Around one third of babies are born by c-section in Australia. Interestingly, the c-section rate in public hospitals is 28 percent, and in private hospitals it's 44 percent (15 percent is the recommended c-section rate from the World Health Organization).
If you're having a planned c-section or have had an emergency c-section, you may be worried about how it may affect breastfeeding. For example, you may worry about a delay in your milk coming in, or how any pain after a c-section may impact upon breastfeeding positions.
The good news is that no matter how your baby is birthed, breastfeeding can work out.
Key steps include getting help quickly if you need it and to being as informed as possible.
Breastfeeding After C-Section
Here are 8 tips to help you begin breastfeeding after a c-section:
#1: Skin-To-Skin Contact
Skin-to-skin contact means having your unwrapped baby (but with a blanket over the top) on your bare chest.
Early skin-to-skin contact between you and your baby helps to get breastfeeding off to a great start. Skin-to-skin contact between you and your baby provides him with the best transition to the outside world. Your chest helps keep your baby warm, calm and provides his food source.
Ideally, skin-to-skin contact would occur straight after your baby is born and as often as possible thereafter, particularly in the early weeks.
Skin-to-skin contact between you and your baby helps:
- Your baby to use his natural instincts to find your breast (see next point)
- Regulate his temperature, blood sugar levels, heart rate and breathing
- Keep him calm
- You and your baby get to know each other
- You to be able to recognise your baby’s feeding cues
- Helps him remain calm
In most hospitals, skin-to-skin contact between a mother and her baby after a vaginal birth is routine practice. In some hospitals it's also routine practice after a c-section while the mother is still on the operating table, provided she is awake.
If skin-to-skin contact is important to you, check with the hospital to see what policies that may have in place. Routine observations of your baby can be done while he is on your chest. Weighing and measuring your baby can wait until later – these things won’t change much in the first couple of hours.
It can be very healing to spend time skin-to-skin with your baby, especially after any stress that may have built up before the c-section.
#2: Baby-Led Attachment
Babies are born with instincts that allow them to find their mothers breasts on their own (this is called baby-led attachment). Skin-to-skin contact helps facilitate your baby to do this.
Baby-led attachment helps lay down the foundation for breastfeeding. When a baby uses his instincts to find his mother’s breasts he learns lots of things. For example, he learns:
- What his mother’s chest smells and feels like. When he knows this, it makes it easier the next time (and the next and so on) for him to find his mother’s breasts.
- How to best position himself to attach best to your breast
- How to bring his tongue forward and down over his lower gum
If your baby has many opportunities, particularly in the early weeks to practice baby-led attachment, he becomes a lot more orientated to your breasts. He more quickly becomes an expert at breastfeeding! Baby-led attachment can reduce the likelihood of sore nipples or other attachment problems.
To practice baby-led attachment:
- Recline back with pillows behind you for support
- Place your baby on your bare chest with his head just above your breasts. In this position, he should be well away from your wound. A pillow placed over your wound may help too
- When he is ready, he will move towards one of your breasts
- As he moves, you can gently direct his legs away from your wound
- Let your baby lead the way, but you can help him by support him behind his shoulders and neck with your wrist and hand. You can also help by keeping him close to you and by helping to keep his body aligned
- Once he nears your nipple, he may lick or nuzzle around
- When he is ready, he will press his chin into your breast, open his mouth wide, attach and start feeding
A baby’s instincts to find his mother’s breasts are easily reproducible, at least for the first few months. Hence, even if you don’t get to do baby-led attachment straight after birth, you will still have many more opportunities.
#3: A Scent Trail
A baby keeps some amniotic fluid in his clenched hands after being born. As he does baby-led attachment, he smears the amniotic fluid on your chest. This leaves a scent trail that helps him to find your breasts for subsequent breastfeeds. Since the smell of amniotic fluid is familiar to your baby, it tends to have a calming effect on him.
For these reasons, some mothers don’t wash their chest (as it would wash off the amniotic fluid) or use any strong smelling substances that mask the amniotic fluid smell (e.g. perfume or deodorant) for at least the first 24 hours after birth.
If you cannot have skin-to-skin contact with your baby straight after birth, you could ask for amniotic fluid to be smeared over your chest and left there at least until after the first skin-to-skin contact happens.
Rooming-in means having your baby in the same room as you at all times. This is normal practice in most hospitals unless you or your baby needs special medical care.
Rooming-in with your baby helps you have a better awareness of your baby’s needs. For example, you will be better able to notice his feeding cues. Babies feed better when their feeding cues are responded to as compared to being fed according to a schedule. If a baby feeds better, he will more likely get what he needs, gain weight better and help establish your supply.
In the early days after a c-section, many mothers find it helpful to have someone around to help them lift and move their baby e.g. for feeds. The hospital may allow your partner or other support person (e.g. a doula) to stay with you for support.
#5: Support Person
Sometimes after a c-section it may not be possible for you and your baby to be together straight away. For example, if you’ve had a general anaesthetic, you may not be awake straight after the birth.
However, it is usually possible for you to be able to be with your baby within the first couple of hours (e.g. when you are in the recovery room).
Until you are able to, your partner is the next best person to hold your baby in skin-to-skin contact.
It can take at least a few weeks to recover from a c-section. Therefore, your partner and other support people may need to take an active role in helping you to care for your baby during this time.
#6: Ensure People Know How You Feel About Breastfeeding
If breastfeeding is important to you, make sure those who are caring for you and your baby know this. In this way, they can help ensure all is done to make sure breastfeeding gets off to the best start possible.
#7: Breastfeeding Positions
You may find some breastfeeding positions more comfortable for the first week or so because of the wound from a c-section. Use whatever position that works best for you and your baby. Here are some positions that mothers commonly find helpful after a c-section:
- Lying down. Lie on your side, with a pillow under your head. A pillow behind your back and/or between your knees could help too. Hold your baby in close with him on his side and feed from your lower breast.
- Football hold. Hold your baby under your arm at your side (as you would hold a football). Support your baby along your forearm with your hand and wrist supporting his shoulders and neck. A pillow can be placed under your baby to help support his weight too.
Gradually, you will find that you can comfortably breastfeed in more positions such as sitting with your baby held in front of you. If your wound is still sore, a pillow on your lap might help.
#8: If Breastfeeding Has To Wait
It is uncommon for newborn babies to need anything other than colostrum and breastmilk.
If something is happening and you don’t understand why, be sure to ask for an explanation. You may also wish to contact an Australian Breastfeeding Association counsellor or seek the advice of a lactation consultant for help and support.