Nursing Tips For After a Cesarean

Kathleen Tackett's picture

QUESTION

Dear Lactation Consultant,
Hi. I am a mom of 2 boys, ages 12 and 11. My husband and I have decided to add to our family. I am very interested in breastfeeding the new baby when he/she comes along. I tried with the first but was very sick!

I had gallstones my entire pregnancy and, leave it to me, was having a gallbladder attack on the day I delivered my son. 14 hours after labor started the doctor decided to do a c-section. After the long labor and surgery I tried very hard to nurse but the pain was so bad I couldn't even get the baby in a position to nurse. I became very frustrated and decided to go ahead and bottle feed.

10 days later I had to go back to the hospital and have gallbladder surgery. I had lots of infection and the doctor said my milk would have probably not have been good for the baby anyway considering how sick I was.

The second pregnancy went very well but once again I had a c-section. The nurses were good to bring the baby in soon after delivery to get me to nurse. The problem this time was, I had a spinal done. I had to lay flat on my back for 12 hours! Once again I couldn't position the baby to feed properly. No one came in to help and frustration set in once again. I had the fear my baby would dehydrate before I could get him fed. I guess this fear was unfounded in my young mind. I was 19 and 21 at the birth of my first children which I think led to some of my breastfeeding failures. No patience!

I am now 32 and would desperately love to nurse this new baby when it comes along. Could you give me some advice on what I need to do?

  • Will the baby eventually latch on and nurse if I give it more time?
  • Is it unhealthy for the baby not to eat in the first several hours?
  • If it doesn't start eating will the hospital supplement with a bottle?
  • What are some techniques I could use to get the baby to latch on and start eating?
  • I will more than likely have another c-section. What are some comfortable positions to use when nursing?

Any advice you can give will be very helpful.

ANSWER

Congratulations on your upcoming birth! It it a good thing to think ahead when you know you will be having a cesarean birth. As a general answer to your questions, it is most definitely possible for you to get off to a good start with breastfeeding.

You asked if it is unhealthy for the baby not to eat within the first hours. Amazingly, it wasn't that long ago (about 20 years) that it was standard procedure for all babies to receive nothing by mouth for the first 24 hours. It was believed then that it was unhealthy for the newborn to eat too soon!

I would definitely recommend that you attend a breastfeeding class before your birth. It is a great way to learn about what's normal during breastfeeding and how to avoid common problems. The best way to insure the baby will latch on and feed well is to breastfeed within the first hour after birth and be sure that the first thing in his/her mouth is the breast.

When you think about it, it is really amazing that breastfeeding is commonly seen in our culture as "an accident waiting to happen." Up until approximately 100 years ago there was no safe substitute for breastfeeding. If a baby didn't/couldn't breastfeed, literally 75-90% of them died. We wouldn't be looking at overpopulation today if breastfeeding wasn't a process that tended to work.

However, the challenge is that it is a learned skill, and most of us didn't grow up seeing it as a normal thing. In addition to attending a breastfeeding class during pregnancy, another excellent way to prepare is to attend La Leche League meetings (You can find one near you on the La Leche League website or by phoning 1-800-LALECHE). There you can not only learn about breastfeeding, but you'll have the chance to watch mothers breastfeed and hear about their experiences. I like to think of La Leche League meetings as a parallel universe where breastfeeding is the norm. Going to meetings is a great way to counter a lack of confidence and unsupportive comments. And you can start now. You don't have to wait until your baby is born.

The key is getting breastfeeding well established at first is to plan to breastfeed long and often during the first few days. It is frequent feedings that triggers the increase in milk production and the establishment of a good milk supply. A good target number is eight to twelve feedings per 24 hours. Research indicates that some mothers who have cesarean births get off to a slower start with breastfeeding when the number of feedings drops below this range.

In order to achieve the most feedings per day, I often advise women in your situation to take maximum advantage of the time during which their pain medication is still in effect to get in as many nursings as possible. Those may be your most comfortable breastfeedings for a while. So talk to your partner and your doctor about helping you to breastfeed right after delivery and in the recovery room. The baby can be laid across your chest while you are supine. A helper can gently support the baby's forehead, if needed, so that his/her nose is free for breathing.

Also, in preparation for the feedings after this, learn what you can (both at breastfeeding class and from the LCs in the hospital) about how to breastfeed lying down and in the football hold. These are positions that prevent the baby's weight from resting on your incision. By nursing lying down, you can doze while feeding, so that you don't have to make a choice between getting the rest you need and fitting in enough breastfeedings.

Plan to take full advantage of all the breastfeeding help your hospital has available during your stay. In some hospitals, you may not see the lactation consultant unless you ask. It would be worthwhile to put in a request to see her so that she can see what you're doing and offer any positioning and latch-on suggestions. That can often make a difference in your comfort.Take this time to learn as much as you can now. I think the more you know, the more confident you'll be in your ability to breastfeed.Best of luck to you!

-- Nancy, IBCLC