Caesarean Birth and Breastfeeding

There are many reasons why you may be considering, or already have had, a caesarean birth. (1) While a vaginal birth is biologically optimal for a healthy mother and baby, it’s not always the safest or most appropriate choice. (2)

You might be facing complications in your pregnancy that make a planned caesarean the safer route. You may have a medical history that suggests surgical birth is a better option, or perhaps your personal preferences, past experiences, or family circumstances mean that a caesarean feels right for you. Sometimes, birth doesn’t go to plan, and a caesarean becomes medically necessary – commonly known as an ‘emergency’ or ‘unplanned’ caesarean.

However your baby enters the world, careful planning, collaboration with your care team, and active, informed participation can all help create a positive, empowering birth. And that matters – not just for you, but for getting breastfeeding off to the best possible start. (3,4)

Preparing for birth

Whatever kind of birth you hope to have, creating a detailed plan of your birth preferences, that considers a range of possible outcomes, can be an empowering way to prepare for your birth experience and for beginning breastfeeding.

Support

Many women preparing for a caesarean birth already have a network of care professionals around them. This might include your midwife, obstetrician, consultant or supervisor of midwives, medical specialists, or social support teams. You may also wish to involve a doula, or a trusted friend or family member who can advocate for you during birth. (5, 6)

Most NHS trusts have specialist midwifery teams that work with mothers and pregnant people who may need additional support, such as those from the LGBTQ+ community, or those with a history of mental illness, trauma, abuse, or stillbirth. Ask your maternity unit what additional support may be available –  having a trusted, supportive care team around you is crucial to your wellbeing and confidence. (7)

Planning for birth

Many hospitals now offer the option of a ‘gentle’ or ‘natural’ caesarean. Small adjustments to how the procedure is carried out can make a big difference, supporting your and your baby’s wellbeing, helping you feel more connected, and making it easier to get breastfeeding started. Here are some examples of ‘gentle caesarean’ practices:

Environment

• Sound – you may be able to request music. 
• Sight – you can request a mirror or a clear drape that will allow you to watch your baby being born.
• Light – lower lighting is gentler on your newborn baby’s eyes and helps create a cosier environment.
• Space – you can request that only essential personnel are in the room with you, to help create a feeling of intimacy with your new baby, and your partner, if you have one.

Delivery

• You can request that your baby be delivered more slowly, to ease their transition into the world. 
• In most cases, immediate skin-to-skin contact should be possible. (8, 9) This is made easier if you ask staff to place monitors on your back, place your IV (intravenous drip, for delivering medications and fluids) on your forearm – leaving your hands free for holding your baby – and, if possible, prop you up slightly. If your baby needs to be taken for medical treatment, or if your hands aren’t free, you might want to have them touched to your cheek first, so you can nuzzle and smell them.
• Delayed (optimal) cord clamping is also a common request that can usually be accommodated. Waiting to cut the cord until it stops pulsating gives your baby the full benefit of iron-rich blood from the placenta. (10, 11) 

Immediately after birth 

• Skin-to-skin contact can continue throughout surgery – some babies breastfeed for the first time while still in theatre. 
• Drying your baby yourself is a powerful, instinctive moment that can help reinforce your bond.
• Vaginal seeding (swabbing the baby’s mouth, nose, and skin with the mother’s microbes) is a relatively new practice which aims to support immune system development in babies born by caesarean. (12, 13, 14). 

Whether or not you’re interested in trying this (you could ask your healthcare team about current evidence and local guidelines), skin-to-skin contact, and the protection of your milk, are powerful ways to build your baby’s immune system. (15, 16, 17)

A record of your birth preferences is a powerful tool. While you can’t script every moment, thoughtful planning helps reduce trauma if things don’t go to plan. It ensures your care team understands what matters most to you. Even in medically complex situations, your wishes can usually be honoured, as long as it’s safe to do so.

Planning for breastfeeding

Let your hospital team know in advance that you plan to breastfeed. Be clear about your preferences, especially if:

• you wish to keep your baby with you, as far as possible (if either of you needs specialist care, it might be necessary to be cared for separately).
• you do not want your baby to be given bottles or formula without your consent. If your baby is not with you, or needs more milk than they can get at the breast, you can be supported to express your milk. In some hospitals, donated breastmilk may be available from a milk bank. If formula is needed, you and your healthcare providers can make a plan together. 

In addition to planning for their birth, some people choose to prepare for breastfeeding by hand expressing colostrum before their baby is born.

Colostrum is your baby’s first milk and your body starts making it from around  mid-pregnancy . It’s nutrient dense and packed with immune factors that give powerful protection to your baby.  

Expressing colostrum during pregnancy can: 

• build your confidence,
• help you become more familiar with your breasts, and
• create a small supply  of your own milk. This can be especially reassuring if your baby needs extra milk in the early days. 

Collecting colostrum in pregnancy is recommended if you have diabetes, as your milk may be a bit slower to increase after birth, and your baby’s blood sugar levels might be more unstable at first. (18, 19)

It is usually recommended that, with approval from your midwife or care team, you can begin hand expressing colostrum from around 36 – 37 weeks of pregnancy. If you know you’re likely to give birth before this, talk to your care team about timings. Depending on where you live, your midwife may be able to guide you through the process and provide sterile syringes for safe storage.

Don’t panic if you try expressing before birth and get little or nothing! This happens to some of us – it’s not a sign that you will have problems making enough milk after your baby is born. (20)

Beginning Breastfeeding

The magic of skin-to-skin

Most babies are ready to feed in the first hour or so after birth. If you are not already holding your baby, ask someone to help you get your baby skin-to-skin with you. Full, bare body contact is what your baby expects after birth. If you’re chilly, have a helper place a blanket or towel over both of you. Skin-to-skin contact:

• keeps your baby calm,
• helps your baby regulate their temperature, heart rate, and breathing,
• helps colonise your baby’s skin with your unique ‘good’ bacteria,
• helps you and your baby start getting to know each other,
• kick-starts your milk-making hormones, and
• encourages your baby to breastfeed. (21, 22)

Your partner or midwife can support you with getting your baby into a good position. Some mothers manage to feed in theatre, or you may find it easier once you are in the recovery area and have more freedom of movement.

If your need for medical care prevents this happening straight away, your birth partner can hold your baby until you’re ready. Babies still benefit from skin-to-skin contact even when they can’t be with you. (23) And skin-to-skin isn’t just for the first few hours! You’ve got weeks and months to enjoy this special way of connecting with your baby.

Getting your milk production off to a good start

However your birth unfolds,  removing milk early and often after birth will help you  to make plenty of milk for the coming months. You can read more about how milk production works here.

Here are some key tips: 

• Skin-to-skin contact. Yes, we’ve mentioned this already, but it really is the best way anyone knows of to encourage your baby to breastfeed. And it feels lovely!
• Feed early and often. Aim for a first feed within the first hour or so, if possible, and offer the breast frequently after that, at least 8 – 12 times in 24 hours. Feeds don’t have to be evenly spaced (e.g. every two or three hours), you just need to fit plenty in, whenever your baby is interested.
• Watch for feeding cues. Early signs that your baby is ready to feed include stirring, hand-to-mouth movements, and rooting (turning their head to look for the breast). If you offer the breast as soon as your baby begins to stir, feeds will be calmer and more peaceful than if you wait until they’re getting worked up. If  you’re not sure whether they’re interested, it’s fine to offer – your baby can always say no!
• Get support early. Your midwife, maternity support team, and other breastfeeding helpers can help you with positioning, latch, and managing any early challenges.

If your baby isn’t ready to breastfeed yet

• Keep your milk flowing. Start expressing your milk as soon as possible after birth and continue frequently to stimulate your supply. Aim to express at least 8 -12 times in 24 hours. 
• As your milk increases, you could switch from a spoon to a small open cup, and then to a breast pump. 
• Hand expressing often works best for the first couple of days. A spoon makes this easy – you can express directly into the spoon and use it to feed the milk to your baby (see videos here). 
• There are many options for feeding your expressed milk to your baby – see our page on bottles and other tools.

You can find lots more information on our increasing your milk supply page.

Getting back on track after a more complicated start

If you’ve got extra challenges, such as:

• premature birth,
• separation from your baby,
• diabetes, or
• your baby is very sleepy, unwell, or just not ready to breastfeed yet, 

expressing your milk is especially important. (24)

Sometimes, a baby is breastfeeding, but not efficiently enough to get all the milk they need. This is more likely after a caesarean birth, as babies may be born a little early, and the anaesthesia used during birth may affect the their early ability to latch and feed. (25)

 You can read about how to tell if your baby is getting enough milk here. If there are any signs that your baby might need more milk, for example:

• your baby is doing fewer poos than expected,
• your baby loses more weight than expected, 
• your baby is very sleepy (waking fewer than 8 -12 times in 24 hours to feed), or
• breastfeeding is painful for you, 

start expressing your milk straight away, and find breastfeeding help. Your body is geared up to make milk in the first few days after birth and it’s important to remove milk – by any means – early and often. (26)  Every drop of your milk, and every moment of closeness, helps your body do what it is meant to do. You’ve got lots of time to sort out the breastfeeding part later! 

For more ideas, you can read our article about getting breastfeeding back on track after a difficult start.

Common Concerns after caesarean birth

Extra fluids from IVs (drips)

The extra fluid given by IV during caesarean birth can increase breast engorgement (tissue swelling) in the first few days after birth. (27) This can be uncomfortable, as well as making it harder for your baby to latch on and breastfeed well. There are lots of things you can do to help – see Engorged Breasts – Avoiding and Treating.

It’s worth being aware that your baby will also have some of the extra fluids from the IV in their body. This can lead to an artificially high birth weight. (28, 29) As this extra fluid comes out in your baby’s wee in the first few days after birth, it can look like they’ve lost a lot more weight than expected. Some experts suggest calculating weight loss from the baby’s weight at 24 hours old, rather than from birth. (30)

Anaesthetic

Any anaesthetic in your system will not be harmful to your baby. However the anaesthetic can make babies extra sleepy during the first few days. You may have to wake your baby up and encourage them to nurse. Keep your baby skin-to-skin as much as possible – this reminds them to eat, and enables you to offer the breast as soon as they start to stir. 

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. Paracetamol and ibuprofen are considered safe for breastfeeding; if you need something stronger, let your healthcare team know. There are lots of options – you don’t need to go without the medication you need, just because you’re breastfeeding!

Practical help and support

It’s useful to check hospital policies on visitors, so you can arrange as much help as possible. Even in hospital, it will be much easier with a partner, family member, or friend to help you care for your baby. If you’re 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 your baby. You may be advised not to drive for about six weeks. Organise as much help as possible with meals, laundry, essential housework, and caring for any older children. Drink enough fluids to keep your urine pale, and eat regularly to maintain your energy. There is no special diet you need to follow to produce milk for your baby – your body will do that naturally, but a nutrient rich diet will help you feel better in yourself as you burn all those extra calories making milk.

Our articles about  Supporting a Breastfeeding Mother and Adjusting to Motherhood have lots of practical tips on making life easier after birth.

Taking your new baby home

If you and your baby are healthy, and feeding is going well, then most hospitals will discharge you after 24 – 48 hours. If you’re not feeling confident with feeding, or ready to go home, you can ask to discuss staying longer. Taking your new baby home can feel very daunting, especially while also recovering from major surgery. But be reassured, many mothers have done this before, and you can do it too!

Going home – things to plan for:

• Creating a safe sleeping space for you and your baby.
• Staying comfortable – pillows, pain killers, blankets, slippers, warm adjustable clothing for easy breast access.
• Keeping essentials nearby – remote, phone charger, snacks, drinks, etc.
• Support from your partner, family, and friends (and breastfeeding helpers, if needed) in the early weeks.
• Rest – you need lots of it to heal, and breastfeeding is nature’s way of ensuring you spend lots of time lying or sitting down! 

Getting comfortable for breastfeeding

Helping your baby latch deeply at the breast helps them to feed effectively and helps prevent nipple damage. Lying down, laid back (semi-reclined), or underarm positions may be easiest at first, to protect your tender abdomen. 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. 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.

Responding to your baby 

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

• opening their mouth, making sucking motions, and turning their head looking for the nipple (rooting), 
• moving their tongue,
• furrowing their eyebrows, perhaps showing tension in their face,
• clenching and unclenching their fists,
• flexing their arms,
• moving their hands to their mouth,
• restless movement, and
• crying – the last resort.

Even if you’re fully alert, it is helpful to have someone with you who can lift your baby, bring them to you if necessary, and help you both get comfortable for feeding.

Night time feeds

Keeping your baby very close at night will make it easier for you to respond to their cues while your body is still healing and may be sore. There are a number of ways you can do this, from a Moses basket next to the bed, a sidecar crib attached to the bed, or by having your baby in bed with you. If you bring your baby into your bed at any time (even if you don’t plan to fall asleep with your baby) it is important to set up your bed in accordance with safe sleep guidelines.

You may find it easier to sleep slightly propped up on pillows for the first few nights. If you’re concerned about safety, it might be helpful to have someone watch over you during feeds. If you want to try feeding your baby lying down (‘side-lying’), one good tip is to try this first during the day, when you and your helper are more awake. If you fall asleep, they can monitor you and your baby.

Support for breastfeeding

Caesarean birth may come with its own unique challenges, but with the right care, planning, and support, it can also be a beautiful and connected beginning. However your baby comes into the world, and whatever path your feeding journey takes, our trained breastfeeding counsellors are here to offer the information, encouragement, and support you need to feel confident and empowered in your choices.

You are warmly encouraged to connect with your local LLL Leader, attend an LLL meeting, or reach out on social media, before your baby arrives. Building your support network early can make a real difference. LLL Leaders and other mothers can offer ongoing reassurance, shared experiences, and practical ideas to help you navigate your journey with confidence and compassion.

You can find your local LLL group here. 

Written by Nicola Sheldon, September 2025

Due for review: September 2027

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References

Copyright LLLGB, September 2025