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This article covers the following topics –
1. The most common myth about Breastfeeding after Caesarean section birth
2. Factors that affect Breastfeeding after Caesarean section birth
3. Initiating the Breastfeeding process
4. Recommended positions for breastfeeding after Caesarean section birth
5. How to know if the baby is properly fed
6. Conclusion
Over the last few years, there has been a rapid increase in the number of Caesarean (C-Section) births all around the world. While some of them are done to save the lives of mother and child, many new age parents are opting for the surgical procedure voluntarily. Whether the decision is a medical necessity or a voluntary choice, your breast feeding journey can still be a successful one. However, there are certain things that you need to be aware of to kickstart that successful journey. So, lets dive right into them.
The most common myth about Breastfeeding after Caesarean Section birth
You must have heard very commonly that breastmilk cannot be produced immediately after caesarean section birth. This myth is so common that even elders and hospital staff believe in it and in most cases, never initiate breastfeeding in the vital birth hour ( more on this later ).
This is absolutely false. Your body is totally capable of producing breast milk immediately after birth, regardless of the type of birth. In fact, breastmilk production starts even before birth, during pregnancy. This milk is known as colostrum and it is very very vital for your baby. It is produced in small quantities and that is all that your baby needs right after birth. In some cases, the colostrum starts leaking before birth. But such cases are rarely found.
In a caesarean section birth, the placenta is removed during surgical process. It is the removal of the placenta that signals the body to start increasing the volume of milk for the new-born. Once the colostrum is fed to the baby, the milk production increases in volume gradually over the next few days. Though it differs from person to person, the milk production starts increasing within 72 hours of birth in most normal cases.
Factors that affect Breastfeeding after Caesarean section birth
Medications : During the surgical procedure, the mother is given different kinds of medications depending upon the complication of the case. The most commonly used are
epidural/general anaesthesia, intravenous(IV) fluids and antibiotics. These have different kinds of impact on the new born. Most of them make the child sleepy and lethargic. This may hinder early initiation of breastfeeding.
Separation due to medical reasons : In some cases, it is absolutely necessary to keep the child and mother separated for prolonged duration. This happens in complicated cases and premature deliveries when the new born is needed to be kept under observation in NICU. It becomes difficult to initiate breastfeeding in such cases.
Emotions : Emotions play a very important role in breastfeeding, espl after a caesarean section birth. The cause of these emotions can be divided into two broad factors –
– Internal – Post delivery, some new mothers feel a void after the child is separated from their bodies. This is known as post partum blues. This can happen more significantly in caesarean section births if the mother and child are separated for prolonged duration of time. Such separation may also cause separation anxiety in the new-born and she can go on a nursing strike too. Also, when the C-section is unplanned and is done out of medical necessity, some mothers may develop a feeling of not being at par with their expectations. They may harbour the feeling of defeat, especially when they were too rigid on giving vaginal births.
– External – The external factors primarily consist of collective behaviour of the people around. They include your family, visiting friends/relatives and hospital staff. These factors are very important and often times, unexpected. So, it is important to prepare yourself mentally beforehand. In India, esp. in joint families, our elders and relatives have considerable involvement on how we handle the new-born. They are often unaware about the correct things to follow to provide best possible care to the new mother and the child. Although there intentions may be positive, they may end up behaving inappropriately which can lead the new mother to get upset. Comparison with other ladies of the family who gave vaginal births, separating baby and mother for prolonged durations and worrying too much about whether the child is well fed or not are some of the things that can be expected.
The hospital staff can even be more disappointing. In India, there are still no regulations for hospitals which provide maternity services regarding doulas/midwives or lactation consultants. More often, the nurses are practically untrained and do not have adequate theoretical knowledge as well. We have came across numerous cases where the staff went on to pinch/ squeeze and mishandle the breasts of a new mother and then declare that there is no milk. Some hospital nurses even show resistance to provide full care during breastfeeding as it requires her to visit more often. Formula milk keeps the child full for a longer duration of time. This is why most hospital nurses insist on feeding formula.
Initiating the breastfeeding process
Now that you understand the factors that can affect your early breastfeeding journey, let’s decipher the ways to overcome them. Here are the tips to kickstart a successful journey of breastfeeding after caesarean section birth –
1. Relish the Vital Hour : Vital hour is the first hour after the child is born. This is the most important time to set things up in the right direction. The baby should be kept skin to skin to the mother near her breasts and should not be interrupted during this time. She should not be separated even for bathing, vaccination or any other non-emergency medical procedure. In case there is a medical emergency, the skin to skin should be provided when the situation is normal. During the absence of mother , the father can give skin to skin contact to the baby. This is called Kangaroo Mother Care (KMC).
Why is it so important ?
– It helps in relieving the separation anxiety in the baby. KMC plays an important in helping the baby to adjust to a completely different environment. Remember, a happy baby is a happy eater.
– It initiates the release of the oxytocin hormone in the mother, which helps in the production of milk.
– It helps the mother to overcome post partum blues. Post partum blues hinder release of oxytocin and may lead to delayed or even reduced milk production.
– It also reduces the chances of the occurrence of hypoglycaemia ( low sugar levels ) in babies.
Inform the doctor and medical staff about your intentions to breastfeed immediately. Some hospitals keep the baby in nursery and may give substitutes without informing the family. Make sure that one of the responsible family member is keeping a watch on this. If it is not possible to provide KMC and feed directly in the first hour due to medical emergency or premature delivery, send hand-expressed colostrum for the baby. It is important to learn hand expressing breastmilk during your preparation for delivery.
Other things to remember during the Vital Hour
– You do not need to wash your nipples before feeding. This is because the Montgomery glands that surround the nipples and cover the areola release an antibacterial fluid that moistens and cleans the areola before feeding.
– If it is not possible to feed directly, never use a feeding bottle. Whether you feed hand expressed colostrum or the formula, using a feeding bottle initially will make the initiation of your breastfeeding journey very difficult. This is because the bottle nipple and human nipples have very different shapes. The milk just flows through the bottle and the baby has to apply minimum pressure to get the milk. This sends the baby into a comfort zone and it becomes very difficult to make her latch onto the breasts later on. Various options that you can use include feeding tubes, lactation aids and paladai.
– Do not use breast pump so early. Colostrum is easier to express with hand than the pump. Pump is better when the milk production is high.
– The colostrum requirement of a baby is only 5-7 ml. Her stomach is very small and this is all that she needs. Do not fall into the trap of top feeding. It will turn into a vicious circle otherwise.
– The baby might be sleepy due to the effect of medication. In such a scenario, try to keep the baby awake. You can do so by kissing her hands, tickling her toes, changing her nappy or rubbing a clean wet towel gently on her face at ambient temperature.
2. The time gap between feeds should be maximum 2 hours. This time is counted from the instance when the baby started her last feeding session. It is always better to offer your breasts as frequently as possible instead of adhering to any strict time schedule. Also, feed with both the breasts.
3. Talk to your family, esp. your spouse beforehand to avoid any of the external emotional factors listed above from the family side. Many first time parents are equally clueless about the things that may happen. If your loved ones know about how their behaviours can affect the wellbeing of mother and baby, they will surely cooperate and be more empathetic.
4. Choose your doctor and hospital wisely. Please do not hesitate to ask tough questions. Ask your acquaintances about their experiences with various doctors and hospitals. Many doctors push for unnecessary interventions. Also enquire if their staff has any knowledge/formal training about birthing. There are certain groups and organisations that mark certain hospitals as baby friendly. Look for the one in your area. Make sure that the external emotional triggers are completely eliminated.
5. Trust your body. If it can create a life, it will produce the fluid required to nurture that life. Do not feel too nervous. Also if the caesarean section is spontaneous, it does not make anyone less of a mother. She still gives her best in all circumstances. Talk to your spouse if you feel low.
Recommended positions for breastfeeding after Caesarean section birth
1. The mother is lying down with her arms resting beside her body in a straight position. The baby is latched onto one breast and her body in parallel to the resting arm.
2. The baby is kept on the mother’s shoulder in an inverted position. The face is towards the breast and the legs are near the neck.
3. The baby’s face is kept on one breast and her legs on the other.
All these positions ensure that the baby is away from the stitched part of the mother’s stomach. She needs assistance of a caregiver, esp. if she is under the effect of medication. Special care needs to be taken so as not to close the airway of the baby while attempting any of these positions. Babies have a natural tendency to search for breasts for milk. The fluid produced by the Montgomery glands make the areola darker and leaves a fragrance which helps the child to find the breasts. As stated earlier, keep a check on the signs if the baby is not under the influence of any medications.
How to know if the baby is having enough
Many times, hospital staff and our family members are sceptical about the quantity of milk produced. Many families force new mothers to give formula milk as they are not sure whether the baby is getting enough milk or not. There are certain ways that you can be sure about it.
– A hungry baby is a restless baby. If your baby is resting well and feeling relaxed, then the milk is enough. Babies need only 5-7 ml of milk on first day. Please remember that there are other reasons also for the baby to get cranky. When mother and baby are separated for longer duration, the baby may be cranky and may cry excessively even in the presence of mother. This mostly happens in the first 1-3 days. Pee and Poop tracking is a more accurate measure as explained in the next point.
– You can also detect this by keeping a track of her nappies. Use cotton cloth in initial few days instead of diapers to keep a track. In general –
Day 1 – 1 wet nappy & 1 soiled nappy
Day 2 – 2 wet nappies & 2 soiled nappies.
Day 3 – 3 wet nappies and 3 soiled nappies.
Day 4 & 5 – 4-6 wet nappies and 3-5 soiled nappies.
The milk production takes off during this time and you may start experiencing fullness in your breasts from 48-72 hours after birth. Many people think that since breasts are not full of milk on Day 1 right after birth, so the milk is not enough. They end up giving formula and fall in this trap. The above nappy schedule from day 4 should continue for about 4-6 weeks. Please remember to give as much KMC as possible. This will keep you both in the right direction.
Conclusion
Whether you have a vaginal delivery or a caesarean section birth, there is no impact on the production of milk eventually. Even mothers opting for surrogacy or adoption can also breastfeed. Just relax and go with the flow. If you stick to the basics described here, you should get a headstart to your breastfeeding journey.
Happy Feeding !!!