Feeding Your Baby After a Cesarean Section
Your Birth Experience
You spend nine months mentally and physically preparing for your baby(ies). You begin to create expectations about delivery and the postpartum period. For some, this may be a vaginal birth and for others it may be a cesarean. As many of us know, not all births go according to plan. While plans can change, it may be useful to at least have some sort of plan for each, in order to prepare yourself for each scenario. Pregnancy, childbirth and the postpartum period involve a tremendous amount of change, joys, challenges, fears, lows, highs and everything in between. No two births are alike and your experience of birth can affect aspects of your transition to parenthood and baby feeding. Use this information to help you feel supported, confident and empowered.
Recovery
Vaginal birth
Any birth will have a recovery period. Your body just delivered a tiny human being! It is completely normal to be sore! Labor is a physical act that can strain your body, so it is important to take this time to REST. During the days and weeks following birth remind yourself it is ok, important even, to only focus on resting and being with your baby- dishes, chores, everything else can wait! Postpartum cramping is also very normal. Your uterus is shrinking back to “normal” or pre-pregnancy size. Depending on birth interventions, you may also experience varying side effects.1 It is important to discuss these possibilities with your doctor.3
Cesarean Section
Nearly 32% of women in 2019 had a cesarean section.2
Cesarean sections are a major abdominal surgery that will take a period of recovery. Recovery looks different for everyone and every birth. And no matter your birth plan, you can think through and state your preferences for a cesarean section in your birth plan. Options such as leaving your arm free so you can touch your baby, planning who will be in the operating room with you, requesting a see through surgical curtain so you can see the baby being born or requesting your own music to be played during the cesarean section are just a few examples of the ways you can personalize the birth of your little one.
Directly after a cesarean section, you will be in the recovery room for observation. After this period, you will be moved back to your room where you will stay until discharge. As with a vaginal birth, soreness and/or pain is expected. Surgery is NOT easy on your body. The soreness, pain, and discomfort may affect the speed of your recovery. You may not be able to move yourself in bed (remember REST) the way you normally could. Holding or picking up your baby may be a challenge or challenging in different positions. No matter what, give yourself grace. Recovery is not always a straight line. Some days may be better than others. Most importantly, allow yourself time to heal and follow your provider's instructions for recovery.3 If at all possible, plan to spend as much time resting in your bed for the 2 weeks afterwards. Having helping hands to bring you food, help with diapering and caring for your little one and taking care of things around the house are great ways to be sure you can focus on your healing.
Pro tip: It can be incredibly helpful to set reminders or alarms on your phone for your medications. Missing a dose can make things much more difficult- so staying ahead of cesarean section pain is the name of the game!
Breastfeeding
Whether you have chosen to breastfeed or not, your body has gone through hormonal and physical changes during pregnancy in order to prepare for pregnancy. You may have noticed in the last few weeks of pregnancy that you were leaking breast milk or colostrum (if not, that is ok!). Colostrum has everything your baby needs until your milk “comes in”. Breastmilk typically “comes in” between 2-5 days postpartum.1 During this time it is completely normal for your baby to want to nurse very frequently in the first few days. They may also experience sleepy periods. Follow baby's lead and hunger cues, do not limit baby’s time at the breast! Their feeding frequency helps to establish milk supply. Once your baby is surpassing birth weight and is nursing consistently 8+ times per day, your feeding schedule may be every 3-4 hours.1
It is important to track wet and dirty diapers during this time (don’t worry, the postpartum staff will remind you a ton!). The wet and dirty diapers will be a great way to tell that your baby is getting milk. You may find tracking your feeds helpful to know how often and how long your baby is feeding (again the postpartum staff and your pediatrician will ask). Do not be intimidated by the questions from hospital staff. Having the information of how often your baby feeds, how long, and the number of wet and dirty diapers is great information!1
Delayed Milk
However, milk “coming in” can be delayed due to a variety of things, such as: maternal insulin resistance, maternal diabetes, prolonged labor, retained placenta, excessive blood loss, obesity, hypertension, hypo-androgenism, and cesarean birth. Your milk is considered “delayed” if your milk has not “come in” fully by 3 days postpartum (72 hours). This is common! Would you believe 44% of women experience a delay in their milk coming in? Yes! See? Not that uncommon! It can feel frustrating to experience the delay. A delay does NOT mean that you will not be successful in breastfeeding.4
You may also experience issues with engorgement while your milk comes in. Encouraging frequent latching will help with both the engorgement and your milk to come in (p. 375). Keeping your baby close by so that they are able to latch is a great way to facilitate this! Many hospitals are beginning to create policies that promote this as well. You can relieve engorgement by massaging your breast before and during feeds, practicing reverse pressure softening, and using hand expression when necessary.1
Pro tip: Getting support from a lactation professional early will assist you in overcoming this obstacle.4
Breastfeeding After Cesarean
As mentioned above, cesarean section recovery can be difficult, as well as lead to a delay in your milk “coming in”. This may not be the case for everyone! A great first step is skin to skin with either birth giver or birthing partner. Once the birth giver is responsive and feeling up to it, they can partake in skin to skin. This is typically referred to as the “golden hour”. However, the benefits of skin to skin are not limited to that hour! Parents who have cesarean sections can feel that they are missing out on the opportunity for the “golden hour”, but skin to skin benefits are ongoing and achievable with either parent, family member, or support person.1 In the next few days and weeks, birth givers who had cesarean sections may find certain breastfeeding positions uncomfortable. Positions like side lying supported by pillows at back and knees, laid back with baby’s legs pointing away from the incision site, sitting up with a pillow across the surgical site for cushion, or the football hold with pillows to support baby and bring them level to the breast may be more comfortable breastfeeding positions.1
Pro tip: Skin to skin benefits for your baby are not limited to the birth giver! Birth supporters can provide the same benefit to your baby.1
Recommendations for Breastfeeding After a Cesarean Section:
- Skin to Skin
- Use pillows for comfort
- Hold onto sturdy objects for support and positioning
- Roll to your side with knees bent and then use your arms to push upright and slowly lower your feet when getting up
- ASK FOR HELP!
Typical mobility may be limited after a cesarean section, requiring you to ask for assistance. Do not hesitate! Remember, cesarean sections are major abdominal surgeries. The pain, discomfort, and fatigue are all common after cesarean sections. Using pillows for support, sturdy objects to hold onto while trying to stand or position yourself, and asking for help are great ways to combat the post cesarean comfort and mobility issues.1
Pro tip: When getting out of bed, many people find that it is most comfortable to first roll to their side with their knees bent and then use their arms to push themselves upright and slowly lower their feet to the floor before carefully standing up.
Traumatic Birth
No matter the details of your birth or the outcome your feelings about your birth experience ARE valid. All too often we hear about birth givers’ expressing their disappointment, confusion, anger or sadness about their birth experiences being dismissed and ignored by their medical team, social circle and even family members. “You and your baby are healthy and that’s all that matters!,” these responses, though possibly well intentioned, often leave birth givers feeling even more alone and distressed. Don’t hesitate to state your needs with clear, direct statements like, “Thank you for trying to support me but right now I need you to understand I am feeling a lot of pain about my birth. It would be more helpful to me if you could listen and validate what I’m experiencing.”
If you had a traumatic or complicated birth experience, call in trauma-focused professional support. You deserve individualized care and attention as you cope with your childbirth experience. Find a listening ear to help you process your thoughts and feelings about your birth. Make a list of your questions you can ask your care providers to help make sense of what you experienced. Your needs and your well-being are so important.
Personal Anecdote
I write this having the experience of a vaginal birth, planned cesarean section and an emergency cesarean section. Despite knowing somewhat of what to expect; every pregnancy, birth, breastfeeding experience, and child is different. Find support in your family and friends.
Resources
- Lauwers, J., & Swisher, A. (2016). Counseling the nursing mother: A lactation consultant's guide (6th ed.). Jones & Bartlett Learning.
- Martin, J. A., Hamilton, B. E., Osterman, M. J. K., & Driscoll, A. K. (2021). Births: Final Data for 2019. National Vital Statistics Reports, 70(2), 1–51.
- Touchstone Book/Simon & Schuster. (2008). Your Physical Recovery and Your Newborn. In Our bodies, ourselves: Pregnancy and birth (pp. 239–249).
- Wilson-Clay, B., & Hoover, K. (2017). The Breastfeeding Atlas (6th ed.). LactNews Press.
