How to make the most of breastfeeding after caesarean section

Undergoing a caesarean section has become much more common in recent years, with 1 in 4 to 1 in 3 births delivered this way globally 1,2 (some countries’ rates are much higher than others).

Pregnant mum sat back and stroking her baby bump

Some women deliver via a planned section, while others must give birth by emergency section due to medical necessity. This raises the topic on the influence of planned and unplanned caesarean on the initiation of milk supply and breastfeeding. Many women are naturally apprehensive on the impact of a caesarean and how to get breastfeeding off to a great start.

It’s important to remember that women who give birth by caesarean section can breastfeed successfully, while doing so may present certain challenges, such as delayed mother and baby bonding time following surgery. Breastfeeding after a caesarean section (or starting to express if your baby cannot breastfeed or if you choose to exclusively pump) should be the same choice and experience as if you had given birth vaginally.

Breastfeeding or pumping in the first hours after delivery and frequently thereafter (8 or more times in 24 hours) initiates (switches on) your milk supply and helps to establish an abundant production. 3-5

Here’s how you can establish breastfeeding, whether your caesarean section was planned or unexpected:

  • If your caesarean section was scheduled ahead of time, this gives you time to plan for your recovery. You’ll likely need some extra help around the household as you recover, heal and bond with your new baby. This can mean leaning on family and friends for support, delegating tasks and chores to others in the household, or even hiring temporary assistance.
  • Plan to discuss the “golden hour”6 after birth ahead of time with your obstetrician/midwife. The golden hour is known as that crucial first hour during which you and your new baby meet, start to bond and your baby begins to breastfeed, so it’s important to have a plan in place for this to happen - even if it must be delayed. Arranging for skin-to-skin contact as soon as possible after birth is important. Your baby can be placed on your chest immediately after birth whilst still in the obstetric theatre. Placing the infant in skin-to-skin early is best practice to encourage the first breastfeed.3,7 This promotes a longer breastfeeding relationship. If your baby cannot breastfeed a contingency plan can be put into place to begin expressing with a hospital grade pump within 3 hours of birth4,8.
  • If your caesarean section was unexpected, you may be tired, drowsy, exhausted, feel overwhelmed, and holding your baby for the first time may be daunting. That’s perfectly okay, because the safety of you and your newborn is paramount! In some cases, your partner, can hold your little one in skin-to-skin until you’re able to yourself. Some babies may need some assistance after birth to breathe regularly, before any skin-to-skin and breastfeeding can take place. Often this is reviewed by your midwife / doctor whilst your baby is placed on your chest / abdomen and your baby takes his first breath. In the obstetric theatre your baby may be placed on a heated cot, dried and then placed in skin-to-skin with you or your partner.

If breastfeeding after a caesarean section is delayed or cannot happen in the hours following birth (due to baby being born early, or transferred to NICU), it is important to begin pumping. Stimulating the breasts with the research-based Symphony® PLUS™ with Initiation Technology™ breast pump in the first hours after birth is important,9–11 as this supports timely initiation and long-term milk production.

If you are unable to breastfeed or your baby is not breastfeeding effectively, using a breast pump to express frequently (8 or more times a day) will stimulate your breast tissue to initiate and build adequate long-term milk volumes for your baby.

Breastfeeding Positions

Following a caesarean, you will need a period of time to recover; after all it is major abdominal surgery. However, you also need to breastfeed your baby within the first hours after birth.

Depending on the anaesthesia (spinal or general), you may need to be on bedrest, may need IV fluids and may need a catheter that can limit your mobility for a few hours after birth. Ask your midwife / nurse to assist you to find a comfortable position for you to hold your baby in skin-to-skin and to breastfeed your baby.

Initially after delivery you may be extremely tired, or not fully conscious and it is normal to be supported and supervised for these first breast feeds. Reclining your pillows / back rest to a 30-45 degree angle means that your newborn baby can be held and positioned on your chest / upper abdomen or adopting a side-lying position so you can breastfeed your newborn comfortably without putting pressure on your caesarean section wound site.

Once you are awake and able to sit up, move around, you can get familiar with the different feeding positions such as the clutch / football / underarm hold, cross cradle. Use a nursing pillow placed on your abdomen to support the position. The side-lying position is also particularly useful and comfortable and many mothers use this position when they have more space in the bed to feel secure.

Did you know?

Medications given for your pain management after caesarean section (while you are in the hospital) are important to take as you’re recovering. These are considered safe to use while breastfeeding your baby.12 If you have any concerns, talk with your midwife about your options. You should be as comfortable and pain-free as possible while you and your little one learn to breastfeed. In fact, being highly stressed or in pain can actually suppress your milk and be disadvantageous to breastfeeding.13

Some analgesic medication given during labour, close to time of delivery may still affect your baby’s state of wakefulness for the immediate hours after birth. Your baby may be more sleepy and lethargic. If so, place your baby in skin-to-skin, watch and look out for those instinctive feeding cues. If your baby falls asleep, or is not suckling effectively, discuss with your midwife about expressing your milk with a breast pump to remove some colostrum and stimulate milk production, until your baby is feeding effectively at the breast.

If you received I.V. fluids while in labour and/or during your caesarean section, a common effect is temporary swelling of the hands and feet after birth. If you had signs of pre-eclampsia your feet, hands and nipples may also be a little oedematous (puffy). Be reassured this does settle quickly after delivery. If you are using a breast pump it is important that you have the correct breast shield size and that this is checked again after the oedema subsides.

Your milk will take a few days to ’come in’. Feeding early, often, day and night every 2-3 hours and holding your baby in skin-to-skin supports building a plentiful milk supply. We understand that nursing after a caesarean section can be stressful and it takes a little more practice and support! Be sure to talk to your midwife or nurse right away if you have any concerns during this time.

Once you and your baby are settled at home, it’ll be important to have help with day-to-day household activities like making meals, cleaning, doing laundry, and other chores. Your main priorities during this time should be healing from your C-section, bonding with lots skin-to-skin with your baby, establishing breastfeeding and building your milk supply. Regular resting will not only allow you to recover after your surgery, but will also ensure you spend time for your little one to learn how to breastfeed. It also provides a time for you to watch out for those all-important signs and feeding cues that your baby gives when he is hungry and rooting.

Undergoing a caesarean section and breastfeeding has its own unique challenges, but they are worth overcoming to know you’re providing your newborn with the best possible nutrition right away in life.

References
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  2. Fröhlich M et al. Differences in rate and medical indication of caesarean section between Germany and Japan. Pediatr Int. 2020; 62(9):1086–1093.
  3. UNICEF, WHO. Protecting, promoting and supporting breastfeeding: The baby-friendly hospital initiative for small, sick and preterm newborns. Geneva, New York: WHO; UNICEF; 2020. 42 p.
  4. Spatz DL et al. Pump early, pump often: A continuous quality improvement project. J Perinat Educ. 2015; 24(3):160–170.
  5. Moore ER, Anderson GC. Randomized Controlled Trial of Very Early Mother–Infant Skin-to-Skin Contact and Breastfeeding Status. J Midwifery Womens Health. 2007; 52(2):116–125.
  6. Niela-Vilen H et al. The golden hour in Finnish birthing units - An ethnographic study. Midwifery. 2020; 89:102793.
  7. Moore ER et al. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2012; (5):CD003519.
  8. Hill PD et al. Initiation and frequency of pumping and milk production in mothers of non-nursing preterm infants. J Hum Lact. 2001; 17(1):9–13.
  9. Meier PP et al. Breast pump suction patterns that mimic the human infant during breastfeeding: greater milk output in less time spent pumping for breast pump-dependent mothers with premature infants. J Perinatol. 2012; 32(2):103–110.
  10. Torowicz DL et al. Human milk and breastfeeding outcomes in infants with congenital heart disease. Breastfeed Med. 2015; 10(1):31–37.
  11. Post EDM et al. Milk production after preterm, late preterm and term delivery; effects of different breast pump suction patterns. J Perinatol. 2016; 36(1):47–51.
  12. Hale TW. Hale’s Medications & Mothers’ Milk™ 2021. New York, NY: Springer Publishing Company; 2020.
  13. Brown A, Jordan S. Impact of birth complications on breastfeeding duration: an internet survey. J Adv Nurs. 2013; 69(4):828–839.