WOUND CARE

Breastfeeding When You Have A Caesarean

WOUND CARE

Breastfeeding When You Have A Caesarean


Breastfeeding When you have a Caesarean
By Lisa Johnston (Registered Midwife. Registered Nurse. BNSc-BMid; MMid)

 

Many women worry about whether they will be able to successfully breastfeed if they have a
caesarean. The great news is you absolutely can! The way your baby is born doesn’t have a
strong indication on your ability (or lack of ability) to breastfeed your baby.¹ There are, however,
a few unique challenges and considerations for the initial stages of breastfeeding after you’ve
had a caesarean. Let’s look at some of the things to consider, and the ways you can equip
yourself to successfully breastfeed.


In Pregnancy:
No matter how your baby is born, getting easy-to-understand quality breastfeeding education in
pregnancy is so important. Whilst breastfeeding is natural, it’s not always easy! Understanding
how the breastfeeding process works, how often and for how long your baby should breastfeed,
baby feeding cues, how to tell if your baby is getting enough milk, how to aid good attachment of
baby to the breast, what is “normal” for breastfed babies, and when to seek further assistance
are great things to get your head around before baby arrives. Check in with your maternity care
provider about what breastfeeding education and supports are available to you. The Australian
Breastfeeding Association (ABA) also offer breastfeeding education sessions (both online and
face-to-face where available), and have a wealth of information and resources available on their
website (https://www.breastfeeding.asn.au/)
Did you know that your body starts making colostrum (the first type of breastmilk you produce)
from around week 16 of pregnancy?³ Though you don’t produce as much colostrum in
pregnancy as you will do after birth, it is still possible to express some colostrum in the latter
stages of pregnancy. This way, you can build up a stash of your own milk in the freezer in case
it’s needed after birth. Because colostrum is super-concentrated it is only produced in very small
amounts, so don’t be dismayed if it feels like there’s barely anything there! Even if you have a
breast pump, hand expressing is the most effective way of expressing colostrum. Have a chat to
your midwife or care provider about when the best time for you to start hand expressing is
(many people don’t recommend it until after 36 weeks of pregnancy), and about equipment to
collect, label and safely store the colostrum in your freezer. The ABA has a whole lot of videos
and information on their website to help you with hand expressing (check them out, and speak
to your midwife about it too because it can be a bit tricky!).²


At Birth:
The anaesthetic and drugs used during and after caesareans are generally safe for
breastfeeding.³ Placing baby on mum’s chest as soon as possible after birth is a great way for
mum and baby to bond, and can help naturally lead into the first breastfeed whenever baby is
ready. Many women are awake when they have a caesarean and, with some support, baby can
be placed on mum’s chest for skin-to-skin whilst still in theatre. If this isn’t possible, skin-to-skin
in the recovery room often is. If you and your baby need to be separated at birth, it is really
important to hand express colostrum within the first hour or two after birth, and three hourly after
that until regular breastfeeding is established. In addition to hand expressing, use a
hospital-grade breast pump to help stimulate milk production, and seek support and guidance
from the midwives and IBCLC (International Board Certified Lactation Consultant) if available.⁴
Sometimes caesareans are associated with a delay in secretory activity in lactogenesis II (the
fancy way of talking about your milk “coming in”, which usually happens around 3 days after
birth). Regular skin-to-skin time, allowing baby access to breastfeed as often as they wish, and
having support from breastfeeding-knowledgeable professionals are all really important at this time, helping to support the processes to bring your “milk in”.¹ ⁴


Positions:
Keeping in mind that you’ve got an incision on your lower abdomen, there are some certain
positions that caesarean mums often find more comfortable in those first few days when the
wound is tender. These include:

  • Mum lying on her back with a pillow behind her head, with baby placed on their tummy
    between mum’s breasts
  • Mum sitting up with baby positioned so there is no pressure on her lower abdomen - a
    pillow placed over the caesarean wound may help both protect the area, and support
    baby at the breast
  • Many women find the “football” (sometimes known as “clutch”) position a good one
  • By 2 or 3 days post caesarean many women are comfortable enough to try
    breastfeeding in a side-lying position ¹ ⁴


Remember that after having a caesarean you’ve both just given birth AND had major abdominal
surgery! That’s a lot to be dealing with! It’s really important to keep up your regular prescribed
pain relief to keep on top of the pain, and don’t be shy to ask for and accept help with picking
up, positioning, and caring for your baby.


How can Partners, Family and Friends Help?
In the first few days after birth, having people to help with picking up, positioning, and taking
baby after breastfeeding will be invaluable. Whilst other people can’t breastfeed for you, they
can help and support in all other ways, allowing you to focus on breastfeeding. This may include
changing nappies, settling baby after a feed, ensuring you have a fresh glass of water and some
good food available, or doing other tasks around the house. Don’t be afraid to keep visitors to a
minimum in those early days, giving yourself plenty of time to rest where you can. And don’t be
shy to ask visitors to bring you over a meal, or hang some washing when they come! That’s a
small price for cute baby snuggles!


Where to Seek Help:
Lots of women need some help at some point during their breastfeeding journey. Some places
to go if you need further information or assistance include:

 

References

  1. Hoover K. Perinatal and Intrapartum Care. In: Wambach K, Riordan J, Editors.
    Breastfeeding and Human Lactation. 5th Edition. United States of America: Jones &
    Bartlett Learning; 2016. p. 227-270.
  2. Australian Breastfeeding Association [Internet]. Available from
    https://www.breastfeeding.asn.au/
  3. Lawrence R. & Lawrence R. Breastfeeding - A Guide for the Medical Professional. 9th
    Edition. United States of America: Elsevier; 2021.
  4. Walker M. Revised by Cox S. Pregnancy, Labor, and Birth Complications. In: Mannel R,
    Martens PJ, Walker M. Core Curriculum for Lactation Consultant Practice. 3rd Edition.
    United States of America: Jones & Bartlett Learning; 2013. p. 715-728.

 

 

Lisa has been a Registered Midwife and Registered Nurse since 2013, and has had the privilege of working alongside many women across all aspects of maternity care. She has a Dual Bachelor of Nursing Science-Bachelor of Midwifery from James Cook University, and a Master of Midwifery from the University of Newcastle.

 

 

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