Breastfeeding After a Cesarean

Breastfeeding is a healthy, healing part of a cesarean that offers many physical and emotional benefits for you and your baby. Women can also face unique challenges following a cesarean and will benefit from extra support from family, friends and professionals.  But when asked about the particular breastfeeding challenges a woman might face after birthing by cesarean, Andrea Syms-Brown, one of New York City’s most beloved lactation consultants, said, “You know what I remind women? I tell them that breastfeeding after a cesarean is exactly the same as after any other birth: the baby needs to be fed and you’ve got the parts!”

Take a look at Andrea’s inspiring words below. If you encounter challenges, seek help! You will find information following my interview with Andrea Syms-Brown, IBCLC.  

My Interview with Andrea Syms-Brown, IBCLC, on Breastfeeding After a Cesarean

Mary Esther: Hi Andrea. I’m curious to hear your top suggestions for a woman who has just given birth by cesarean. How can she get breastfeeding off to a good start?

Andrea: Sure. Number one, I’d say skin to skin contact. Right away. The baby is just born, if you can’t have the baby fully on you, how about cheek to cheek? How about hold the baby’s hands?  Whatever skin to skin with the mother is great.  Whatever skin to skin with the dad is great. Whatever you can manage. The skin to skin is important in so many ways.

Number two, I’d say the minute you can, try to help the baby start feeding. If the baby isn’t feeding, start hand expressing milk.  You compress the areola with your thumb and forefinger. It’s always exciting for women to see what comes out, to see the colostrum.  If the baby is right there and not ready to latch onto the breast, squeeze the areola and milk is going to run right out on your finger. It’s like honey! The baby can lick it off. If the baby is away from you, you can hand express into a medicine cup they provide, and then feed the baby with a dropper or syringe.

Mary Esther: So, if the baby isn’t breastfeeding right away,  hand express, even during the repair? And later continue hand expressing? Why not get a pump?

Andrea: A pump will get milk out, but your hands are much stronger because of the way they apply positive pressure.  When you place the machine on – the pump – it applies negative pressure, like a vacuum. With the hands on, it is positive pressure that works very similarly to how the baby feeds. So, yes, you can use the pump, but hands are far more efficient and you can feel what you are doing. That’s what we do in the rest of the world!

Mary Esther: What else would you say is important in the first few days?

Andrea: Feed your baby frequently! First, get yourself as comfortable as you can. After a cesarean, sitting straight up probably won’t feel so good. Neither will sidelying. You can recline. You’ll feel what is right for your body. You don’t want to feel the incision pulling, so you adjust, maybe with a pillow behind your lower back, maybe a pillow under your thighs. You do what’s right for your body and where you are with the healing. Then, you feed your baby. Frequently! Feeding them frequently doesn’t over-extend their tiny stomachs. By feeding, they are learning to feel satisfied and learning to feel hungry as the stomach expands.

Mary Esther: What particular breastfeeding challenges might a woman face after birthing by cesarean? And what have you found helps women cope well with these challenges?

Andrea: You know what I remind women? I tell them that breastfeeding after a cesarean is exactly the same as after any other birth. The baby needs to be fed and you’ve got the parts!  This is reassuring to women. They can feel distressed because the baby didn’t come through the birth canal. Breastfeeding can make up for some of this with its immunological factors. Ok, the baby didn’t come through the birth canal, but you can provide the colostrum that will protect the baby. Women appreciate this. They see they can do this. They see they can protect their baby.  

But there can be challenges. Delayed onset of lactogenosis II (the mature milk that follows the colostrum) is sometimes an issue after a cesarean. If a woman lost a lot of blood, or if her health isn’t great before or after the birth, we might see the milk coming in around day five, instead of around day three when we would typically expect. If lactogenesis II is delayed, she can keep hand expressing and pumping and most of all feeding her baby as frequently as she can. How frequent is frequent? As often as the baby is hungry! Sometimes babies will be sleepy for the first day or two, but we really want the baby to be fed regularly (Note from M.E.: see my interview with Jill Bergman on skin to skin care after a cesarean for her comments on frequent, hourly feeding).

It seems obvious, but after a cesarean it is really important to give yourself time to rest and recover. I often work with women who are raring to get out. Enjoy the cabin fever, I say, give yourself time. You are healing from birth, and from surgery. You need rest!

Mary Esther: If a woman is struggling with breastfeeding, where can she go for help?

Andrea: International Lactation Consultants Association (ILCA.org) is an international resource for lactation consultants. I would suggest lining up a lactation consultant before you leave the hospital. Don’t struggle for a week and then reach out. Make a plan so you have good support in place.

Mary Esther: Do you have any tips for partners or family members on ways to support breastfeeding after a cesarean?

Andrea: Partners can track down a lactation consultant. They can feed the nursing mother and line up a team to cover laundry, shopping, cooking, cleaning, and care for other children, family members, and pets. Sometimes everyone just needs to remember to ask the nursing mom, “What do you need?”

Mary Esther: Are there any resources you’d recommend for a woman either before she gives birth or afterwards that might offer ideas and support?

Andrea: You know, there are good sites and good books like Kellymom.com and Breastfeeding Made Simple, but I work with all kinds of women including women from other countries. What I’ve seen is that if women see breasts in the books that don’t look like theirs, they can think they can’t do it. And a lot of information can be dogmatic. I feel it is so important to work with your body, and your baby. See a lactation consultant, or find a breastfeeding group, get support that fits your situation.

Mary Esther: Thanks so much, Andrea. Any final thoughts?

Andrea: You know, I’ll just say that I see again and again how important it is to women who give birth by cesarean to get the breastfeeding going. It is huge. As a private lactation consultant, I see women in their homes. They are relaxed.  I ask them about the birth and there is always some grief around the cesarean. And with breastfeeding, they feel they can do something, it’s very healing for them. It’s exciting for me to see these mothers almost re-birth their babies as they get more skilled and proficient with the breastfeeding. It makes them feel good, having done it themselves, natural. I witness this all the time.

Mary Esther: Thank you so much for talking today, Andrea!

Andrea Syms-Brown IBCLC,RLC, is a New York City-based private practice lactation consultant. She provides individual and group postpartum lactation support and has been a baby care and breastfeeding educator in NYC and the tri-state area for the past 26 years. She is a regular expert contributor to The Bump.com Real Answers and is the creator of Caring For A Newborn with Andrea Syms-Brown, an online baby care workshop film available at bitfamseries.com. Andrea most recently served as both President and Education Director of the New York Lactation Consultant Association.

Contact: www.babyinthefamily.net     andreathelc@gmail.com

Help is out there. Don’t struggle alone with breastfeeding challenges!

• International Lactation Consultants Association ILCA.org has contact information for lactation consultants.
• La Leche League International LLLI.org will get you free phone support and information about La Leche League meetings near you.
• Find a chapter meeting or online support through International Cesarean Awareness Network http://www.ican-online.org.  
• If you have a problem with milk supply, get in touch with your nearest milk bank. Contact Human Milk Banking Association of North America at https://www.hmbana.org.

Additional Resources:

• The Womanly Art of Breastfeeding by La Leche League International
• Breastfeeding Made Simple, by Kathleen Kendall-Tackett and Nancy Mohrbacher  
• Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family by La Leche League International and Diane Wiessinger  
• http://med.stanford.edu/newborns.html for a resource on hand expression of breastmilk
• Kellymom.com  for general breastfeeding information

“I didn’t get the natural birth I had always envisioned but I am proud to say that breastfeeding is going great for us. My milk came in on day two, he regained his birth weight in three days, and he is now five months old and we are still exclusively breastfeeding. I had minor difficulties like some imperfect latches at the beginning, a little pain, and over-supply, but in general my boobs have been major milk machines! I adore the feeling of breastfeeding and the bond it nurtures between us. I am also proud of my choice to bed share. I love snuggling with him all night. I don’t mind feeding him in the night because we are both half asleep when he nurses. He’s a great sleeper and I think it has something to do with the fact that he knows I am always there for him, even in the night. He is so strong, so passionate and growing so perfectly. I might not have gotten the natural birth that I wanted, but I am getting to be the natural mama I always longed to be and that is so much more important.” Athena Reich