mother's hand holding newborn's hand

Many C-section deliveries are unplanned, which can leave some new moms feeling unprepared to adapt their nursing plans. Our resident IBCLC, Katie McGee, explains how C-sections affect breastfeeding

Cesarean sections can be planned or unplanned, urgent or emergent. Changes during labor, malposition of the baby, or previous cesarean sections can make a C-section a necessity, sometimes with little warning. As you prepare for your little one’s arrival, consider the fact that a C-section may be a possibility, to ease some of your pre-labor anxiety. While a C-section is a major abdominal surgery, it is extremely common, and does not have to derail your breastfeeding goals.

What new moms and moms-to-be need to know about breastfeeding after a C-section

Your milk may come in more slowly.

According to KellyMom, the abrupt hormonal shift that occurs when the placenta separates from the uterus is what signals your milk to come in—so moms will receive the same signal for a C-section or vaginal birth. However, stressful births (vaginal or cesarean) tend to have their milk come in a little bit later. That said, be prepared that having a C-section increases the chances your milk supply may come in more slowly than in mothers who delivered vaginally. This doesn’t mean you will necessarily have a problem with milk supply because you delivered via C-section; it just means your transition from small amounts of colostrum to ounces of breastmilk may take a little longer. Your baby may nurse more frequently as your milk supply comes in. If you deliver by C-section, combining extra pumping sessions with nursing may be recommended: the additional stimulation can help establish your full supply more quickly.

You may have to pump, even if you planned to only breastfeed.

If you and your new baby are separated, even briefly, by a NICU stay or for other medical reasons, it’s important to start pumping until you can nurse (if you plan to breastfeed). An IBCLC can help you get properly sized flanges and plan out a pumping schedule. Even if pumping was not part of your plan, it may be necessary temporarily in order to initiate milk supply during this period of separation until your baby can take over. As soon as your baby is stable enough to breastfeed, you can transition from bottle to nipple.

Lactation consultants may be available—so ask for one.

Ask for lactation consultation early and often to make the most of the team available to help you during your hospital stay. Early support and guidance is essential to lactation success.  Finding a local La Leche League group will help you connect with other new nursing mothers when you get home.

You may need to nurse in different positions.

If your C-section was unexpected, you may not have factored your own recovery into your plans for your first weeks as a new mom. You’ll need to find nursing positions that do not cause increased pressure on your abdomen during the first few weeks. With the clutch or “football hold,” the mother has a lot of control over the infant, and the baby’s body is angled away from the surgical incision. This can be ideal to get started, but you don’t have to be locked into this one position long term. IBCLCs can help you explore many positions—many not necessarily “by the book”—that work for you and your baby.

Your pain medications may not be incompatible with breastfeeding.

A C-section is a major surgery, and your recovery will be much like that of other major abdominal surgeries. Avoiding excessive pain by keeping up with your recommended pain medications during recovery is a good idea. Don’t try to “tough it out” — pain and stress can work against milk-making hormones, so pain control after surgery is important. If you are concerned about a medication’s compatibility with breastfeeding, seek out answers from IBCLCs who have reliable, accurate and up-to-date resources for verifying your medication and its compatibility for your baby. If at any time throughout your lactation you are advised to “pump and dump,” pause to verify with an IBCLC. When in doubt, you can always “pump, label and hold”: Pump the milk as usual, label it with medications you were taking at the time, and hold it (on the counter for 4 hours or in the fridge for 7 days) until you receive the information you need to make fully informed decisions about usage.  

When you are recovering from a C-section, the most important thing is to be good to yourself. Accept help with meals, phone calls of support, and try to rest and recover whenever baby sleeps. The best helpers are those willing to pamper and feed you, and allow the baby to stay skin-to-skin or close to you. If your goal is to breastfeed, frequent early nursing is important. Avoid “helpers” who want to scoop up the baby and take or keep the baby away from you, which may decrease nursing frequency. Set up a room or two in your house that allows the baby to be in easy arm’s reach for breastfeeding on demand while you rest and heal.

Katie McGee is Ashland Health’s on-staff International Board Certified Lactation Consultant. She and other lactation experts are on call to answer questions, provide consultations, and help our moms in any way they need, through any stage of their breastfeeding journey. To speak with an IBCLC, contact the team of moms at Ashland Health today.