By Ellen Rubin, IBCLC

A common misperception among women who undergo a cesarean birth is that the process itself will delay onset of breastmilk. Beginning a breastfeeding relationship with the perception that the cards are already stacked against you contributes to breastfeeding challenges.

After the delivery of a newborn, the mother’s body experiences a drop in progesterone, due to the removal of the placenta, and an elevation of several hormones which activates the next stage of breastmilk production. This is realized when new mothers’ perceive their milk “coming in”, with a feeling of fullness in the breasts, often 3-4 days after the birth of their babies. Making breastmilk is driven by hormones and is put in to play no matter the type of delivery or whether a mother plans to breastfeed or not.

In an otherwise healthy Mom, a delayed onset of lactation with a cesarean birth would not be due to hormonal factors and is therefore most likely related to some of the procedures that accompany a cesarean birth. These include the impact of the surgery on the mother, including IV fluids, medication, and pain from surgery; the impact of these factors on the baby, especially in his ability to coordinate sucking and breathing, and the greater likelihood of separation of mother and baby after the birth. The good news is that we can identify these factors and work to reduce their impact. Even better, these preparations will be helpful no matter how you deliver your baby!

Before the Birth

Prenatal breastfeeding education: Take advantage of the many resources which offer breastfeeding instruction. We offer a monthly prenatal breastfeeding class as do many birthing hospitals. This will take the guess work out of positioning and latch and help ensure the best possible start. Attending a breastfeeding support group, such as La Leche League, before your baby is born also provides valuable resources and a ready community of breastfeeding moms. You can find a La Leche League group in Pennsylvania HERE.

Childbirth education: Childbirth classes offer a realistic view in to the birthing process and teach non-drug strategies to pain management. Even if you know you will be using labor medication, these techniques may reduce the amount needed to keep you comfortable.

Prep your support group: Alert your partner and family of your decision to breastfeed and encourage them to join you in learning more about the process. Doulas are a fantastic source of support for you and your family before, during, and after the birth, no matter the mode of delivery. If you are preparing for a schedule caesarean, speak with your physician about minimizing the amount of time you will receive IV fluids and anesthesia.

After the Birth

Skin-to-skin: Request that the baby be placed skin-to-skin with you immediately after the birth and not be removed unless it is medically necessary. Many of the exams and tests can be done while the baby is skin-to-skin or delayed until after the first feed at the breast. If Mom is medically stable, plan on rooming in.

Breastfeed early and often: On the first days of life, babies take only small amounts of colostrum and need to go to the breast frequently. After a caesarean, a baby may be groggy and have difficulty coordinating his sucking pattern. Frequent opportunities at the breast will increase the likelihood of success. If the baby does not latch, colostrum can be hand expressed into a spoon and fed to the baby in small quantities. Continue to hand express regularly until the baby is nursing or until you are able to switch to regular pumping. This will also reduce engorgement for mothers.

Avoid pacifiers: Time spent with a pacifier costs calories and practice time at the breast.

Pain management: A caesarean procedure is major surgery and will require pain management afterwards. Unlike labor medications, however, most pain medication reach the baby in only small amounts and should not interfere with breastfeeding. Be both wary of and take advantage of these pain medications. They may afford you more opportunities to practice breastfeeding as they keep you comfortable, however pain at the breast is usually a sign of a less than optimal latch and the medications can prevent the pain which may alert you to this. As you are nursing, check for outwardly signs of a good latch – wide open mouth, flanged lips, chin deep in the breast – and when the baby comes off the breast, check to see if the nipple is rounded which is also a sign of a good latch.

Consider the impact of IV fluids: This extra fluid can impact the mother and contribute to engorgement. A helpful technique to address engorged breasts and fluid retention is Reverse Pressure Softening – instructions can be found HERE .

Continue to involve your support group: As you begin your breastfeeding journey, keep in mind the many people who can support you along the way. While nobody will be able to nurture the baby at the breast as you do, your partner can take care of you – whether it is sitting by your side, bringing you a snack, or a foot massage. Friends and relatives, while often eager to “help” by holding the baby can instead provide meals or do chores. Consider making a list of tasks that would be helpful around the house and keeping it accessible. If a friend asks how she can help, direct her to the list and encourage her to choose.

Schedule a visit at the Breastfeeding Center of Pittsburgh with an International Board Certified Lactation Consultant (IBCLC): If you have any questions, concerns, or are feeling any discomfort, schedule an appointment with an IBCLC. They can help with the basics of latch, assist with positioning, create a breastfeeding management plan and address the cause of breastfeeding pain.

Ellen Rubin is an International Board Certified Lactation Consultant.