Breastfeeding After a Cesarean

by Anne Smith, IBCLC

In the United States, nearly one in four births is a cesarean birth. Many of these cesareans are unexpected, so it is a good idea for the expectant mother to become informed and educated about the procedure before her baby arrives.

An operative birth versus a vaginal birth can impact the breastfeeding experience in several ways. Mothers who have eagerly anticipated a vaginal birth may feel disappointed and inadequate because their expectations haven't been met, and they may even be afraid that because they "failed" at giving birth, they may also "fail" at breastfeeding. These concerns are unfounded, because there is no reason that nursing can't be successful for the mother who has had a c-section. Breastfeeding can help normalize the experience of an operative birth.

Initiation of breastfeeding is often delayed, because mothers who have delivered via c-section often need some extra time to recover before they physically feel like holding and nursing their new baby. As soon as they are fully conscious and alert and able to hold the baby, they can begin breastfeeding. Mothers who have epidural rather than general anesthesia are generally able to hold the baby sooner and nurse him for a longer period of time initially.

Nursing as soon as possible after birth has advantages for mothers who have had cesareans just as it does for mothers who deliver vaginally. It promotes bonding, provides stimulation to bring the milk in sooner, releases the hormone oxytocin to help the uterus contract, provides the baby with the immunological advantages of colostrum, and takes advantage of the fact that the newborn's sucking urge is strongest in the first couple of hours after birth. There is an extra advantage for the cesarean mother: nursing during the brief period of time before the regional anesthetic wears off provides a time of pain-free, more comfortable nursing during the baby's first feedings at the breast.

Babies born via c-section may be somewhat drowsy and lethargic, especially if the mother was exposed to anesthetics for a prolonged period of time during labor. This doesn't mean that breastfeeding won't be successful, but it can mean that the milk may take a little longer to come in than it would after a vaginal birth. The baby may need some extra encouragement and stimulation in order to stay alert during feedings (see article on "Waking the Sleepy Baby"), but this period of lethargy generally only lasts a short time.

Many mothers are worried that the medications prescribed for them after delivery will adversely affect their babies. Both the antibiotics and the medication used for pain relief are usually not a problem, and are routinely given to the mothers of newborns. Although these medications do pass into the milk in very small amounts, the volume of colostrum or milk produced during the first few days of nursing is small, so the amount ingested by the baby is minimal. Mothers should be encouraged to take the smallest amount of pain medication they need in order to stay as comfortable as possible in the post-operative period, but there is no reason to try to be a martyr and not take the medication at all. It will not harm the baby, and mothers who have had a surgical birth often need the extra rest they get when their pain is managed. By the time the milk is fully in, they often find that they don't need as much medication as they did in the very beginning.

C-section moms need to be aware that antibiotics are routinely given after a cesarean, and may cause an overgrowth of yeast that can result not only in a vaginal yeast infection, but also thrush in the baby's mouth or diaper area, as well as on the nipples. Mothers should become familiar with the signs, symptoms, and treatments for yeast so that if the problem does develop, they can treat it promptly and nip it in the bud. (See article on "Information Sheet and Care Plan for Yeast (Candida)").

Mothers who have had surgical deliveries often find it difficult to find a comfortable position in which to nurse without putting pressure on their incision. If epidural anesthesia is used, they are usually awake during the birth and can nurse on the delivery table in the operating room. In this case, they will need help in positioning the baby because they will be nursing on their backs and one or both arms may be restrained due to the placement of the IVs.

The side lying position is often preferred during the first day or so after surgery. The mother should turn slowly on her side, and put a rolled up towel next to the incision in case the baby kicks. The baby should be placed on his side facing the body, chest-to-chest. He should always be directly facing the breast so that he doesn't have to turn his head to nurse. A rolled up towel placed behind the baby can help keep him from pulling off the breast as he relaxes during the feeding. Putting a pillow under her knees can help reduce the strain on the stomach muscles and support the back. She can use the side rails to help her roll over when she is ready to offer the other breast. The hospital nurse can be a big help with these early feedings, because it can be challenging to find a comfortable position in the early days after surgery.

The football, or clutch hold, can also be a more comfortable alternative to the traditional cradle hold. The baby should rest on a pillow and be held along the side. If the cradle hold is used, the baby can rest on a pillow that covers the tender incision. Many mothers find that the cradle hold is more comfortable after the first few days of recovery from surgery, but not in the very beginning.

It is just as important to make sure the baby is latched on correctly after a cesarean birth as it is after a vaginal birth. Making sure that the baby opens wide and latches on well behind the nipple and not just on the tip can help avoid nipple soreness and facilitate effective milk transfer.

If the mother knows that she will be delivering via c-section before the birth, she can make choices in advance that will facilitate breastfeeding. She can choose a hospital that has policies supportive of breastfeeding, such as not routinely giving bottles and allowing rooming in. She should find out how much time she and her baby will be allowed to spend together. Rooming in offers several advantages. Extra help will be needed in caring for the baby, so it is a good idea to find out in advance if there is the option of a private room that allows the father or other family member to stay with mother and baby around the clock.

Some hospitals have policies that require that babies born via c-section spend the first 24 hours in the nursery under observation, although the trend in most hospitals over the past few years has been to separate mothers and babies as little as possible. If the hospital has such a policy, and the baby is healthy, the mother can discuss the possibility of waiving this requirement with her doctor. If the baby has medical problems that require observation after birth, she should ask about the availability of electric breast pumps on the maternity floor, and pump as soon after birth as possible and every couple of hours after that. Pumping will help stimulate the milk supply, prevent engorgement, and provide valuable colostrum that can be fed to the baby in the nursery until mother and baby can be together again.

It is recommended that the mother discuss the options of general versus regional anesthesia before surgery. Often in elective cesareans, regional anesthesia is an option and mothers are able to breastfeed sooner. Even if general anesthesia is used and putting the baby to the breast is delayed, there is no reason that the nursing couple can't make up for lost time once they are together.

The hospital stay will be longer after a cesarean than after a vaginal delivery. The mother should use this extra time to get help with finding a comfortable position to nurse, and get as much rest as possible. Once she returns home, she should establish a nursing station (see article on "Establishing Breastfeeding: Starting Off Right"). Since she is recovering from surgery as well as adjusting to life with a new baby, it makes sense to take it easy, limit visitors, and take advantage of family members and friends who want to help.

There is no reason that mothers can't nurse their babies successfully and for as long as they want, even though they do have to overcome some additional challenges in the beginning after a cesarean birth.

Anne Smith, IBCLC has been a La Leche Leader since 1978 and IBCLC since 1990. As a nursing mother, LLL Leader, and IBCLC, Anne has worked in many areas over the years. She has led support group meetings, taught breastfeeding classes, trained breastfeeding peer counselors, worked one-on-one with mothers to solve breastfeeding problems, helped thousands of mothers with breastfeeding questions over the phone, held workshops for health professionals, taught OB, Pediatric, and Family Practice Residents breastfeeding at Bowman Gray School of Medicine, and run a breast pump rental station for the past eleven years.

Copyright © Anne Smith. Permission to republish granted to Pregnancy.org, LLC.