Breastfeeding After a C-Section
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, 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.
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 hr 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. 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.
by Linda Walrod
What are the chances that'll I'll have to have a c-section?
Few people would choose to go through major surgery to give birth to their baby, but it does happen to many. Statistically speaking, the national average for a c-section is about 25%. But within each hospital, there will be strong derivations on this average. Depending on the doctors and policies in the hospital, your chances of having a c-section could be much higher or, hopefully, much lower. The best way of finding out is by talking to your doctor or a hospital administrator and asking what the c-section rates are for your particular hospital. This information should be readily available and help you understand your odds.
What situations usually warrant a c-section?
Cord prolapse (when the umbilical cord falls into the vagina)
Bleeding from the placenta
Abnormal pelvic structure, for example as a result of a serious injury.
Shoulder presentation of the baby.
Serious maternal health problems (e.g., infection, diabetes, heart disease, high blood pressure, etc.) when labor would not be safe for either mother or baby.
Dystocia (difficult childbirth), which includes labor that fails to progress, prolonged labor, and CPD (cephalopelvic disproportion) when the baby is too large to pass safely through the mother's pelvis.
Breech presentation (buttocks or feet first).
Fetal distress. The baby may show signs of distress such as slowing of heart rate or acid in the blood before vaginal delivery can be completed quickly.
What type of pain relief is offered before and after a cesarean?
Because a cesarean is major surgery, you will have to have some type of anesthesia during the delivery and then some pain relief afterwards. There are usually three types of anesthesia that are used in the c-section. General anesthesia or gas causes the mother to be completely asleep during the surgery. This is most common in emergency or life-threatening cesarean. The other two types of regional anesthesia, epidural and spinal, allow for the mother to be awake during the c-section. These will numb the mother from her breasts to her toes. To read more about the differences in epidurals and spinals, read Spinal, Epidural, and Combined Spinal Epidural Techniques: A Comparison in our Childbirth Cubby.
After a c-section, pain relief may come in a variety of forms. Most common are: morphine drip in your IV, Demerol, Percocet, Motrin 600 or 800, Tylenol 3 (with codeine), and Darvocet. Most women only need these prescription medications for a week or two, and then are able to use Advil or Tylenol after that.
How long will it be until my baby is born?
Once the c-section has started, it only takes about 5-10 minutes for the baby to be born. Then about 30-45 minutes for the doctor to check everything out and close up.
What is the procedure for a cesarean?
A catheter is placed into the bladder to drain urine during surgery.
An intravenous line inserted
An antacid for your stomach acids
Monitoring leads (heart monitor, blood pressure)
Anti-bacterial wash of the abdomen, and partial shaving of the pubic hair
Skin Incision (vertical or horizontal (most common))
The doctor can then open the amniotic sac and deliver the baby. You may feel some tugging, pulling and some pressure.
BIRTH!!!! (Accomplished by hand, forceps, or vacuum extractor)
Cord Clamping and cutting
Placenta removed and the uterus repaired
Skin Sutured (usually the top layers will be stapled and removed within two weeks)
You will be moved to the Recovery Room (If the baby is able s/he can go with you.)
For more detailed information on the surgery, read Cesarean Section - What Happens During Surgery.
Can I still breastfeed if I had a cesarean?
YES!!!! Although you may encounter a few more difficulties in starting out, breastfeeding your child after a c-section is absolutely an option! The two most common difficulties are incision pain and getting started soon after surgery. The best ways to tackle these difficulties is by educating yourself in advance. Let the hospital staff know WAY in advance that you want to breastfeed your child. When you find out you are having a c-section, remind them that you still are planning on breastfeeding and you want to have the baby put to the breast as soon as possible. It is not uncommon for babies to be brought to the mother in recovery to breastfeed. If the hospital staff insists you must be out of recovery before seeing the baby, let them know that you want no bottles or artificial nipples used in the meantime. Most women are in recovery for about an hour, so unless there is a medical need for it, most babies can wait that long before their first introduction to the breast.
When you are first ready to breastfeed your new baby, ask for a lactation consultant to help. You will probably need someone to help position the baby at first since you will probably still be numb from surgery and unable to move easily. Learn in advance, alternate positions for nursing your baby after a c-section. This will help in the second difficulty, incision pain. If you are fortunate enough to nurse your baby in the recovery room or shortly after, you will probably still be numb around the incision and may be able to hold and feed the baby in the typical cradle hold. But once the anesthesia wears off, incision pain will make nursing more difficult. The football hold and side-lying positions are excellent positions for a c-section mother to successfully breastfeed her baby.
If you are worried about how the pain medications will affect the baby, be sure to discuss it with your doctor. There are options that are okay for mother to take while nursing. The hospital's lactation consultant is always an excellent source of information and help. Be sure to enlist her help whenever you feel unsure.
How long do I have to stay in the hospital?
Most hospitals like to keep mom and baby for 3-4 days, although some moms have been released sooner than that. You will have to stay longer if complications arise.
What will my recovery be like?
Recovery will vary based on age, body type, and general health. Most women will deal with gas pains (as your digestive functions resume), incision pain, uterine contractions, and exhaustion. Usually within a day or two, you will be encouraged to get out of bed and walk. As painful and uncomfortable as this might sound, it is EXTREMELY helpful in your recovery. Usually a nurse will stand with you. Take your time as you sit up and turn to dangle your feet off the edge of the bed. Once you feel okay, stand up. If you feel lightheaded, immediately sit down and wait. If you feel okay, take a few steps with the nurse. Do this as often as you can, and lengthen the distance until you are able to walk on your own. DO NOT ATTEMPT TO LIFT YOUR BABY OR CARRY YOUR BABY.
Most doctors want to know you are passing gas before you are discharged. Foods will probably be limited at first and gradually increased to normal. If you had staples to close your external incision, it will be checked daily for infection and will possibly be removed on the day of your discharge. This is not very uncomfortable.
One of the most common recovery comments I've heard is that most women feel really good the first day. This is usually because the anesthesia from the surgery is still lingering, and often moms are on a "high" from seeing and holding their new baby. They feel surprisingly good and painfree and feel like this was a "breeze." Then on the second day, reality sets in. The incision pain is sharper, you feel more tired, it's harder to get around. This is very common and doesn't mean something is wrong. Just take it easy and rest.
Other parts of recovery are similar to a vaginal birth. You will still have uterine contractions (to help the uterus contract back down to size), exhaustion, uterine massage (to also help the uterus return to normal), and postpartum bleeding. Often c-section moms are surprised that they have to experience lochia even though they did not have a vaginal birth. So, just like after a vaginal birth, your lochia flow will be checked and you will have to wear pads for a few weeks after birth.
How long until my incision stops hurting?
Recovery time varies for many women. Some women feel fine after just a few weeks, while others continue to feel uncomfortable for months. But, on average, most women will feel pretty well recovered within 6-8 weeks. Keep in mind that a sudden increase in pain or discharge from the incision area warrants a call to your doctor.
I've had one cesarean (or more!). Will I have to have another cesarean?
In the past, the saying used to be "once a c-section, always a c-section." This is simply no longer true. Depending on they type of incision and reason for your c-section(s), a VBAC is possible. VBAC stands for Vaginal Birth After Cesarean. If you had a horizontal incision (uterine) then the possibility exists for a VBAC. If you had a vertical incision (uterine) then chances are that you would have to have a repeat cesarean because of the risk involved. A horizontal incision is believed to be stronger and less stressed during pregnancy and delivery. But with a vertical incision, there is a greater chance of uterine rupture . . . a potentially life-threatening situation.
How can I prepare for a c-section?
Plan ahead. No one can predict whether or not you'll need an emergency c-section. So prepare yourself with information. If you know you'll be having a cesarean, take special c-section prenatal classes.
Discuss your pain relief options. If it means talking to the anesthesiologist about the difference between epidurals and spinals, then do it.
Ask about having someone with you and ask about photos. Support during the birth of your baby is important. Also ask about photo options. Some hospitals will let your partner take pictures of your baby's birth.
Ask to wait for labor to begin before having your planned c-section. Many experts believe that even a little bit of labor gives the baby some of the advantages of uterine contractions in stimulating breathing and ensuring maturity. If you have had a previous c-section with a vertical uterine incision or have a long way to travel to get to your hospital, this may not be advisable.
Request a running commentary on the delivery process and to watch the actual delivery if you would like.
Tell the staff that you and your partner want to hold the baby right after delivery. You and your partner should be allowed to hold your baby in the recovery room unless the baby needs medical attention. If you feel up to it, you can breastfeed immediately, too. Don't be afraid to ask questions throughout your labor and delivery so you are comfortable with every procedure.
Enlist help for when you go home. Chances are you'll need someone around to help you care for yourself and your baby for at least a week. Be sure to let them know that you need them for help with the house and caring for the baby, NOT just someone to hold the baby for you. Don't try and be supermom after a c-section. You risk your own health by doing this. Get LOTS of rest and remember . . . you had major surgery; you need time to heal.
Okay - so I wish I had known so much more at 4am when suddenly I was about to have a c-section. There are so many things that I look back on and have realized would have helped if I had been told. So.. here are my tips for you who are about to have a c-section or the new and healing c-section Mom: Also see the Frequently Asked Questions (FAQ) and Topics pages for more information.
Shaking: My arms shook the entire time that I was in the OR for my procedure -- it was as if I were freezing cold, but I wasn't. I just couldn't keep my arms still. If you are getting this tip ahead of time, just don't be surprised. They tell me it is a normal reaction to the anesthesia (I had an epidural which was used to add in more major medication for during the procedure). I have also heard of hospitals which require/request that women's arms be strapped down for the duration of the procedure - though this was not my personal experience.
Pain Medicine I: When my c-section was done, the doctors pumped some major pain killers into my IV. They made me pretty spacy for the first hour or two after the procedure was done. I have a clear memory in recovery of holding my son in my arms and not being able to speak quickly enough to keep in time with the conversation around me. It was scary to be in the middle of all that and not be able to communicate.
Gas: During abdominal surgery it is common for air to get trapped inside you. Think about it and it makes sense. What might not make sense to you is why your shoulder hurts incredibly. This is a common form of transferred gas pain. Stay away from carbonated beverages and take the anti-gas medicine the nurses give you access to. It will pass eventually (at which point they will let you start eating real food again!).
Pain Medicine II: Don't let it wear off completely. The day after my c-section I didn't understand that the reason I wasn't feeling a lot of pain is that my IV pain medication hadn't worn off yet. I made the huge mistake of assuming I didn't need the major pain killers I was being offered. And then the medicine wore off in the middle of the night. I was not a happy person. Once the pain catches up to you it really is hard to get back on top of it again. All this also made it much harder for me to get up and around.
Get Moving : Of course listen to your nurses and doctors, but do what you can to get walking as soon as you can. I have heard from many others that though this was hard, they believe it sped up their recovery. I will always wonder how much of my slow recovery was a result of my not getting up and around as soon as I could.
Lactation Consultant: If you are intending to breastfeed - request a lactation consultant ASAP. Even if you took all the classes (like I did!), the c-section adds so many new challenges that a professional showing you the best positions and making sure you are as successful as you can be is a great booster. See the breastfeeding topic page for websites and books to support your efforts.
Help: Ask for it. Demand it. Assume that you will be recovering from your major abdominal surgery and learning how to be a mom to your new baby (or babies!). If you have questions about your physical condition - call your doctor! I can't tell you how many times I reasoned myself out of calling and asking a simple question (Am I bleeding too much? Too long? Should I feel this specific pain?). Your doctor is out there to answer questions - it is part of what they get paid for. Consider hiring a postpartum doula to help you through this challenging start to being a mom. Physical Therapy: This one is most important 6 weeks or more after your c-section. If you are feeling pulling from your scar... if you are taking a LONG time to get to the point where you can move without pain - ask your doctor about a referral to a Physical Therapist. There are amazing things they can do. It was only after getting myself to a Physical Therapist for a few sessions of scar mobilization that I really started to feel as if I could move like myself again. If you are in the DC area - I highly recommend the kind people at http://www.painpoints.com