Breastfeeding after a Cesarean Birth

By Kelly Bonyata, BS, IBCLC.

These are a collection of suggestions for nursing after a cesarean birth. You can do it!

Educate yourself and arrange for breastfeeding help

Find a La Leche League group near you! Try to attend at least one meeting before your baby is born. Ask questions!

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Talk to the lactation consultant (LC)–assuming your hospital has one on staff–and ask that she meet with you as soon as you get out of the operating room. She can help you position your baby as painlessly as possible. If an LC is not available, ask one of the nurses and/or have your partner or another helper available to help out.

What about anesthesia and medications?

The anesthesia and any pain meds you are given should not affect your milk. There are many pain meds that are compatible with breastfeeding, so be sure to ask your doctor for one that is commonly used for breastfeeding mothers. Do try to use medications only as needed, to reduce the amount of sleepiness in you or your baby. Excess sleepiness can make breastfeeding challenging in the beginning. Here are suggestions for waking a sleepy baby.

A low grade fever in the mother is common during the early days after a cesarean birth, and should not be a reason to separate the mom and baby. As long as the mother washes her hands well before touching the baby, there is no reason for separation, even if the mother has an infection.

First nursing after birth

If possible, the time immediately after your baby is born is a great time to start breastfeeding. You will still be under the effects of the spinal/epidural and probably not yet feeling any discomfort. You will likely have to nurse lying on your back, because of the epidural. Since one arm may be restrained, it may get a little tricky. 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). When nursing in this position with a newborn, have someone nearby to make sure baby’s nose doesn’t get blocked, since you both may be groggy from the meds. Have your partner or a nurse help position the baby, and use lots of pillows around you to help with support.

Nurse early and often

Ideally, you’ll want to put your baby to breast within the first hour. Studies show that when time to breast is longer than this, babies have more difficulty breastfeeding and engorgement is more severe. If something prevents the baby from being put to breast within the first hour, you should begin pumping with a hospital-grade breastpump.

Watch for your baby’s hunger cues. Breastfeeding at least every 2 hours during the day with a nighttime span no longer than 4 hours is highly recommended–you’re aiming for 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 (i.e. formula or sugar water).

Nursing positions

Once you can turn over, try turning to one side and nursing in a side-lying position (see below). 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.

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.

Below are step-by-step instructions on getting into the side-lying position (in a hospital bed) after a c-section:

Begin with the bed in a flat position and side rails up.
Use extra pillows behind the mother’s back for extra support.
Carefully roll to one side while grasping the side rail and relaxing the abdominal muscles. Move slowly to avoid strain.
To protect the incision from the baby’s kicking, cover the abdomen with a small pillow or towel.
Place a pillow between the legs to minimize the strain on the stomach muscles.
Lean back into the pillows behind the back.

When using side-lying position, baby should be placed on his side, facing your body, chest to chest, so he doesn’t have to turn his head to nurse. Baby’s feet should be drawn in close to your body with his head either lying on the bed, or on your arm, whichever feels most comfortable to you. You can either roll your body forward to latch, or pull the baby toward you.

(Thanks to Kathy Kuhn, IBCLC for these tips)

Avoid supplements

Be sure to let the hospital staff know they shouldn’t give any supplemental bottles or pacifiers, as these artificial nipples can cause problems with breastfeeding. If you are told that supplements are medically necessary, request that they be given via cup or feeding syringe rather than a bottle to avoid the risk of nipple confusion.

You can request that your doctor provide written orders that the baby is to be breastfed, and have no artificial nipples of any kind (no pacifiers or bottles) and that IF supplements are medically required, they should be given by an alternative method rather than by bottle.

When will my milk come in?

The abrupt hormonal shift that occurs at the separation of the placenta from the uterus is what signals your milk to come in. Thus mom’s body will get the same signal whether she has a cesarean or vaginal birth. Moms who have stressful births (cesarean or vaginal) tend to have their milk come in a little bit later.

Your milk may come in anywhere from day 2 to day 6 (usually around days 2-3). If your milk is slow coming in, try not to worry, but put baby to breast as often as possible and stay in contact with your lactation consultant so she can monitor how baby is doing. Using these tips on how to be sure baby is getting enough milk will also reassure you. Baby can do quite well on colostrum alone in the early days, as nature intended.

To encourage an abundant milk supply:

Nurse as soon after birth as possible. If something prevents the baby from being put to breast within the 4-6 hours, you should begin pumping with a hospital-grade breastpump. Get the okay from your doctor/midwife ahead of time to nurse your baby in the recovery room – this shouldn’t be a problem unless you or baby are having medical problems.
Nurse frequently. Breastfeed your baby at least every 2 hours (from beginning of nursing to beginning of the next nursing) during the day, with no more than 4 hours between nursings at night. You’re aiming for at least 10-12 nursings per 24 hours. More frequent nursing results in greater milk production at one week and thereafter.
Avoid unnecessary supplements. Do not supplement baby with anything (formula, water, etc) unless it is medically indicated. Supplementing will do two things – missing feedings will reduce breast stimulation and milk removal (both needed to increase milk supply), and babies who are supplemented tend to need to eat again later than if they had nursed – so again you’re losing much-needed nursing time.
Ensure that baby is nursing well. If baby is not latching well and transferring milk well, then it can affect milk supply and the speed that your milk comes in.

Going home

If all is going well, some moms prefer to ask for an earlier discharge so they are not at the hospital an extended length of time. If you do this, be sure that you have some help at home, and try to get as much rest and nourishment as possible – especially fluids. Do see if there is a lactation consultant (IBCLC) at the hospital (or another local lactation consultant) who will make at least a couple of home visits to be sure all is going well with breastfeeding, and help you (if necessary) to fine-tune positioning and latching.

Get help around the house postpartum. If possible, have your partner take a few days to several weeks off work (as much as you can afford!) to help out. You won’t be up to housework at ALL at first. Even accomplishing basic tasks for your own and your baby’s needs will be tough. This is major surgery. Your body will need time to recover. If taking time off is not an option for your partner, look into getting others to help. Do you have friends or family who can check in on you? Someone to help with the laundry, dishes and cooking? Can you pay a professional to clean up once a week (this will make you feel better)? You could hire a local 13+ year old to help out. Ask at church (if you attend), your local school, or even your local Girl Scout troop. It will be very helpful if you can find someone who can come for an hour or two every afternoon to do dishes, laundry, straighten up, and maybe even keep an eye on the baby while you shower or potty or nap.

Other C-Section Resources

Breastfeeding After a Cesarean by Anne Smith, IBCLC
Breastfeeding After a Cesarean by Dr. William Sears
C-section recovery tips from other moms

General links on getting a good start to nursing @