If you have a cesarean birth (c-section), either planned or unplanned, you can breastfeed your baby. It’s important to know that interventions during your labour and the c-section can impact nursing in the early days. If you know what those impacts may be, you can be prepared. You may require more support in the early days to get breastfeeding off to a good start. But that’s okay. For more information see Preparing to Breastfeed.
Breastfeed as soon as possible and often
Many mothers and parents breastfeed in the operating or recovery room right after a cesarean birth. The sooner you can hold your baby skin-to-skin and breastfeed, the better for both of you. If you are separated from your baby, the baby's father, your partner or another family member can hold the baby skin-to-skin until you are available.
Nursing soon after birth stimulates your body to produce a lot of milk. This increase in milk production usually occurs in a few days. However, it is often delayed following a cesarean birth. Causes of this delay may include:
- strong medications received during labour, such as those given via an epidural.
- the physical stress of surgery on your body.
- a delay in the first feeding.
- fewer feedings in the early days.
- a sleepy baby.
Colostrum is very nutrient dense and provides everything your baby needs until your milk comes in.
Milk production usually increases dramatically between days three and four but this could happen as early as day two and as late as day six. After a cesarean birth this occurs closer to day five or six. If you are concerned, express some colostrum after a feeding. Offer it to your baby in a cup, spoon, eye dropper or syringe. The extra removal of colostrum will encourage your body to make milk quicker. And your baby gets more to eat. If you expressed colostrum in the final weeks of pregnancy and stored it in the freezer, you can feed your thawed colostrum to your baby (see Prenatal Colostrum Expression).
Medications given to you during labour may make your baby extra sleepy. It may take up to a week or more before they are eliminated from your baby’s body. Your baby may not be alert enough to nurse well in the early days. If this is the case, hand express your milk and feed it to him with a cup, spoon, eye dropper or syringe. Avoid bottles, if possible. They can make it harder for your baby to latch. When your baby becomes more alert, you can put him to your breast. For more information see Establishing Your Milk Supply.
Medication given by IV increases the amount of fluid in your body. This can lead to increased breast engorgement (fullness) in the early days. It may make it harder for your baby to latch. You may need to express some milk before feeding your baby. For more information see Breast Engorgement.
Normal Weight Loss
Most babies lose weight in the first few days. Your baby will not begin gaining weight until after your milk production increases. After that, you can expect your baby to gain around 20 to 35 g/day. If you got IV fluids within the final two hours before the birth, your baby also got these extra fluids. As your baby pees out these extra fluids, it may seem like a large weight loss. This extra fluid is eliminated by your baby’s body in the first 24 hours. For this reason it is recommended that your baby’s weight be taken 24 hours after birth. This weight can be used as your baby’s starting weight. Babies often lose up to 7% of their birth weight. A weight loss of 8% to 10% may be fine for some babies. However, it is recommended that mother and baby be seen by a healthcare provider to evaluate the breastfeeding. If your baby is losing too much weight, you may need to temporarily supplement. This will be short-term until your body is producing lots of milk and your baby is drinking well. For more information see How to Know Your Baby is Getting Enough Milk and How to Protect Breastfeeding while Supplementing.
Find a comfortable position
Laid-back and reclining positions are generally more comfortable for mothers following a cesarean birth. These positions are also helpful for activating your baby’s natural feeding reflexes. Other options are the football hold, cradle hold, and cross-cradle hold. If your baby is latching well, the side-lying position can be very comfortable. Protecting the surgical site with a pillow or folded blanket can be helpful. A kick at the incision site can be extremely painful. Ask for help to find a position that is comfortable for both you and your baby. For more information see Positioning and Latching.
Take time to heal
Recovery from a planned cesarean birth tends to be faster than recovery from an unplanned one. With an unplanned c-section your body has gone into labour and the surgery is often very fast. Both planned and unplanned cesarean births are major surgery. You will likely need to take pain medication. This should not interfere with breastfeeding.
Parents who have cesarean births often need more time to heal and recover than they expect. For the first few weeks you will likely find it difficult to move around, get up, sit down, use stairs and sometimes even cough or laugh. Try to get as much rest as possible. Eat regularly (particularly protein-rich foods) and drink water every time you nurse your baby.
Set Up a Nursing Station
It can be helpful to have useful items right where you are going to be nursing. These will likely include: a water bottle, snacks, diapers, diaper wipes, blankets, your phone, charging cords, TV remote, reading material, etc. This will help you reduce the number of times you need to get up and down. If you live in a two-story house, you will probably want to have a nursing station on both floors. Then when you sit down to nurse everything you need will be close at hand. This will save you from walking up all of those stairs every time you need to change a diaper!
Accept help from friends and family
Allow others to do as many of the other baby and household tasks as possible. It allows you to focus your energy on healing and breastfeeding. See How Partners and Supporters Can Help for ideas. Have someone you trust watch your baby while you take a shower or have a short rest. This can do wonders for you. Babies like to be held. When they are not feeding, they can be held by others.
Be Kind and Patient with Yourself and Your Baby
It will take time for you to recover from surgery and feel like your old self again. It will also take time for your baby to recover from birth. And it will take both of you time to learn how to breastfeed together. Spending time holding your baby skin-to-skin can help both you and your baby relax.
Complicated Feelings
If your cesarean birth was unplanned, you might have feelings of guilt, anger, or disappointment about your birth experience. You may have people tell you that it doesn’t matter because you now have your beautiful baby. Those kinds of comments can make you feel even worse. Feeling sad about your birth does not mean that you are not happy and grateful to have your baby. Of course, you are. But it can be difficult to sort through all of the feelings of sadness, anger, shame or grief for the loss of the birth you hoped for. It can be very helpful to talk to someone about your experience. This may be a friend who also had an unplanned cesarean birth, a La Leche League Leader, or a counsellor or therapist.
Get Help with Breastfeeding
If you are having problems breastfeeding, or chestfeeding, or you are anticipating having a cesarean birth, contact a La Leche League Canada Leader or an IBCLC (International Board Certified Lactation Consultant) for support. Most issues can be overcome with good information and support.
References:
Hobbs, A. J., Mannion, C. A., MacDonald, S. W., Brockway, M., & Tough, S. C. (2016). The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum. BMC Pregnancy & Childbirth. 16:90.
La Leche League International. (2017, November). Breastfeeding After Cesarean Birth.
Updated January 2023