Breastfeeding after a c/section
If you have a scheduled c/section and are planning on breastfeeding, then this blog is for you!
It’s also for any pregnant mama planning on breastfeeding - even if you are planning for a vaginal birth, this is great information to have just in case you were to end up having a c/section!
Having a c/section CAN affect breastfeeding, however there are ways to mitigate this impact!
#1 Golden hour
What is the golden hour and why is it so important?
The golden hour is the first hour after birth.
Ideally, baby would be put skin to skin with mom immediately upon delivery and stay there for an uninterrupted hour of skin to skin.
Research has found this hour of skin to skin has many benefits, including:
decreased rates of postpartum hemorrhage
better temperature regulation for baby
less need for supplementation for baby
better breastfeeding rates and outcomes
“The Golden Hour encompasses a set of evidence-based practices that contribute to the physiologic stabilization of the mother-newborn dyad after birth. Important elements of the Golden Hour include delayed cord clamping, skin-to-skin contact for at least an hour, the performance of newborn assessments on the maternal abdomen, delaying non-urgent tasks (e.g., bathing the newborn) for 60 minutes, and the early initiation of breastfeeding. The Golden Hour contributes to neonatal thermoregulation, decreased stress levels in a woman and her newborn, and improved mother-newborn bonding. Implementation of these actions is further associated with increased rates and duration of breastfeeding.”
It is important to realize the impact the golden hour can have on mom and baby, while also understanding that this will not always be medically possible.
When having a c/section, golden hour is not always possible. Depending on the reason for the c/section (emergency, scheduled, etc.), skin to skin in the OR (operating room) may not be an option. The safety of mom and baby will always be put first, and may eliminate the possibility of this hour of skin to skin. This will also depend on the medical team and on the facility, some may allow skin to skin in the OR while others may not.
Here’s what you can do:
make it clear to the medical team that you would like your birthing experience to include the golden hour if possible
make a plan for what you want to happen if this is not possible! (ex: baby comes right to you when you are both stable, initiating skin to skin as soon as possible)
What you can do if this golden hour is interrupted:
begin skin to skin as soon as you and/or baby are stable - typically once you and baby are moved to the recover room (PACU), baby can immediately be placed skin to skin
skin to skin as much as possible the first few days postpartum - when you are awake, it’s great to put baby on your chest rather than swaddling them up. This can help promote bonding and can positively benefit milk supply and breastfeeding success!
#2 Baby’s weight loss
It is normal for baby’s to lose weight after delivery. This only becomes concerning when baby’s wight loss is above 7%, even more concerning at 10% or above. It is important to know that having a c/section can lead to an increase in weight loss for baby! Before and during a c/section, it is typical to receive a few bags of fluids to prevent hypotension (low blood pressure) during the operation. This can lead to an inflated weight for baby upon delivery. Baby then pees out this extra fluid, which can lead to a higher weight loss percentage. This is something to keep in mind if your healthcare provider is worried about baby’s weight loss!
Infant’s tend to lose more weight in the first postpartum days when:
labor meds are used
more intrapartum fluids have been given
there was no labor prior to cesarean
Due to this risk of an increased weight loss for baby, it is especially important to be feeding baby often enough! Anytime baby shows feeding cues, even if it has only been an hour since they fed, offer the breast again! It is expected for a newborn to feed 10-12 times in 24 hours! Sometimes feedings will be an hour apart, sometimes 3. You cannot overfeed a baby at the breast, and all of this stimulation the first few days can make such an big impact on milk supply and breastfeeding success. Skin to skin and frequent feedings can make a world of difference.
#3 Delay in milk “coming in”
Your body starts making colostrum mid-way through pregnancy. Unless otherwise medically indicated (high weight loss, baby is not pooping or peeing enough, etc.), colostrum is enough for baby until milk “comes in”, or transitions to mature breastmilk, anywhere from 2-5 days postpartum. Having a c/section does have the possibility of delaying milk “coming in” up to 72 hours. Engorgement occurs as milk “comes in”, and studies have found that women with cesarean birth experience peak engorgement 24-48 hours later than those who deliver vaginally. This is typically not something to worry about, just something to be aware of! This is why it can be important, no matter the type of delivery, to keep baby close as much as possible the first few days postpartum. Lots of skin to skin and feeding on demand can help prevent or lessen this delay in milk coming in! Again, the goal should be 10-12 feedings in 24 hours!
#4: Pain
Pain has actually been shown to inhibit oxytocin, which is crucial for letdown when breastfeeding. “If a mother is in severe pain or emotionally upset, the oxytocin reflex may become inhibited, and her milk may suddenly stop flowing well. If she receives support, is helped to feel comfortable and lets the baby continue to breastfeed, the milk will flow again.” Studies have also found that pain can impact breastfeeding initiation and success. If you have a c/section and find yourself in pain, it is important to remember that you just had a major abdominal surgery and pain management is crucial for recovery. There are many pain medications that are safe to take while breastfeeding. If you have any concerns about the pain medications available to you, be sure to ask your healthcare team. Pain medications typically given in the postpartum period (tylenol, ibuprofen, oxycodone) are considered safe to take while breastfeeding.
#5 Support
Recovering from a c/section while breastfeeding and taking care of a newborn can be quite the challenge! Having a good support system can make such a big difference in your breastfeeding journey. Studies have found that partner and family support can have a positive impact on breastfeeding initiation, duration and success. If you have a c/section planned, you can set your support system up with expectations! Letting them know exactly how they can help: bringing baby to you, diaper changes, helping you remember to take your pain meds, washing any necessary bottle or pump parts, bringing you snacks and water when you are breastfeeding, etc. This can all make such a positive impact on your recovery, pain and breastfeeding journey! Including your partner or support person in breastfeeding education (having them attend lactation consults and/or breastfeeding classes) can also positively impact breastfeeding!
#6 Positioning
It is typical for hospital staff to show you a cross-cradle hold for breastfeeding while you are in the hospital as this is one of the most common breastfeeding positions. Some mamas may find this to be uncomfortable after a c/section, especially if there is extra pressure on the abdomen. I would encourage you to ask the hospital staff to show you how to position baby for feeding in the football hold. While this may not be favorable for everyone, I find a lot of c/section mamas find this position most comfortable and it is great to have a couple breastfeeding positions under your belt when leaving the hospital so you have options!
I hope you found these tips helpful! I wish you the best of luck in your breastfeeding journey! You got this mama!
xoxo, Hannah
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Berens, Pamela, and Wendy Brodribb. “ABM Clinical Protocol #20: Engorgement, Revised 2016.” Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine vol. 11,4 (2016): 159-63. doi:10.1089/bfm.2016.29008.pjb
Newborns often take weeks to return to birth weightHooda, Reetu et al. “Impact of Postoperative Pain on Early Initiation of Breastfeeding and Ambulation After Cesarean Section: A Randomized Trial.” Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine vol. 18,2 (2023): 132-137. doi:10.1089/bfm.2022.0208
Following Cesarean Delivery, Postoperative Pain Affects Likelihood of In-Hospital BreastfeedingPostoperative Pain After Cesarean Birth Affects Breastfeeding and Infant CareMahesh, Pasyodun Koralage Buddhika et al. “Effectiveness of targeting fathers for breastfeeding promotion: systematic review and meta-analysis.” BMC public health vol. 18,1 1140. 24 Sep. 2018, doi:10.1186/s12889-018-6037-x
Woods Barr, Alexis L et al. “#EveryGenerationMatters: Intergenerational Perceptions of Infant Feeding Information and Communication Among African American Women.” Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine vol. 16,2 (2021): 131-139. doi:10.1089/bfm.2020.0308
Ogbo, Felix Akpojene et al. “Breastfeeding in the Community-How Can Partners/Fathers Help? A Systematic Review.” International journal of environmental research and public health vol. 17,2 413. 8 Jan. 2020, doi:10.3390/ijerph17020413
