challenges we faced was the lack of extensive scholarly research on the subject. A notable factor that contributed to the issue was the limited data available regarding an exploration of the breastfeeding behaviors of women after cesarean section in Nigeria. Given the task at hand, it was quite demanding to find the required materials, books, or information and organise the data, requiring a significant investment of time and effort.

In addition, the study's findings may be constrained by the small number of participants and the limited scope of the research, which mainly revolves around National Hospital, Abuja. Therefore, the findings of the study have limited practical implications, highlighting the need for further research.

In addition, the individual experienced significant constraints due to financial constraints. As a student with limited financial resources, they had to carefully navigate these constraints throughout their study. The exorbitant transportation fees at the research site proved to be a significant hindrance in meeting the financial obligations tied to travel expenses.

Furthermore, the person had a packed schedule due to their scholarly obligations, including attending lectures and participating in a range of educational pursuits.

1.9 Definition of terms

Breastfeeding: Breastfeeding is the act of feeding breast milk to an infant. Babies can be fed directly from the mother's breast, or breast milk can be pumped and then fed to the baby from a bottle.

Cesarean section: Cesarean section, C-section, or cesarean birth is the surgical delivery of a baby through a cut (incision) made in the birth parent's abdomen and uterus

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