Breastfeeding after a caesarean birth

Starting breastfeeding after caesarean births can be more difficult. So here we explain how things like positioning and pain relief can make it easier...

We know from research that some mums find it harder to get breastfeeding started after a caesarean birth. But worry not because once you’ve started breastfeeding, how your baby was born doesn’t affect their chances of being breastfed at six months (Prior et al, 2012).

How to get breastfeeding off to a good start after a caesarean birth

It’s recommended that you have skin-to-skin contact with your baby as soon as possible after they’re born (NICE, 2019). This means your baby is placed naked onto your bare chest.

Skin-to-skin contact with your baby straight after they’re born by caesarean has plenty of benefits (Stevens et al, 2014). The many benefits for you and your baby of holding them skin-to-skin include:

  • helping with bonding
  • increasing levels of breastfeeding hormones
  • giving the baby time to have their first breastfeed
  • mums say that it feels right and can help with feeling calmer.

(NICE, 2019; Stevens et al, 2019)

We know that if a mum can’t have skin-to-skin contact with her baby, their birth partner holding the baby skin-to-skin is also beneficial (UNICEF, 2019b). One study found that when mums’ partners held their babies skin-to-skin, they had more stable heartrates and temperatures, they cried less and they started breastfeeding earlier than those who didn’t have this. The partners also felt less anxious and depressed and were more confident in their parenting skills.

Tips: how to get the breastfeeding support you need after a caesearean

After a caesarean birth, you should be offered extra support as well as early skin-to-skin contact to help with breastfeeding (Beake et al, 2017; NICE, 2019). Extra support could include the following…

  1. Getting comfy

You can ask your midwife to help you to find positions that are comfortable for breastfeeding (NICE, 2019).

  1. Feeding support

Your midwife can be super helpful for helping you to breastfeed your baby, especially after a caesarean. From the start, they’ll support you with keeping your baby as close to you as possible with as much skin-to-skin contact and access to the breast as possible (NICE, 2019).

They can help to make sure your baby is latching effectively, especially if they’re drowsy from medication or if your breasts are engorged after having IV fluids. They’ll also help to make sure your baby feeds frequently and will continue to support you with breastfeeding your newborn (e.g. help with recognising feeding cues) (NICE, 2019).

If your baby is unable to breastfeed directly, they’ll teach you how to express your milk. This means you can provide milk for your baby and keep up your milk supply (NICE, 2019).

  1. Pain relief

Do ask for help if you’re in pain after your caesarean. There’s no need to suffer in silence, especially if it’s affecting your ability to breastfeed (Karlström et al, 2007; Brown and Jordan, 2013; NICE, 2019). It’s fine to take paracetamol and ibuprofen to help with the pain but aspirin and codeine are not recommended when breastfeeding (NHS, 2019).

  1. An accurate birth weight

Try to get an accurate birth weight for your baby. It’s more accurate for babies born by caesarean birth to have their birth weight recorded 24 hours after they’re born. That’s because of the effects of caesareans on their weight (see above).  

A more accurate birth weight means you’ll worry less about your baby losing weight. And that means it’s less likely you’ll be so concerned about their weight that you supplement your baby’s breastfeeds with formula (UNICEF, 2019a).

  1. Time

Do give yourself time to adjust to becoming a mum, you’ve just been through an amazing but huge change in your life. Plus, it takes time for you and your baby to recover physically from the caesarean birth and from any medications you had (NICE, 2019).

  1. Encouragement and emotional support

It’s good to get plenty of support from those around you. We all need a little encouragement when we’re doing something new after all, so lap it all up. It might really help to have a good heart-to-heart chat with the people around you too (NICE, 2019).

  1. Practical help

Do accept all offers of help and certainly don’t be afraid to ask for it – you’ve just had an operation and a baby after all. Help isn’t just good for you, it’s good for your baby too. Research says that mums who ‘look after themselves’ by asking for more help are more likely to breastfeed for longer (Tully and Ball, 2014).

  1. Self-help strategies

If the going gets tough, you might find an extra supply of strength from the inside with a few strategies up your sleeves. Some mums find mindfulness, relaxation, positive self-talk and setting themselves goals helpful (O’Brien et al, 2009).

Breastfeeding positions

It’s important to find a breastfeeding position that’s comfortable for both you and your baby. This helps your baby to latch well and helps you to maintain the position for as long as your baby needs.

Some mums like to cover their caesarean scar with a pillow or cushion to protect it, others prefer positions that keep their baby away from it. Some mums find the position of the cannula in their hand or arm from the caesarean can affect how easy it is to find a comfortable breastfeeding position. So it might be worth discussing this with midwives beforehand.

When your baby is breastfeeding, they should come to your breast chin first and nose to nipple, head not twisted, nipple towards the roof of their mouth and them very close to you. Read our article How to help your baby attach and breastfeed for more information.

Here are some positions you could try…

Lying down on your side

Lying down feeeding

This position can be quite restful as well as keeping pressure away from your scar. If you’re using a pillow for your head, it needs to be kept away from the baby. Here’s how to breastfeed like this:

  • Some mums find it helpful to have pillows and cushions supporting their back or between their knees. If you have larger breasts, you could try lying on a thin cushion or folded towel.
  • Once you’re in position, your baby can be placed close to you so you’re facing each other
  • You can guide your baby using your free hand.
  • Try to make sure you bring your baby to the breast rather than leaning over to post the breast into the baby’s mouth.
  • You might need help to roll over to feed from the other breast.

 

Laid-back breastfeeding 

 

Laid-back breastfeeding

This position helps to trigger a baby’s instincts to position themselves and latch on to breastfeed. It can also be a very restful breastfeeding position for after a caesarean birth. That’s because you don’t have to sit upright and your body supports your baby’s weight.

You can put your baby stomach down on top of your body wherever it feels comfortable. This might be diagonally across your body so your baby is away from your scar. Then you can relax and enjoy the cuddle with your baby.

For more details about what laid-back breastfeeding is and the ideas behind it, see our article here.

Rugby-ball or underarm position 

Rugby ball feeding

This position might help to keep your baby away from your scar. For more on how to breastfeed in this position, see our article about breastfeeding positions.

Extra considerations for this position after a caesarean are that you might find it helpful to have lots of pillows behind you to help support your back. You might also want pillows under your arm to help to support your baby’s weight . You’ll also want to avoid discomfort and help your baby to latch by bringing them to your breast rather than leaning forward to post your breast into their mouth.

Why a caesarean birth might make breastfeeding more difficult

Frequent, effective removal of milk from a mum’s breasts enables breastfeeding to get started and to continue. That’s because the more milk your baby takes, the higher your levels of breastfeeding hormones (prolactin and oxytocin) will be and the more milk you’ll make. We also know that the earlier breastfeeding starts, the more likely it is to continue. A caesarean birth could affect this in a variety of ways…

  • Pain - from the scar and by the baby not latching well at the breast because the mum finds it harder to get comfy (Tully and Bull, 2014). This could cause a mum not to feed as often or for as long.
  • Loss of mobility - can make it harder to get into a comfortable position to feed and to pick the baby up when they want feeding (Tully and Bull, 2014).
  • Not going through labour - if a mum has an elective caesarean birth before labour starts, she’ll miss out on the labour hormones. This might lead to lower levels of breastfeeding hormones and less preparation of babies for bonding and feeding (Prior et al, 2012; Zanardo et al, 2013; Hobbs et al, 2016).
  • Long and stressful labour - an emergency caesarean birth can leave you feeling tired, anxious for yourself and your baby or frightened about what’s going happening. This stress can lead to lower levels of breastfeeding hormones (Hobbs et al, 2016).
  • Exhaustion - in both mum and baby can lead to the baby feeding less often and less effectively.
  • Medication - can lead to a mum feeling drowsy or unwell, which can make early breastfeeding less likely. Medication can also affect the baby, making them drowsy and less able to breastfeed effectively (Brown & Jordan, 2013; UNICEF, 2019a).
  • Separation - if mum and baby are separated, this can mean less chances for early breastfeeds.
  • Less opportunities for early skin-to-skin and a delayed first breastfeed - caesarean births might mean less opportunities for skin-to-skin contact. Skin-to-skin contact and the baby having their first breastfeed as soon as possible after birth help breastfeeding to become established (Moore et al, 2016).
  • Effects of caesarean on the baby - babies born by caesarean are more likely to have mucous, which can affect how interested they are in feeding (Tully and Ball, 2013). Intravenous fluids during labour can cause a mum’s breasts to become swollen, making it harder for the baby to latch (Genna, 2017). The IV fluids during labour can also boost a baby’s birth weight, which can lead to worries that they’ve lost too much weight and to formula supplementation and no/less breastfeeding (Chantry et al, 2014).
  • Loss of confidence - mums might be less likely to believe their bodies can nurture and feed their baby and that breastfeeding is going well. Well-meaning family members might also be more likely to suggest a mum gives her baby formula (this makes breastfeeding more difficult) so she can rest after her caesarean (Tully and Ball, 2013).
  • Night feeds - feeding at night can be particularly difficult after a caesarean birth as family members or supporters are not available to help with picking the baby up and positioning them. Some mums say they feel asking midwives for help is a sign of failure.

Take a look at our articles for more about the practicalities of recovering from a caesarean birth and for tips to help you recover more quickly.

This page was last reviewed in November 2019.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

You might find attending one of our Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

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Brown A, Jordan S. (2013) Impact of birth complications on breastfeeding duration: an internet survey. Journal of Advanced Nursing. 69(4):828–839. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22765355 (Accessed 23rd August 2019)

Chantry C, Dewey K, Peerson J, Wagner E, Nommsen-Rivers L. (2014) In-hospital formula use increases early breastfeeding cessation among first-time mums intending to exclusively breastfeed. J Pediatr. 164:1339-1345. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4120190/ (Accessed 23rd August 2019)

Genna C. (2017) Supporting sucking skills in breastfeeding infants. 3rd Ed. Jones and Bartlett Learning, Burlington, MA: 65-88.

Hobbs A, Mannion C, McDonald S, Brockway M, Tough S. (2016) The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum. BMC Pregnancy and Childbirth. 16:90. Available at: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s1288… (Accessed 23rd August 2019)

Karlström A, Engström-Olofsson R, Norbergh K-G, Sjöling M, Hildingsson I. (2007) Postoperative pain after cesarean birth affects breastfeeding and infant care. JOGNN. 36: 430-440. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17880313 (Accessed 23rd August 2019)

Kroeger M, Smith L. (2004) Impact of birthing practices on breastfeeding: protecting the mum and baby continuum. Jones and Bartlett Publishers, Sudbury, MA: 157-161, 173-174.

Moore E, Bergman N, Anderson G, Medley N. (2016) Early skin-to-skin contact for mums and their healthy newborn infants’. Cochrane Database of Systematic Reviews. (11):CD003519. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003519.pub4/full (Accessed 23rd August 2019)

NICE. (2019) Caesarean section [CG132]. Available at: https://www.nice.org.uk/guidance/cg132 (Accessed 23rd August 2019)

NHS. (2019) Recovery - caesarean section. Available at: https://www.nhs.uk/conditions/caesarean-section/recovery/ (Accessed: 23 August 2019)

O’Brien M, Buikstra E, Fallon T, Hegney D. (2009) Strategies for success: a toolbox of coping strategies used by breastfeeding women. Journal of Clinical Nursing. 18: 1574-1582. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19220615 (Accessed 23rd August 2019)

Prior E, Santhakumaran S, Gale C, Philipps L, Modi N, Hyde M. (2012) Breastfeeding after caesarean delivery: a systematic review and meta-analysis of world literature. Am J Clin Nutr. 95(5):1113-1135. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22456657 (Accessed 23rd August 2019)

Stevens J, Schmied V, Burns E, Dahlen H. (2014) Immediate or early skin-to-skin contact after a caesarean section: a review of the literature. Maternal and Child Nutrition. 10:456–473. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24720501 (Accessed 23rd August 2019)

Stevens J, Schmied V, Burns E, Dahlen H. (2019) Skin-to-skin contact and what women want in the first hours after a caesarean section. Midwifery. 74:140-146. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30954633 (Accessed 23rd August 2019)

Tully K, Ball H. (2014) Maternal accounts of their breast-feeding intent and early challenges after caesarean childbirth. Midwifery. 30:712-719. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4451198/ (Accessed 23rd August 2019)

UNICEF. (2019a) Supporting breastfeeding research. Available at: https://www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/research-supporting-breastfeeding/supporting-breastfeeding-research/ (Accessed 23rd August 2019)

UNICEF. (2019b) Research on skin-to-skin contact. Available at: https://www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/research-supporting-breastfeeding/skin-to-skin-contact/ (Accessed 23rd August 2019)

Zanardo V, Pigozzo A, Wainer G, Marchesoni D, Gasparoni A, Di Fabio S, Cavallin F, Giustardi A, Trevisanuto D. (2013) Early lactation failure and formula adoption after elective caesarean delivery: cohort study. Arch Dis Child Fetal Neonatal Ed. 98:F37–F41. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22516475 (Accessed 23rd August 2019)

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