By Ali Weatherford in consultation with Cassie Terrillion, IBCLC
Under normal circumstances, our bodies tend to know what to do once we get pregnant. The hormones start firing, our bodies start changing and growing new parts, fetuses become fully formed babies, labor is triggered, new hormones start to fire, the cervix changes and opens, the baby rotates and descends, birth happens, we reach for our babies and bond, the placenta is born, milk is made, babies eat.
As long as this flow isn’t interrupted too drastically, it just happens. So then what if there is a big interruption like a cesarean? Does this mean we can’t make milk or feed our babies? Absolutely not!
You might have heard that a cesarean is a big obstacle to breastfeeding, and it’s true that it might be more challenging to breastfeed after a cesarean. But it’s still VERY possible!
Probably the most common obstacle is the delay in being able to hold your baby and have some skin-to-skin contact. Depending on the reason for the cesarean and how the baby tolerates the birth, the baby might need a little extra support and can’t be directly on your body for some amount of time. Also, it’s not standard practice in most operating rooms to encourage immediate skin-to-skin contact. This usually means a mother doesn’t hold her baby until she’s in the recovery room, which could be as long as 45 minutes or an hour. Having immediate skin-to-skin contact with your baby after birth can definitely benefit breastfeeding. The touch and closeness is one of the things that tells your body that the baby is here, and it’s time to switch to milk-making mode! It also activates the baby’s instincts to feed.
Without that, it can be more challenging to breastfeed, but there are some other triggers that happen:
- The detaching of the placenta from the uterus is another big signal for the body that birth is done and it’s time to switch gears. The placenta is removed during a cesarean, so your body still gets that signal immediately.
- Hearing your baby cry is another signal that the baby has arrived and that can often help prepare your body for breastfeeding.
- Of course, your body has also been preparing to feed your baby throughout your pregnancy. By the time you are entering the second trimester of pregnancy, your body has already done a lot of the work that makes breastfeeding possible. This is how people are sometimes able to pump milk for their very premature babies immediately after birth. The hardware is all there and the battery is charged. All that is needed is for someone to push the power button!
How to Minimize the Effects of a Cesarean
There are some things you can do to help minimize the effects of a cesarean on your breastfeeding:
- It’s a great idea to request that your baby be put onto your chest immediately after birth whenever possible so you can get that additional benefit for your breastfeeding. Some hospitals and doctors do this as standard practice after a cesarean, but in other locations you will need to request this.
- Stress can interfere with breastfeeding. You might have your own helpful strategies for lowering stress levels. Definitely utilize all the tools you have to stay relaxed. It can be really helpful to focus on your baby during and immediately after a cesarean. That can lower stress levels too. Think about your baby, listen for your baby, talk or sing to your baby. Breastfeed as soon as possible. Sometimes, this can happen in the operating room while the surgery is being completed.
- If you are able to get your baby immediately for skin-to-skin contact, watch your baby for signs of readiness. They will usually become more alert and start “rooting” or “pecking”. You might see they are looking for something! They may open and close their mouth like a fish, or bob their head around. This is a great opportunity to attempt a first feed.
- Breastfeed as often as possible. The more often the baby stimulates the breast, the more milk is made.
- If breastfeeding in upright positions is uncomfortable because of the healing incision, try other positions. Some people are able to comfortably breastfeed in a side lying position or with support from another person.
- Get all the help you can from a lactation consultant while you are in the hospital. They can offer plenty of great advice to get your breastfeeding off to a great start and help you position your baby for your comfort.
When You’re Separated from Your Baby
When you can’t be with your baby immediately, it doesn’t mean all is lost. If you need to be separated from your baby for some amount of time:
- Consider using hand expression to collect small amounts of milk. Your partner, a nurse, or a lactation consultant might be able to deliver that milk to your baby on a spoon or in a small cup or syringe. This is great when you know it will be just a short separation of a few minutes or hours. You can use this instructional Care Plan that describes the process of hand expression or watch this video to see how it’s done.
- If you will be separated for more than a few hours, pumping might be needed. Hospitals have high-grade pumps that do a very good job of mimicking a breastfeeding session by a baby. Getting on a pumping schedule that would be similar to your baby’s feeding routine can help your body continue to go through the milk-making process and ensure that there will be plenty of milk in the future. Consult your lactation consultant to help you decide what will work best for your situation.
- Sometimes a schedule of hand expression AND pumping are necessary so that you have milk to deliver to your baby and are also stimulating the breasts enough through pumping. Hand expression is usually the best way to maximize the amount of milk you remove. For the first 2-3 days after birth, you only make very small amounts of milk called colostrum. Using a pump to remove this milk might work, but some of those precious drops get lost in the hoses and huge bottles that are attached to collect the milk. Hand expression helps to preserve every drop. Hospitals have high-quality powerful pumps that you can use while you’re there. There is usually no need to bring your own.
While You’re Healing
As you are recovering and healing from your cesarean in the following days and weeks, there are things you can do to support breastfeeding:
- Take advantage of as much skin-to-skin time with your baby as possible. This will continue to support your body’s milk-making abilities.
- Continue to feed your baby as often as possible.
- Make sure that you are well-hydrated, well-fed, and getting plenty of rest and relaxation time.
See a lactation consultant if you are struggling or feel unsure about your milk production. There are often many suggestions they can offer to make things easier for you and give you more confidence.