Caesarean Birth and Breastfeeding

During pregnancy your body is preparing to give birth and your breasts are getting ready to feed your baby. If you go into labour and give birth without intervention, your body releases hormones to help with breastfeeding. Breastfeeding completes the normal, natural cycle of pregnancy, labour and birth. A caesarean birth interferes with these natural processes and may make establishing breastfeeding more of a challenge. However, many mums successfully breastfeed after a caesarean birth and with the right information and support so can you.

Whichever way we give birth, our bodies need time to recover and to adjust to feeding a new baby. Birth by caesarean usually means a longer hospital stay, and a longer recovery time because this is major abdominal surgery so it may impact upon establishing breastfeeding.

Before the birth
Common concerns
A good start for breastfeeding
Practical help and support

Before the birth

Whichever way you will be giving birth, the best preparation is to find out as much as you can about labour and breastfeeding beforehand. Choosing your place of birth and your caregiver can reduce your chance of a caesarean. It’s worth researching caesarean rates before you decide. When planning, bear in mind that:

An induced birth can lead to more interventions, increasing the chance you’ll need a caesarean.
Continuous support during labour from a woman you feel comfortable with and trust can reduce the risk of a caesarean birth.
Simple things like eating and drinking, moving around and relaxation can improve your experience of labour.

Hospital policies can have a major impact on how you get started with breastfeeding. It can help to tell hospital staff beforehand that you intend to breastfeed and to emphasise:

Your baby is not to be separated from you, provided neither of you needs special care.
No routine supplementary bottles or dummies are to be given to your baby, because this will interfere with breastfeeding.

An unplanned caesarean
A caesarean after a long or difficult labour can leave you feeling extremely tired and frustrated. However the hormones released during labour have already prepared you and your baby for breastfeeding.

A planned caesarean
Knowing in advance that you will be having your baby by caesarean can let you prepare, both emotionally and practically. When possible, going into labour first can help get breastfeeding off to an easier start. If you have had a previous caesarean, it is not always necessary to have one the next time. Discuss your options with your health professionals.

After any caesarean
Whether or not you were expecting a normal birth, a caesarean may leave you feeling disappointed or upset. It’s normal to feel angry or sad about what happened and to mourn the loss of the birth experience you were hoping for. It is quite understandable to feel this way and these feelings may affect the way you feel about your baby and breastfeeding.

Breastfeeding can give you confidence in your body’s abilities. When you breastfeed, your baby needs you. The close physical contact can also help you to feel better emotionally. Breastfeeding helps your womb to contract, which will help you heal more quickly. And it’s nature’s way of ensuring a mum spends time sitting or lying down, resting and recovering.

Common concerns

IVs or drips
Ask that your IV drip be inserted into your forearm, rather than in the back of your hand (and without the supporting board if one is used). This will allow you more freedom of movement when holding and feeding your baby.

The extra fluid from an IV can increase any swelling in your breasts, making it harder for your baby to latch on. Breastfeed frequently (at least 8–12 times in 24 hours) and see Engorged Breasts—Avoiding and Treating for suggestions.

Anaesthetic
Any anaesthetic in your system will not be harmful to your baby. However the anaesthetic may make your baby very sleepy during the first few days—you may have to wake him up and encourage him to nurse. Holding him will make this easier, as you will be aware of when he is stirring and ready to latch on.

Antibiotics and pain relief
Pain relief and antibiotics are routinely given after a caesarean. Pain relief will be essential to help you through the early days. Over the counter pain medications, such as paracetamol and ibuprofen, are considered safe for breastfeeding. If you need something stronger, then discuss this with your health care team, who can check which drugs are compatible with breastfeeding. You may need further antibiotics, but be aware that these increase the risk of a thrush infection for you and your baby.

Fever and infection
Following a caesarean there’s an increased chance of infection (of the incision or urinary tract), which can lead to fever. If this happens, you should clean your hands before handling your baby, but there’s no need for you to be apart.

A good start for breastfeeding

Consider antenatal expression
Separation or feeding problems are more likely if your baby is born early, if you have an induced birth, or if you have a health problem such as diabetes. It’s possible to express colostrum before the birth so that your milk will be available for your baby if separation occurs. If your baby doesn’t breastfeed well in the first few days you’ll already have learnt the trick of expressing, avoiding the need for infant formula.

Breastfeed as soon as possible

Try to breastfeed as soon as you are alert enough to hold your baby, in the recovery room if possible. Mothers who have had an epidural (regional anaesthetic) have even breastfed on the delivery

table. At this stage you will be free from pain as the anaesthetic will not have worn off. Although you may be lying flat on your back and may need some help positioning your baby, there is lots of new information which shows that you don’t need to be sitting up to breastfeed. Simply lying there, skin-to-skin is enough to prompt a baby to nuzzle onto your breast himself. If you are drowsy your partner can help by holding your baby close to you.

Partners can help
A caesarean birth increases your risk of separation from your baby. Your partner can step in to help here. Research has shown that babies benefit from skin-to-skin contact on another’s chest when they can’t be with mum—they are calmer and cry less.

Skin-to-skin contact with your baby
Breastfeeding as soon as practically possible will boost your confidence about being able to feed later on. It’s important, and never too late, to enjoy skin-to-skin contact with your baby. This:

Makes it easy for him to breastfeed when he is ready.
Helps you learn your baby’s feeding cues.
Calms your baby and keeps him warm.
Encourages bonding.

Tuck a blanket over both of you to keep warm.

Get comfortable for breastfeeds
Lying down or using the underarm position may be easiest at first. Use extra pillows for support and comfort—behind your back, under your arms or between your knees. A rolled up towel or small

pillow can cover and protect your incision. You can also breastfeed in a comfortable, reclining position. See Positioning & Attachment for tips. Getting your baby attached well at the breast helps him feed effectively and helps prevent nipple damage. Be aware that pain relief can mask pain during breastfeeding. If your nipples are squashed or flattened after feeds, or look sore or damaged, seek help without delay.

Practical help and support

Many mothers find it useful to check hospital policies on visitors, so they can arrange as much help as possible.

Even in hospital you will need either your partner, or a family member or friend to help you care for your baby. Arrange for as much practical help as you can get. When you are on your own, ring for help from hospital staff when you need it.

Once at home, extra help will be essential. You will be recovering from major abdominal surgery and need to rest, recover and concentrate on nursing your baby. You may be advised not to drive for about six weeks. Organise as much help as possible with meals, laundry and essential housework, and with caring for any older children. Drink enough fluids to keep your urine pale, and eat a balanced diet. Simple meals will be easier to prepare.

See Supporting a Breastfeeding Mother and Adjusting to Motherhood include practical tips on making life easier after birth.

Baby feeding cues
Mothers often find they need help responding to their babies’ early feeding cues. If you feel groggy after birth, it helps if the people supporting you are aware of the signs your baby needs to feed. These include, in increasing urgency:

Opening his mouth, making sucking motions and turning his head (rooting) looking for the nipple.
Moving his tongue.
Furrowing his eyebrows—perhaps showing tension in his face.
Clenching and unclenching his fists.
Flexing his arms.
Moving his hands to his mouth.
Followed by restless movement.
Then crying—the last resort.

Support for breastfeeding
Extra support is essential if you have a caesarean. Because the birth process is different you may experience more challenges establishing breastfeeding. Gathering accurate information and establishing a support network beforehand will stand you in good stead for breastfeeding your baby.

La Leche League Leaders can offer you support and additional information. You may also find it helpful to meet with other mothers at your local LLL group where you can exchange practical tips on nursing and mothering.

Adapted from an article by Sara Walters, which first appeared in LLLGB’s members’ newsletter Breastfeeding Matters.

Before the birth

Common concerns

A good start for breastfeeding

Practical help and support

Further Reading

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