During pregnancy your body is preparing to give birth and your breasts are getting ready to feed your baby. If you are told you need to have a caesarean birth you may wonder if you will still be able to breastfeed as you planned. Mothers successfully breastfeed after a caesarean birth and you can expect your healthcare professionals to support you with getting breastfeeding established straight away.
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 practical support from friends and family can make a big difference to you.
Whichever way you will be giving birth, find out as much as you can beforehand about labour and breastfeeding. Whilst some aspects will be out of your control, choosing your place of birth and your caregiver can reduce your chance of a caesarean.
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.
Tell hospital staff beforehand that you plan to breastfeed and to emphasise:
You want to keep your baby with you, provided neither of you needs special care.
You don’t want your baby to be given bottles or dummies without your permission, 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 an caesarean
Whether or not your caesarean was planned, you may still feel upset or sad about what happened and 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 at first.
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 you spend time sitting or lying down, resting and recovering.
Common concerns
IVs or drips
To make holding and feeding your baby easier, 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). You can request that your catheter be inserted after your spinal anaesthetic has taken effect, to make the procedure more comfortable.
The extra fluid from an IV can increase engorgement. Before breastfeeding, you can easy any swelling back by pressing your fingers around the nipple area (reverse pressure softening) and see Engorged Breasts—Avoiding and Treating for suggestions.
IV fluid will also transfer to your baby. This can lead to an artificially high brith weight which may result in a higher percentage weight loss in the early days. Weighing your baby at 24 hours old may give a more accurate baseline weight.
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 them up and encourage them to nurse. Keep them close and offer the breast whenever they 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. 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.
A good start for breastfeeding
Express your milk 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 can be very helpful to express and store colostrum before the birth so that your milk will be available for your baby if separation occurs. See Antenatal Expression of Colostrum.
If your baby is a bit sleepy at first you can hand express drops of colostrum and give it on a spoon. You partner could help with this.
It can sometimes take a little longer to have a plentiful milk supply after a caesarean birth. Hand expressing frequently will encourage this process. If you baby needs a supplement offer it with a spoon, syringe, feeding cup or supplementer.
Breastfeed as soon as possible
You can breastfeed as soon as you are alert enough to hold your baby, in the recovery room or even 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, 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 themself. If you are drowsy your partner can help by holding your baby close to you.
Skin-to-skin contact with your baby It’s important and never too late, to enjoy skin-to-skin contact with your baby. Tuck a blanket over both of you to keep warm. Skin-to-skin
Encourages your baby to latch on and feed frequently.
Helps colonise your baby’s skin with your own individual ‘good’ bacteria.
Calms your baby and regulates their temperature.
Encourages bonding.
If your need for medical care prevents this happening straight away, your birth partner can step in. Babies still benefit from sking-to-skin contact even when they can’t be with you.
Get comfortable for breastfeeds
Getting your baby attached well at the breast helps them to feed effectively and helps prevent nipple damage. Lying down, laid back 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. . See Positioning & Attachment for tips. 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.
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 their mouth, making sucking motions and turning their head (rooting) looking for the nipple.
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.
Followed by restless movement.
Then crying—the last resort.
Practical help and support
It is 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 your partner, family member or friend to help you care for your baby. If 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.
Support for breastfeeding
Try to contact an LLL Leader, attend an LLL meeting or join an LLL Facebook group before your baby arrives to establish your support network. The LLL Leaders and other mothers will be able to give you ongoing support and enouragement, along with useful practical ideas. You can find your local LLL group here.
Written by Sara Walters, Karen Butler, Sue Upstone, Bronwyn Davies and mothers of LLLGB.
