It’s important to mention from the outset that there are many mothers who’ve had a c-section and have breastfed successfully.
The information contained in this article is general in nature and may or may not be relevant or occur in every individual situation.
However, being fully informed about every possible affect a c-section may have on breastfeeding is important.
This is because when we are fully aware of possibilities, we are better prepared to tackle them and hence better able to overcome them.
Research has found lower rates of early breastfeeding after c-section compared to vaginal birth. It has also been found that women who have c-sections after labour has begun (an emergency c-section) have higher rates of breastfeeding than those women who have elective c-sections (c-setion with no labour).
So, in what ways does a c-section affect breastfeeding? Here are 7 things you need to know.
#1: It May Delay Your Milk Coming In
A mother’s milk coming in is hormonally driven, and is set into motion after the birth of the placenta. Hence, no matter what birth events occur, as long as the placenta is removed, in almost all situations a mother’s milk will come in.
If there truly is a delay in a mother’s milk coming in after a c-section, this may have more to do with the circumstances that are more likely to occur (or less likely to occur) after a c-section, rather than the surgery itself. For example, it’s known that breastfeeding within an hour of birth and early skin-to-skin contact help breastfeeding get off to the best start possible. Such practices tend to occur less often after a c-section, and it may be due to these sorts of things that a delay a mother’s milk coming.
Implementing such practices after a c-section may eliminate any delay in your milk coming in.
#2: Drugs Used May Affect Early Breastfeeding
C-sections are usually done using an epidural or spinal anaesthetic, or a combination of both. A general anaesthesia is reserved for special or unusual situations.
Bupivacaine (marcaine) is the most commonly used drug in an epidural and/or spinal anaesthetic for c-sections. Research from the 1980s found bupivacaine affected a baby’s behaviour for up to 6 weeks after birth (e.g. reduced hand to mouth movements on day one, and reduced visual skills and alertness). These days, smaller doses of anaesthetics are given, and often in combination with opioids such as fentanyl.
Research also indicates opioids can have a negative effect on a baby’s feeding behaviours and breastfeeding outcomes when used during labour. However, there’s insufficient research about the possible affect drugs used in a c-section may have on breastfeeding, including a baby’s feeding behaviours.
Some mothers who’ve had a c-section notice their babies are quite sleepy, especially in the early days after birth. Some also notice their baby doesn’t seem interested in attaching to the breast, especially in the early days. Whether this is coincidence, circumstantial or related to the c-section (e.g. the drugs used, or perhaps due to a baby not being born when physiologically ready to be), requires further research. If these things happen to you, working closely with a lactation consultant can help immensely and these problems are usually short lived.
#3: The First Feed May Be Delayed
Being skin-to-skin with your baby as soon as possible after birth helps breastfeeding get off to the best start possible. Having an epidural or spinal anaesthetic for a c-section often makes it possible for you to be able to be with your baby soon after birth.
However, if the mother has a general anaesthetic for a c-section, there will likely be a delay in when her baby receives the first breastfeed. If medically possible for the baby to do so, it’s important for her to be kept in skin-to-skin contact with the partner until she can be with her mother as soon as possible. Breastfeeding is usually possible within the first couple of hours, although you may need some assistance to position your baby.
#4: Pain May Make Early Positioning And Attachment Challenging
Pain relief medication is often needed for a few days after having a c-section. Having your pain under control may improve breastfeeding outcomes as it can help make it more comfortable to hold, and position and attach your baby. Read here for tips about breastfeeding positions after a c-section.
If the c-section was done using an epidural or spinal anaesthetic, this can be used to deliver pain relief after the birth too. Research has found that babies of mothers who received a bupivacaine epidural after a c-section breastfed better and gained weight more rapidly in the early days than those whose mothers got non-steroidal anti-inflammatory (NSAIDs) pain relief only.
Pethidine is one pain relief medication which has been found to have a more prolonged effect on a baby’s behaviour. So, if possible, other pain relief medications may be better options.
Pain relief medication can lead to sleepiness in you and your baby. If you find this is an issue, paracetamol and NSAIDs may better options. The key may be to giving these sorts of medication routinely rather than in response to pain.
#5: Altered Hormonal Patterns May Impact Early Breastfeeding
Research has found hormonal patterns of oxytocin, prolactin and cortisol differ in mothers who gave birth by emergency c-section versus vaginally. Mothers who gave birth vaginally had significantly more oxytocin pulses than those who had a c-section.
It was also found that women who had a c-section lacked a significant rise in prolactin levels at 20-30 minutes after the onset of breastfeeding.
Also, there was a correlation between oxytocin pulsatility on day 2 and the duration of exclusive breastfeeding in the mothers who gave birth vaginally. This suggests the development of an early pulsatile oxytocin pattern is important for breastfeeding.
#6: It May Increase The Risk Of Early Supplementation
Research has found babies born via c-section before labour began had a significantly higher percentage of weight loss than those who were delivered after labour had begun.
With a higher percentage of weight loss comes an increased risk of supplementation being required, such as with formula. Early formula supplementation has been associated with an earlier cessation to breastfeeding.
#7: It May Mean A Baby Is Not Physiologically Ready To Be Born
When planning for an elective c-section, there may be benefits to allowing labour to begin spontaneously before the surgery.
Since physiological mechanisms exist which cause labour to start, the lack of these may mean a baby isn’t fully physiologically ready to breastfeed most effectively. A baby born via c-section also doesn’t get exposed to the normal physiological processes of a vaginal birth (e.g. the release of oxytocin, beta-endorphin and adrenalin).
The lack of such processes may impact on how well a baby used his instincts early on to seek his mother’s breasts and attach.
Remember, many mothers successfully breastfeed after a c-section. Although, there may be some early challenges, there are also many things you can do to help breastfeeding get off to the best start possible after a c-section. Read our article, Breastfeeding After C-Section – 8 Tips For Success, for more information.