26 Apr

Breastfeeding after a Caesarean Birth

Photo: Ashley Marston

As part of caesarean awareness month in April, we’re sharing some information on breastfeeding after a caesarean section. Your caesarean may be planned or unplanned, but either way it needn’t derail your breastfeeding journey – the key is to be informed so you can be as prepared as possible.

First, BfN Supporter Zoë Chadderton shares some information on caesarean births, how they can affect breastfeeding, and steps you can take to help get feeding established – with links to a factsheet by BfN pharmacist Dr Wendy Jones. Then we’ll hear from Alyson, a BfN peer supporter, on her experience of breastfeeding after a C-section.

About caesareans & breastfeeding: Zoë Chadderton

There are three types of C-sections:

  • Planned (also called elective) – this is planned ahead of time, and may be for a number of reasons, e.g. placenta praevia. 
  • Emergency – this takes place during labour, normally because of  slow or no progress in labour  or baby/mum in distress. Despite the term “emergency”, the actual surgery is performed in much the same way as a planned section, it just hasn’t been planned ahead of time.
  • Crash – an actual emergency, mainly if the baby is in danger and needs to be born very quickly.

Most sections happen under local anaesthetic – an epidural or spinal block. General anaesthetics are rare, but can occur.

Generally speaking, a caesarean birth can cause breastfeeding to be a little delayed compared to a vaginal birth because mum doesn’t get the natural surge of oxytocin that can help with her milk supply. However, that absolutely doesn’t mean that you can’t breastfeed after a C-section – just that you need to be aware of the issues that may arise, and how to deal with them to help get feeding successfully established.

Planned sections can be better in some respects because mum isn’t exhausted from the stresses and strains of labour, and she can plan what she would like to happen such as skin to skin in theatre, immediately after birth. Mums who are planning a section can also think about hand expressing colostrum before the birth (antenatal expressing), which may help if baby is delayed in going to the breast, and more importantly helps the mum be secure in her technique in a non-stressful situation (it can be quite stressful learning how to hand express because you HAVE to, because your baby isn’t feeding, rather than relaxed “I’m learning a useful skill” antenatal expressing). Even if you are not planning a caesarean birth, it can be a good idea to learn how to hand express before your baby is born – you can start after 37 weeks, and information on technique can be found here*.

Pain can be an issue – many mums worry about baby kicking their scar – and you may struggle to sit up for a while after surgery, so there are several feeding positions you can try to work around these issues. Lying down on your side with your baby beside you on the bed; underarm (also called rugby hold); and in some cases laid back feeding (also, confusingly, called upright hold or biological nurturing) can be really useful. Try out a few positions and see what works for you (see here for some tips). Check out BfN pharmacist Dr Wendy Jones’ factsheet for information on your pain relief options while breastfeeding – there are many options which are perfectly safe for you and your baby. Don’t be a hero – take that pain relief.

Get some skin to skin contact with your baby as soon as you are able – preferably in theatre immediately after birth. Mention it to the midwives, even in an emergency – it can make a real difference to baby’s instinctive behaviour at the breast by getting hormones flowing for both of you and allowing both you and baby time to get to know each other and start your feeding journey. Finally, be patient. Take your time, baby might not feed as quickly as you expect (this applies to all babies!), but skin to skin, hand expressing and help from the ward staff or breastfeeding peer supporters will all help. Good luck!

*(N.B. this video refers to small babies – however the technique remains the same for all babies, the only difference being that colostrum would more likely be collected in a syringe or cup rather than a spoon.)

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Alyson & Charlie’s Story

I had always intended to breastfeed my baby, and throughout my pregnancy was hoping for as natural a birth as possible. I’d read about how breastfeeding often gets off to an easier start after a natural labour, so I felt I would be giving myself and my baby the best possible chance of success.

But apparently my baby hadn’t read the birth plan. I found out at 36 weeks that he was breech, and to top it off, his head measurement was (literally) off the charts…a trait he inherited from both me and my husband. We were told there was a 50/50 chance that he would turn head-down, but that if he didn’t and we tried for a breech birth, there was a high chance that his big head would get stuck and we’d have to have an emergency (or even a crash) C-section.

I was shattered by the news. I felt like the natural birth I’d planned for was disappearing before my eyes, and my chances of breastfeeding along with it. We decided to take a week, to see if the baby turned, and to fully research breastfeeding after a C-section so that we could be prepared. I was pleasantly surprised by what I found, and realised that a C-section needn’t spell disaster for breastfeeding – I just needed to be aware of what might happen and prepare for it. This was just as well. Despite me doing various bizarre exercises to try to spin him around, the baby remained resolutely breech, so we booked a C-section for 39 weeks…and suddenly everything seemed very real indeed!

I visited my local breastfeeding drop-in group before the birth, to speak to the peer supporters there and get some information. They were amazing. They showed me some positions (“laid back” feeding, and the rugby hold) that minimised the risk of the baby kicking my incision, and that would mean I wouldn’t have to completely sit up – since my core muscles would take a while to heal. They also explained how I wouldn’t experience the same hormonal changes that I would have done in labour, and how this might mean my milk was a little delayed in coming in. To combat this, they advised lots of skin to skin contact with the baby, starting immediately after birth and continuing throughout the first days and weeks. They explained that this would help to get the oxytocin flowing, and also give the baby a chance to follow his instincts and find his own way to the breast.

On the day of the birth, I discussed our plan with my midwife and surgical team. They were very helpful, and showed me how to put on my gown so it could be easily pulled down for skin to skin. When Charlie was born (complete with frankly enormous head), he was placed onto my chest almost straight away, and I held him like this, skin to skin, for the first couple of hours. I was amazed to see him start “rooting” for the nipple – it sounds unbelievable, but he did a sort of sideways shuffle/crawl until he was lined up, then latched himself on and stayed there for an hour. I had heard about this in my research and my visit to the breastfeeding group, so I knew I should just leave him to it as long as I wasn’t in pain, but it was still amazing to watch.

There was some concern from the midwives that he slept for a long time after this first feed, so we spent an hour trying to wake him up and persuade him to latch on, but he was absolutely zonked out. One midwife suggested we give him some formula, but my instinct (and everything I had read about getting breastfeeding established) was to avoid this if at all possible. While I was not against formula per se, I didn’t want to fill him up with it and therefore reduce the amount he needed from me, which would impact on my supply and potentially delay my milk coming in. Luckily another midwife suggested we express some colostrum into a syringe, so that we could feed him that. She showed me how to hand express, and I was delighted to see drops of thick, yellow colostrum coming out – the midwife told me this was a great sign that things were happening as they should. I’ll never forget her, she was so kind. I managed to express a couple of millilitres, which we carefully dropped into Charlie’s mouth and he lapped up without even waking up! About an hour later he woke up again and latched on for another feed – we were observed by a midwife, who told us that the latch looked good, and that she didn’t have any concerns about him feeding. This was very reassuring.

We were discharged from hospital after 36 hours, and went home to begin our lives as a family of three. Charlie spent the first night at home feeding A LOT. It was pretty constant from about 9pm to 4am, not wanting to be put down, and only really being content on the breast. If I hadn’t spoken to the peer supporters, I think I would have really panicked that the C-section had messed things up, that I didn’t have enough milk and that he was starving – but as it was, I’d been warned that this may happen, that he was just “putting his order in”, stimulating the breasts to kick-start my supply. I don’t know if this was more pronounced because of the C-section – it may well have happened anyway. It was pretty gruelling, but being prepared for it was key…I got comfy on the sofa with a mountain of snacks, drinks and a whole lot of Netflix. I felt very lucky to be facing this after a straightforward birth, rather than an exhausting labour, so that was a definite positive of the C-section for me. I also sent my husband off to get a bit of sleep, so he’d be refreshed and ready to tag in for a while later! Obviously he doesn’t have boobs, so did a lot of cuddling, bouncing and singing for an hour or so while I grabbed a quick nap. This really helped. It’s an absolute myth that dads can’t help or bond with their breastfed babies, there is so much that they can (and do) do.

My milk came in on day 3. I felt like I transformed into a Pamela Anderson lookalike overnight, which was both alarming and reassuring…this breastfeeding thing was really working! Charlie continued feeding like a trooper, and over the next few weeks my supply regulated and I felt more normal again. It was also really useful to use the hand expression technique I’d been taught in hospital, when I needed to keep things comfortable between feeds.

I found the “laid back” position really helpful, semi-reclined on the sofa/bed with Charlie lying diagonally across me. It felt very comfortable and seemed to give him the chance to follow his instincts without too much interference from me. Over time we adapted the position so I could feed him sitting more upright, with him straddling my leg. I found, with a bit of practice, I could feed like this in many situations – useful when we were ready to go out for a coffee! At night, his side-sleeper cot was a lifesaver – because of my incision, I found it really tricky to get in and out of bed in the first few days, so it was great to be able to just slide him towards me and feed in the laid back position.

I was lucky that Charlie took to breastfeeding pretty easily, and never had any real issues with latch etc. After a normal weight loss in the first few days, he gained weight well, and continued to breastfeed for almost a year. My C-section did have an impact on breastfeeding, but since I knew in advance, I was able to prepare and combat it – through immediate skin to skin, understanding frequent feeding (aka normal newborn behaviour!), avoiding unnecessary top-ups, and overall being led by my baby and feeding on demand, to let nature take its course. I was so pleased that we were able to breastfeed successfully, despite not having the natural birth we’d planned. I struggled for a while with the feeling that I hadn’t given birth “properly”, that my body had somehow failed me (I’ve now worked through this and know that any means of safely getting a person out of yourself is the “proper” way to do it, and is the opposite of failure), and breastfeeding really helped me to feel that something was working out the way I intended.

My advice to anyone intending to breastfeed would be to find out as much as you can before your baby is born, including the possible implications of a C-section, whether you’re planning to have one or not. As I discovered, birth plans are just a plan, and they don’t always work out the way you expect. Most of all, don’t assume you’re doomed before you even start – do your research, find a local group, ask your midwife, call the National Breastfeeding Helpline. They will be able to give you support and information, even before the birth, and help get breastfeeding established. You’ve got this!