Breastfeeding After Cesarean Birth

Hey Karolina! Do you have any tips for c-section mamas that may struggle with their milk coming in right away. Is there anything that I should be doing leading up to the surgery? With my son my milk did not come in and he lost a good amount of weight. I intend to have a box of formula on hand but I’d like to avoid giving that if at all possible. Thank you!

Getting Your Milk Supply Off to a Good Start after Cesarean Birth

Antenatal Colostrum Harvesting

The best way to prevent breastfeeding problems is to get a head start. More and more lactation consultants in United States recommend something called Antenatal Colostrum Harvesting – hand expressing your milk while you are still pregnant. This is a quite common practice in most European countries, especially United Kingdom.

If your pregnancy is not high-risk you can start expressing daily at the 34th week of pregnancy. This practice is especially important if you have gestational diabetes, have a planned cesarean birth, having a Large For Gestational Age (LGA) or Small For Gestational Age (SGA) baby.

Try to express your colostrum right after a warm, relaxing shower. You can express the droplets onto a spoon or into a medicine cup, then use a syringe to draw it out. You can refrigerate and re-use the same syringe for 48 hours, adding more colostrum as it’s expressed, then freeze it in an airtight zip-close bag, including your name, date of birth as well as time and date of when colostrum was collected. This information might be necessary for the hospital staff.

Nurse in the First Hour

After leaving the comfortable, secure confines of the mother’s womb, your little human enters an unfamiliar and perhaps unsettling environment. With a cesarean birth, this happens much more abruptly, so we need to be especially nurturing in the first hours of life. If possible, nurse your baby immediately after she is born.

You will most likely still be under the effects of spinal/epidural, so you won’t be feeling any discomfort yet. Since you will have to remain laying on your back for few hours, it may get a little tricky to find a comfortable position for you and baby, especially when you are still restrained. Try positioning baby lying face down across your breasts (similar to cradle hold, but baby is higher up and away from your incision, and mom is lying flat).

While in recovery, ask the nurse and your partner to hold the baby in a position while on your chest so you can relax and only focus on one another. As long as baby is healthy and there is no pressing medical concerns, don’t be afraid to tell anyone who might suggest she needs to be bathed or measured or anything else that you are keeping her with you for the time being. Those things can be done later. Smile, be polite and be firm. It’s your baby, not the hospital’s!

If you and your baby are separated after birth or baby is unable to breastfeed, hand express or pump within the first hour after birth and at least every 3 hours thereafter until baby is able to begin nursing. This will jump-start your milk production.

Keep Baby Skin to Skin As Much As Possible

Being skin to skin with your newborn baby is one of the most beneficial things you can do in the first weeks of life – and longer! Early skin to skin contacts reduces crying, pain, stabilizes your baby’s blood pressure, temperature AND blood sugar!

Have your baby only wearing a diaper and your bra removed, snuggle him upright, nestled between your breasts. Being so close to the “source of food” will make your baby more likely to nurse frequently. By doing all that, you are ensuring an increase in your milk volume.

Nurse Frequently

During the first 3 days after birth, most babies nurse non-stop. Nursing sessions may feel like marathons and last hours, without a clear beginning OR end. You may wonder… will it ever get better?! It is especially difficult as you just had a pretty major surgery! But I promise – this does not need that you don’t have enough milk.

Your baby’s stomach is really tiny right now (a size of a cherry!…) and it will gradually get bigger and stretch over next few weeks as your milk comes in. Watch for your little baby for signs of hunger. Breastfeed at least every 2 hours during the day with a nighttime span no longer than 4 hours. You’re aiming for at least 10-12 feedings per 24 hours during the early weeks.

As long as baby is nursing well, there should be no need for any supplements of any kind (formula or sugar water). Keep Your Baby Close Staying close to your baby after you get home is CRUCIAL. It helps you to react quickly to her earliest hunger signs, hence, increase your milk production. It’s THAT simple!

Nursing Positions for Hospital and Home

Once you can turn over, try turning to one side and nursing in a side-lying position. Have your partner or a nurse help you with positioning pillows.

Another position that may be more comfortable is the football hold. Sit somewhat upright in the bed and place the baby on a pillow, between your arm and your side, with your hand cupping the underside of his head. You may find at first that it’s difficult to find a “comfortable” nursing position.

Try experimenting as much as possible to get the most comfortable position, and don’t hesitate to ask for help getting positioned from your partner, nurses, or the hospital lactation consultant. Whichever position works best, make sure the baby’s tummy is towards you.

You might want to bring a few extra pillows from home (or a nursing pillow), as hospital pillows are pretty small and flat. My absolute favorite is The Breast Friend Pillow. Many moms find the side-lying position the most comfortable during the first day or so. It’s an easy way to nurse and rest at the same time. Using a small blanket, or pillow – even a rolled up towel – can help protect your incision while you nurse lying down.

Follow these step-by-step instructions on getting into the side-lying position after cesarean birth

  1. Begin with the bed in a flat position and side rails up. Use extra pillows behind your back for more support.
  2. Roll to one side while grasping the side rail and relaxing the abdominal muscles. Move slowly so not to strain yourself.
  3. To protect the incision from the baby’s kicking, cover your tummy using a small pillow or towel.
  4. Put a pillow between your legs to lower the strain on your tummy muscles
  5. Lean back into the pillows behind the back and relax
  6. When using side-lying position, baby should be placed on his side, facing your body, chest to chest, so she doesn’t have to turn his head to nurse. Baby’s feet should be drawn in close to your body with her head either lying on the bed, or on your arm, whichever feels most comfortable to you.
  7. You can either roll your body forward to latch or pull the baby toward you.

The Use Of Pain Medication

Medications used for pain relief after cesarean birth are usually compatible with breastfeeding. So are antibiotics and other medications which may be prescribed.

If there is any question about a particular medication, a doctor can almost always prescribe a substitute that has been found safe to use while breast­feeding.

Less than 1% of most medications passed into a mother’s milk, although there are variations to this. Most medications are compatible with breastfeeding, even during the newborn period. You can always get in touch with me via the contact form, and I will be happy to help you understand the safety of your medication.

But Most Importantly. . .

After any delivery, a mother needs to allow her body to rest and heal. Ideally, this means little to no housework, and no running after other little ones. The maternal mortality rate is highest in the postpartum period, so special consideration needs to be given to the care of the mother.

If you are a single mother or your partner has to return to work shortly after the birth of the child, try to organize a support team prior to the birth of your child to help during this time. The support team can include family, church members, new mother/breastfeeding support groups, or a postpartum doula.

Breastfeeding should be comfortable. Learning a new skill often takes time, no matter how your baby arrived! If for any reason breastfeeding is not going smoothly or you find it painful to breastfeed, please contact me, I’d love to help you!

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