Breastfeeding for any new mother can be a challenge but for those who are recovering from a caesarean section, there are extra complications. It is possible that milk production can be delayed or limited because of the effects of the operation. Discomfort in the abdomen can also make finding a comfortable position for breastfeeding difficult.
There are solutions to all these difficulties and with perseverance and good support, it is possible to establish a successful breastfeeding routine post caesarean.
Problems With Lactation
In certain circumstances there can be problems with the initial milk supply after a caesarean birth.
Medication can inhibit the production of milk after both emergency and elective caesareans. With elective caesareans, a delay in milk production can also occur because the body is not aware that birth has occurred.
Going into labour sets in motion a series of hormonal releases which set the stage for lactation. After the baby has been born, oxytocin causes the placenta to be expelled by the body. This in turn leads to a rapid drop in the levels of oestrogen and progesterone. This drop allows the hormone prolactin to kick in, instigating milk production.
With an elective caesarean, the body does not go into labour. The placenta is not expelled but surgically removed. As the hormonal releases associated with labour have not occurred, the body does not immediately realise the baby has been born. Consequently, there is a delay in the drop of oestrogen and progesterone, which in turn inhibits prolactin from starting milk production.
Although the new mother will still be able to provide her baby with colostrom, it can take five days or maybe more for the breastmilk proper to come through.
Signs of Dehydration in Babies
This delay can be serious if the mother does not realise she isn’t producing enough breastmilk. The worst case scenario is for a baby to suffer dehydration or malnutrition. In such cases, it is vital to seek medical help immediately.
There are various signs to look out for that could indicate a baby is not receiving enough breastmilk.
- Few wet nappies or nappies with strong smelling and yellow urine
- Dipped fontanels
- Chapped lips
- An unresponsive and sleepy baby
- Drop in birth weight. All babies lose about 10% of their body weight immediately after birth. A greater decrease could indicate they are not receiving sufficient milk.
Support With Breastfeeding
If milk production is delayed, it is important to realise that this does not mean that breastfeeding is impossible. The milk will come through eventually. What is required is extra support for the breastfeeding mother.
Consult a midwife or health visitor and see if it is possible to organise 1-2-1 breastfeeding support. Organisations such as La Leche League and in Britain, the National Childbirth Trust Breastfeeding Line, should be able to provide advice and put mothers in touch with local breastfeeding councillors.
Expressing Breastmilk
Expressing breastmilk is particularly useful post caesarean. A good electronic pump is best for regular use and can be rented rather than purchased outright.
Expressing serves a twofold purpose. Firstly, a post caesarean mother can establish exactly how much milk she is producing by measure the amount expressed. Secondly, regular expressing can help stimulate milk production, especially if the infant isn’t on the breast regularly. This could be the case if a baby is receiving supplemental feeds of milk becuase their mother’s milk is insufficient.
Formula and Donated Breastmilk
If there is a delay between the colostrum and first milk, then supplemental bottle feeds will be unavoidable. Feeding a baby with a bottle as well as the breast will not necessarily result in nipple confusion and inhibit future breastfeeding. Nor will feeding a baby formula, either as its initial sole form of nutrition or as a top up for insufficient breastmilk.
Formula is not the only option for supplemental feeds. Some areas run breast milk donation scheme.
Breastfeeding Positions
Whether or not there have been problems with lactation, positioning the baby comfortably for a feed will be an issue. C section incisions can make holding baby close to the stomach uncomfortable. Using a cushion to support the baby is one option. Special breastfeeding pillows are readily available from various mother and baby outlets. It is also possible to use a pillow off the bed to cushion the abdomen.
Many of the more common breastfeeding positions are difficult or uncomfortable for breastfeeding mothers recovering from a caesarean. There are, however, certain positions that are perfect for post caesarean breastfeeding.
- Lying down position. This is a restful position, particularly good for late night feeds or the early days of recovery when the new mother is particularly fatigued. Lie on one side with the knees bent at 90 degrees. Support the back with a pillow. The baby should lie close to the mother, chest to chest with her mouth in line with the nipple. Use a pillow for support if necessary. The mother should support the baby’s head with her hand.
- Rugby ball position. This is a good alternative to the traditional cradle position which keeps the child’s weight off the abdomen whilst allowing the mother to hold him. The mother should make sure she is sitting comfortably and support her back with pillows if required. The baby should be held on her back, in an under arm position close to the mother’s side. To support the baby’s head and shoulders, spread the fingers and thumb of one hand to create a v shaped cradle. Keep the baby’s head level with the nipple and support him with a pillow if this helps to make the position more comfortable as well as keep the baby close to the breast.
Sources
Abbett, Mandy. A Mother’s Guide to Breastfeeding. NHS booklet, 2008.
Eisenberg, Arlene, Murkoff, Heidi and Hathaway, Sandee. The First Year: What To Expect. London and New York: Simon & Schuster, 2004.
Hogg, Tracey and Blau, Melinda. Secrets of the Baby Whisperer. London: Vermillion, 2001.
BabyCentre website. Making Breastmilk: How Your Body Produces Nature's Perfect Baby Food (accessed January 29, 2010).
Military Obstetrocs & Gynecology. Oxytocin (accessed January 29, 2010).
Natasha Sheldon - A writer since 2000, Natasha Sheldon holds a BA Hons in ancient history and archaeology and MA in ancient history and historiography.
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