Are you worried about breastfeeding after a C-section birth?

A cesarean delivery will not stop you from breastfeeding your baby. However, your post-surgery recovery can make things a little more challenging. We’ve written this guide for you to discover what you need to know about getting breastfeeding off to a great start after your cesarean.

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Guide to Breastfeeding after A C-Section

The Unplanned C-Section

Around 30% of babies in the USA are born by emergency c-section. A traumatic delivery can result in mixed feelings surrounding the birth of your baby. It’s not uncommon to feel disappointed, guilty, angry or upset following an unplanned c-section. You may need to come to terms with the feeling you’ve failed or been cheated out of a ‘normal’ birth.  The surgery can also trigger body issues such as feeling disfigured or unattractive due to your scar.

These negative emotions can harm breastfeeding by affecting your let down reflex. These feeling may be fleeting or have long-term effects on your mental health. It’s important to have as much skin to skin with your baby when possible. This releases the hormone oxytocin to promote bonding with baby.

You may also benefit from having a debrief of the delivery, from your doctor, whilst you are in the hospital. The ICAN is a non-profit organization which can provide you with ongoing support after your c-section.

The Planned C-Section

Knowing you are having a cesarean gives you more time to plan for the delivery and postpartum. This gives you time to gather resources and ask your care providers about their policies during your hospital stay.

Your hospital policies can have a huge impact on your breastfeeding success. Ask your care provider what their breastfeeding policies are. The gold standard is a hospital which has been accredited by the Baby Friendly Initiative. Important areas to ask about are:

• Do they use a nursery or rooming in?
• Can someone stay over to help you with the baby?
• Can the staff support you with breastfeeding?

You can make extra arrangements to support your needs. This may include paying for a private room or hiring extra carers such as a private duty nurse or a lactation consultant.

Milk Supply

Regular breastfeeding is the best way to establish your milk supply. After a cesarean, there are a few important factors to ensure a good milk supply for baby.

Delayed Mature Milk

It’s important to know that it can take longer for your milk to change from colostrum to mature milk. It usually takes around 2-3 days, however, may not happen until day 4-5 after a cesarean. This is because your body has the task of healing from surgery and making milk at the same time. It doesn’t mean you have a low milk supply. Unless there are other reasons, you do not need to supplement baby with formula milk if they are feeding regularly and passing plenty of wet and dirty diapers.

Skin to Skin

The best way to get your feeding off to a good start is by feeding baby within an hour after delivery. This usually means feeding in the recovery room. If you or baby is unwell this can be delayed. You should start feeding as soon as possible. This will signal to your body you need to make more milk. If your baby is in a neonatal unit, you should start hand expressing as soon as you can.

Nurse often

Your baby should feed around 8-12 times per day. Your breasts work as a supply and demand system. The more baby feeds, the more milk you’ll make. Feeding often sets you up for a great milk supply when your mature milk ‘comes in’.

Access to Baby

Having your baby with you at all times (rooming in) is best for you and baby. You will be able to recognize baby’s hunger cues and become more responsive to their needs. It also means you can have plenty of uninterrupted skin to skin.  Rooming in means your baby won’t receive any teats or formula supplements without you knowing.

Nursing Positions

Finding a comfortable nursing position after delivery can be difficult. Immobility, scar pain and IV drips can all cause problems. The best positions for c-sections moms are:

Lying Down – Either side lying or laid-back feeding are ideal for the first feed when you can’t move much. They are also great if you have a co-sleeper at home, as you won’t need to bend over your wound.

Football Hold – Is perfect for keeping the weight of baby off your scar. It’s also ideal for avoiding IV drips as you can use a pillow to support baby rather than your arm.

Cradle hold with Nursing Pillow – This is the perfect solution if you find it uncomfortable to feed lying down. Sitting upright on a chair may be more comfortable. The nursing pillow takes the weight of baby off your scar.

You may want to bring extra pillows or blankets to the hospital to help position you better. Don’t be afraid to ask staff for help if you are struggling. Until you are mobilizing you’ll need help lifting baby or changing their diaper. If your IV is causing problems, ask the staff if it can be removed, or re-sited to make feeding easier.

Baby

There are a few things you need to consider about your baby’s condition after a C-section.

Sleepy Baby

It’s very common for a baby to become sleepy after a C-section. They are just as exhausted as you from the birth. We highly recommend learning how to hand express your colostrum. That way if your baby is too sleepy to feed you can give them colostrum by spoon. It’s crammed full of calories to give you baby energy to wake and feed. Always put baby to the breast before you express, as they are much for efficient at emptying your breast.

Supplements

Unless there is a medical reason, your baby does not need to be given formula supplements. If they do need to be supplementing it may be possible to offer expressed milk rather than formula. Giving formula can hurt your milk supply as your breasts think you don’t need as much for your baby. Remember the more milk you remove from the breast (nursing or expressing) the more you make.

Baby in Special Care

If your baby is in NICU they usually have an open-door policy to promote breastfeeding. You’ll need to consider expressing your milk to feed baby. In the early days, you can do this by hand expressing. Once you get bigger volumes you can start to use a breast pump. Ask your hospital if they are able to provide a hospital grade pump for you to use during your stay.

Weight Loss

During your cesarean, you will receive lots of IV fluids. You should know that there is a link between fluids in labor and increased weight loss in babies. This is simply because your baby weighs heavier at delivery due to those fluids, giving an artificial birth weight. Your baby will pee and poo all this excess out over the first few days, leading to a larger than average weight loss. If feeding is going well, and your baby appears healthy and there are no signs of dehydration your doctor may be happy forgo supplements. If you do need to supplement baby with expressed milk or formula, we suggest cup feeding to prevent problems with teat confusion.

Medications

You’ll need to take a few medications for your C-section, after all, you are having major surgery. It’s important to know how these drugs may affect your breastfeeding.

Anesthetic

The type of anesthetic you receive during the caesareans may vary depending on whether it’s planned or unplanned.

Regional anesthetic – An epidural or spinal will cause a block to the lower region of your body. It wears off after a few hours. These can make baby very sleepy and may affect your let down reflex.

General Anesthetic – This will make you completely unconscious during your delivery. You will need time to recover and become conscious. Usually, breastfeeding is delayed; however, you can begin as soon as you feel ready.

Pain Relief

You will be offered pain medications after delivery. The medication you are offered will be compatible with breastfeeding. Doctors need to ensure they are safe for breastfeeding before prescribing them.  Very small volumes will be passed on to your baby during feeding; however, it is unlikely to affect them. If you are unsure of a medication, you can ask your doctor to substitute it for one you feel more comfortable with.

It’s important you take your pain relief, post-delivery. Remember you’ve had major abdominal surgery and will feel sore. Missing meds can lead to excessive pain and result in skipping feeds or poor milk supply.

Antibiotics

Having a C-section can put you at greater risk of infection after delivery. The most common causes are wound infections or a UTI from catheters.  If you need antibiotics, there is no need to separate you from your baby.  If your baby needs antibiotics, we recommend using a mitten to cover their cannula, which can get in the way during a feed. Remember that any antibiotic use can cause breast thrush, which both you and baby will need to be treated for.

Support

Gathering your support is essential when you have a cesarean, you’ll need it more than you would after a vaginal delivery.

For First Feed

You will be completely immobile from the waist down for the first few hours. Ideally, you should feed in the recovery room. This means you’ll need a lot of help from your birth partner and staff to position you and baby. Extra pillows are highly recommended at this point to provide your body with support. If your baby is in NICU you should receive assistance from staff to hand express your colostrum at the earliest opportunity.

In Hospital

The support you receive with feeding in the hospital will vary depending on where you give birth. Staff should support you; however, they will be unable to stay with you 24hrs a day. You will benefit from having your partner or helper stay with you. This may mean you have to pay extra for a private room for them to stay overnight.

At Home

We highly recommend using a co-sleeping crib when you have a C-section. They provide you with easy access to baby without having to bend over and pick your baby up. Don’t try to be superwoman, accept help from family and friends when they offer. You should also consider hiring a postpartum helper that can help out with cleaning and cooking in the first few weeks.

Self-Care

Rest

Once you are home, you’ll need plenty of rest. It’s important to rest to help you recover and for your milk supply. Set up a feeding station next to your bed. That way, you can have everything you need for feeding and diaper changes close to hand. This makes night feeds so much easier and gives you peace and privacy to feed during the daytime.

Eat Well

Eating a diet full of vitamins and nutrients will help your recovery. It will also provide baby with high-quality breast milk. If your diet is lacking, you may want to try boosting your intake with a multivitamin. Plenty of fluids will help hydrate your tissues and aid healing, whilst improving your milk supply.