Newsletter #33: Breastfeeding & Caesarean Sections

By the BMSG Editorial Team

Some mothers-to-be know that they are going to have a Caesarean-section, but some end up in the operating theatre with an emergency C-section – and may not know what to expect. Either way, you absolutely can breastfeed even after a C-section. Forewarned is forearmed; what are some of the difficulties of nursing after a major surgery and how can you prepare for them?

1.     General anaesthesia vs local anaesthesia

Most C-sections in Singapore are carried out under local anaesthesia; that is, a spinal block or epidural. With an epidural, mothers will be awake throughout the entire procedure and can even have skin-to-skin in the operating theatre. Having an epidural also means that once the baby is ready to be passed to you, you can initiate breastfeeding as soon as possible, whereas with GA, you may not be able to meet baby for a few hours after the procedure as you slowly awaken from the strong anaesthetic. In fact, both baby and you may be too groggy at the beginning to breastfeed effectively. However, even if you need to undergo GA for medical reasons, you can still breastfeed your baby.

Deborah Su, a mum of two children, breastfeeding her baby post-operation. (Photo credits: Deborah Su)

2.     After-effects of anaesthesia

Many mothers will endure some side-effects of anaesthesia, such as uncontrollable trembling, chills, and nausea. These side-effects can be quite strong as the dose of anaesthesia that is given for open surgery is much higher than the dose for a vaginal birth.

One mother, JoBeth Williams, recalls that she was trembling so hard after surgery that she did not dare to carry her baby at first as she was afraid she would drop her. It was not until the trembling subsided after about half an hour that she was able to initiate the first latch. Another mother, Wendy Sim, experienced dizziness and severe nausea for up to nine hours after the procedure. Wendy shared that even though she had such extreme side-effects, she persevered in having her baby close to her so that they could benefit from skin-to-skin contact. Despite this seemingly rocky start, both JoBeth and Wendy went on to have smooth breastfeeding journeys with their babies!

A mother who has had a c-section can initiate breastfeeding just like she would with a normal delivery,

Also, remember that after delivery, a C-section baby may be quite sleepy as she also feels the after-effects of the anaesthesia. Skin-to-skin contact will certainly help, as will rubbing baby’s feet or chest to rouse her. Secondly, C-section babies may post a higher birth weight and slightly higher initial weight loss due to IV fluids given during the surgery. Keep this in mind, as studies have shown that babies whose mothers received more IV fluids before birth urinated more during their first 24 hours and as a result lost more weight. Therefore you should not worry too much about a slightly higher initial weight loss, as long as you can see baby is drinking well and producing the right amount of wet and dirty diapers.

Wendy shared that even though she had such extreme side-effects, she persevered in having her baby close to her so that they could benefit from skin-to-skin contact. Despite this seemingly rocky start, both JoBeth and Wendy went on to have smooth breastfeeding journeys with their babies!

3.     Protecting your wound while nursing baby

The C-section wound can be very tender and painful in the first few days or even weeks. Many mothers have difficulties bending, sitting up, and walking. Try and arrange for as much help as possible to have baby brought to you, or safely co-sleep with your infant so that you do not have to move too much. Mother of four Chng Bee Wee recalls how after all her C-sections, all she did was rest in bed and breastfeed!

You can also experiment to figure out which breastfeeding holds work best for you. Many websites will recommend side-lying to nurse, but some mothers actually find this very difficult as the wound is not comfortable when lying on the side. You may find it easier (although it might take a bit longer for you to get ready) to sit up and nurse with cradle hold instead. Deborah Su, who had two C-sections, is one of many mothers who prefer to use a breastfeeding pillow which can help to protect the wound area, while other mothers may find that the pillow presses on the wound and is very uncomfortable. Many lactation consultants recommend the football hold as this keeps baby’s body away from the wound, but again, some mothers find the position unnatural while others welcome how easy it is!

In the end, it is really a matter of figuring out what works for you! The most important thing is to keep an open mind and be willing to try as many things as possible so you can decide what is the most comfortable and effective position for you and baby to breastfeed in.

Nursing pillows can help to cushion the c-sect wound during breastfeeding.

4.     Preparing for your milk to kick in

Contrary to popular belief, a C-section actually does not affect how fast your milk comes in. Since milk production is kickstarted by the removal of the placenta from the uterus, a mother who has had a C-section will make milk at the same rate as a mother who has had a vaginal birth. As always, it is important to nurse your baby on demand and latch baby as often as he cues for it with rooting motions, small sounds, and rubbing his face with his hands. The best way to get your milk supply up and running is to tell your breasts to make more by nursing your baby as often as possible.

Since you will likely be at the hospital for a couple of days, make use of your time there to get as much assistance from the hospital lactation consultants as possible. Enlist your hospital LC to help you attach baby to the breast as soon as possible after delivery, and ask for them to check the baby’s latch and milk transfer if you are not sure if things are right. Don’t forget that you can and should continue to seek professional support after going home! Nurul Huda Alkhatib was lucky to have picked a hospital with a proactive parent support system. “The lactation clinic from the hospital called me post-discharge just to ask how I was doing and if my breastfeeding was okay. They assured me that I could just call them if I had any questions or worries,” she says.

Ask your doctor for breastfeeding-friendly painkillers.

5.     Ease your pain

Some mothers are afraid to take painkillers, worried about the effects that the medication might have on baby. Don’t worry – after a C-section, it is standard practice for doctors to prescribe antibiotics and painkillers that are safe for breastfeeding; if you are concerned, it is always good to check in with your gynaecologist or even the nurses in the maternity ward.

Why is it important to take your meds? Firstly, the antibiotics serve to ward off possible infection of your wound. Secondly, remember that a C-section is in fact major surgery, and you need to take care of yourself as well. This includes relieving any post-operative pain, especially if it is making it difficult for you to cope with caring for your baby or even with day-to-day life. While it is true that what you eat and drink while you are breastfeeding make their way into your milk supply, where it can then be transferred to your nursing baby, it is important to remember that your baby only gets a tiny fraction of what you put into your body – and that these breastfeeding-friendly medicines, at their appropriate dosages, should not have an adverse effect on your nursing baby. Of course, the painkillers are optional, and if you are able to manage well with your level of unmedicated pain, you may wish to go without.

Surround yourself with good support and getting your partner on board can make way for a smooth start to breastfeeding.

6.     Surrounding yourself with support

One thing that all the C-section mums we spoke to agreed on was that support was vital to successful breastfeeding. Some mothers recruited their relatives to help out, such as their own mothers or sisters who fully supported their decision to exclusively breastfeed their baby. Others were lucky enough to have spouses who could make flexible work arrangements to stay home and help. Some of them were even able to hire pro-breastfeeding confinement nannies who were knowledgeable and experienced in assisting C-section mothers nurse their babies.

This sort of support is invaluable also in settling things like all the household chores and childcare for older kids so that the new mama can stay in bed, rest, recuperate, and concentrate on feeding the newborn. According to mother of two Ashtalaxmi Dinakaran, having a supportive husband and family was crucial when it came to breastfeeding. Nurul Huda agrees, saying, “If my mother had not given me words of encouragement, to remind me to pump especially when I was already so exhausted, I don’t think I would have the perseverance to exclusively breastfeed for the last 11 months.”

Another way that your support network can help is to prop mama up in her decision to breastfeed. Nili Seah, who has a baby daughter, absolutely hated people asking her to give the bottle to baby, as well as other unconstructive remarks. “I feel that I want to nurse her whenever we both feel she needs or just wants to nurse,” she says. Making sure that you have someone solidly on your side at home can be really uplifting for a vulnerable new mother, who needs encouragement that she is doing the right thing for her baby.

“I feel that I want to nurse her whenever we both feel she needs or just wants to nurse,”

Newsletter #32 – Mothering the Mother: Making Confinement Work for Breastfeeding

By Nabila Hanim (BMSG Editorial Team Member)
Photos courtesy of Far’ain Jaafar

Far’ain Jaafar, a BMSG EXCO member and one of BMSG’s breastfeeding counsellors, recently gave birth to her second baby. During her pregnancy, Far’ain, who advocates for mothers prioritising self-care during postpartum, took great efforts to prepare for her second round of confinement. We speak to Far’ain and a few experts who have worked with new mothers to find out how modern mums who are living on their own can have a restful and invigorating postpartum recovery that is also conducive for breastfeeding.

For many of us, confinement may mean a lot of things. For some, it would mean endless days of no showering, a lot of pain and discomfort, and worrying over how to take care of a new baby.

For Far’ain Jaafar, however, confinement is a period for a mother to heal inside and out, while bonding with the baby in as many ways as possible. Having read about the many ways to practice confinement across cultures and believing that the postpartum period, or fourth trimester, is one that should be focused just as much on the new mother, Far’ain decided that she would like to give more thought to her confinement this time around.

After the birth of her first child, Far’ain was well taken care of by her in-laws. Knowing that she would be on her own with her husband and son this time around as they are now living on their own, Far’ain prepared herself and got her husband on board to ensure the postpartum period eased her transition into becoming a breastfeeding mother again.

Far’ain did a lot of reading and research prior to the birth of her baby. Reading up about postpartum, or also known as the Fourth Trimester, helped her better understand the needs of a new mother.

Mothering the Mother

Knowing that her Estimated Date of Delivery (EDD) was going to be during the holiday season where her family members were going to be on vacation, Far’ain ensured that her husband was equipped to provide for her well-being first, above everything else. “In general, I made sure that there (he was going to) be able to meet my needs so that I will be able to meet the needs of my baby, especially when it comes to breastfeeding.”

Johanna Wagner, doula and founder at Bumpwise, which provides antenatal classes, workshops and doula services for expecting mothers, believes that care and recuperation for the mother is just as important, if not more, during the postpartum period. “It’s such a crucial time for mum and baby, and we must focus on nourishment, healing, and bonding. Often, sadly, mums and everybody around them focus only on the baby, but we must make a point of also holding the mother who is going through a transformation physically as well as emotionally.”

Giving birth takes a toll on a new mother’s body; having spent nine months carrying baby and going through childbirth is enough to make a mother feel weakened. Yen Lim, owner at Madam Partum, a Traditional Chinese Medicine (TCM) company for pre- and post-natal care, says it is normal and expected for a new mother to feel this way. “The rigours of childbirth deplete the postpartum body of Qi (energy or life force) and blood. It is common for most mothers to experience a weakened body constitution after birth. Hence, the confinement period is a crucial moment where mothers are nursed back to their pre-pregnancy health and vitality through a proper confinement care and nourishment plan.”

Importance of Nourishment in Postpartum Care

Having understood this, Far’ain spent plenty of time during her pregnancy discussing with her husband how she will be cared for during confinement. “I knew that I needed to nourish myself with nutrient-dense food and eat in a timely manner so that I’ll be able to nourish my baby and meet her needs. Hunger, or even food not pleasing to me, will affect my emotional state during confinement,” said Far’ain.  This is a common occurrence with mothers going through postpartum, who go through drastic hormonal fluctuations as the body regulates itself to the pre-pregnancy state. “I ensured that my husband was equipped to prepare my confinement meals by discussing with him about the topic during my pregnancy and curating my confinement meals menu for him to refer to,” said Far’ain, who spent hours researching and reading up on confinement practices during her pregnancy.

“I made sure that there was someone who’ll be able to meet my needs so that I will be able to meet the needs of my baby, especially when it comes to breastfeeding.”

The Confinement Diet

While there was plenty of confinement catering options in the market, it was never an option for Far’ain. As she prefered to customise her diet to her needs, she felt that it was logistically easier for her husband to prepare confinement food that was also suitable for everyone in the family to consume. However, since she knew that a lot fell on her husband’s shoulders, she ensured that the recipes were easy to prepare. “Nothing complex or time-consuming. Anything that required long periods of time on the stove were prepared using the slow cooker,” she said.

Far’ain designed a diet plan and menu that was easy for her husband to refer to during her confinement. This was then printed and placed somewhere visible in their kitchen. *For explanations of some of the meals stated above, scroll to the end of this post.

Managing Expectations During the Postpartum Period

Far’ain admitted that confinement this time around was more challenging due to the presence of her older child who turns five this year. Feeling left out, as what is normal for children after receiving a new sibling, he threw a lot of tantrums and displayed attention-seeking behaviour when visitors fawned over the baby. This distressed her a little, but she knew that she needed the mental capacity to focus on breastfeeding and caring for her new baby. “I also kept in mind the rigour needed to meet the breastfeeding needs of a newborn. That greatly helped to strengthen my resolve,” added Far’ain.

As a second-time mother, Far’ain knew to expect and manage some breastfeeding challenges. She faced engorgement and also had to tackle her baby’s initial shallow latch. Managing her expectations actually made her feel more confident about her body and how to manoeuvre around the roadblocks along the way. “I religiously did my breast massages and kept a positive mindset to pull through the discomfort. I also made sure that I kept correcting my baby’s shallow latch in order to help her achieve a good latch. I varied my nursing positions in the day mainly to prevent any blocked or clogged ducts, and avoided underwired bras.” Far’ain found that going braless for many hours in the day also helped her to avoid any pressure on her already-tender breasts.

Prioritising Self-Care & Rest

Far’ain made sure to also allow time for her body to rest significantly during this period despite the demands of breastfeeding and caring for a baby and an older child. Doing what she called “breastsleeping”, Far’ain said: “Baby co-sleeps with me and I’ve mastered the art of nursing while side-lying. I’m still physically at rest while nursing!”

Whenever her husband was occupied with her first-born, Far’ain was open to having to carry her baby during meals as she knew he needed time to tend to their son. Sometimes, she was also alone at home with the baby when her husband brings him out to spend some time together. Maintaining a flexible and positive mindset helped her adapt to the little changes she had to make, as opposed to her first confinement period where her in-laws took care of everything.

Far’ain also coped with having to carry baby around by babywearing. “Babywearing helped me to meet the needs of my baby and took care of my sanity!” she laughed.

Having an older child and living on their own meant that at times, Far’ain still had to carry her baby during meal times when her husband was occupied with her first-born. Learning to manage expectations and developing a positive mindset was a good mental shift for her to cope with her expanding role as a mother of two, yet still being able to maintain her health and well-being.

As many proponents of postpartum would agree, focusing on self-healing is a crucial aspect of postpartum recovery. Far’ain, who followed the Malay cultural tradition of massage after confinement, went through daily postpartum massages for a few days in order to regain her physical strength and to pamper herself as many other mothers would. This did not stop her from continuing to breastfeed her baby.

“I scheduled my massages around the times that baby would feed. This meant that I would have to either feed her before or after the massage session, or on some days, express a little bit of breastmilk for others to feed her while I was in a massage session. My masseuse was also fine with me taking a little interval to feed my baby,” said Far’ain, who also added that mothers should be comfortable and open to discussing arrangements such as these with their masseuse and family members in order to give baby access to the breast as much as possible.

The postpartum period is focused on recovery, but it is also a period of adaptation and can be very overwhelming, what with the fluctuating hormones of a new mother. “Honestly, it was a really difficult and tiring time for me. But I knew that it’s not forever. So I ensured that I put in place whatever I could to make my recuperation smooth. The days get better as I regained my strength. There were bad days and there were good days. It’s all right to have bad days, cry, forgive, repair, reflect and learn to make it better.”

“I scheduled my massages around the times that baby would feed. This meant that I would have to either feed her before or after the massage session, or on some days, express a little bit of breastmilk for others to feed her while I was in a massage session. My masseuse was also fine with me taking a little interval to feed my baby.”

Recipe for Success

Far’ain also advises mums to breathe and adopt a positive mindset. Especially when it comes to breastfeeding, the people who make up the support system of the breastfeeding mother must be equip to help her achieve her goals, not prevent it.

Tips for Breastfeeding Success after Delivery:

  • Empower yourself, your spouse and your caregiver on how to get through the challenging early days of breastfeeding – read widely to gain knowledge or attend breastfeeding workshops
  • Know where to get breastfeeding support For example, BMSG has put in place multiple avenues for mothers to receive support. Also, request to see the lactation consultant before being discharged from the hospital, to ensure that your baby’s latch is corrected and checked for any possible issues in order to rectify them early. This is also a good time to ask any questions or concerns.
  • Assemble your support team! This is so essential during and after confinement. The people you place around you can make or break your breastfeeding efforts. Keep close the ones who will make breastfeeding easy and uncomplicated and who would help you to successfully breastfeed and learn to wear imaginary earplugs for those who would affect you negatively but whom you have to face daily/regularly during your confinement. Remember a “simple” remark such as “Are you sure you have enough milk?” can affect your greatly (thanks to fluctuating hormones and being new to breastfeeding)
  • Prioritise nutrient-dense diet – Remember to have your proteins, fats, carbohydrates, vitamins and minerals in your food. Drink water and consume lots of healing fluids in the form of soups/non-caffeinated teas/herbals. Confinement is not the time to be concern about weight loss. The goal is to regain health and vitality through nutrient dense food and being gentle to our body. Our bodies went through a life force of pregnancy and birth.

Words Can Make or Break

Echoing Far’ain’s view of how important it is to keep a strong support team near the breastfeeding mother, postpartum doula Fauziah Abas, who founded prenatal and postnatal care company Revivify, feels that it is important for family members or anyone who will be caring for the mum during the confinement period to be educated on how to treat her sensitively. “Family members need to be mindful about words that may have a negative impact on a new mother,” said Fauziah, who has been a birth and postpartum doula for several years now. Having spent a lot of time caring for new mums, she finds that well-meaning remarks can make or break a new mother, on top of the other physical and mental challenges that she may feel are insurmountable.

“The job of family members is to physically assist the mother and refrain from making hurtful comments especially when she faces breastfeeding challenges,” said Fauziah. “(Family members ought) to respect  the mother’s wishes to breastfeed as long as she intended to and not to impose their opinions about breastfeeding based on their own negative experiences,” she said. She also added that the immediate family can do more to control the number of visitors and help to give the mother as much space as she can to rest and breastfeed her baby.

Forty Days for Forty Years

Regardless of which cultural confinement practices you choose to follow or not, postpartum is a period for the mother to find herself and rejuvenate her body, mind and spirit to her old self. While it is particularly challenging in this period of time where the new mother may feel isolated and alone without her “village” of help and support, new families must be open to learning how to support a new mother and especially if she is new to breastfeeding. As many elders across cultures and ethnicities have widely advised, investing in these forty days (or more!) of confinement will bring meaningful returns for forty years to come.

[We have also previously written on Indian Confinement Practices. Click here to read.]

*** About the Confinement Recipes***

  • Most of the recipes Far’ain consumed were adapted from the book “The First Forty Days” by Heng Ou
  • Air Kunyit – Turmeric Water; helps with reproductive and womb health
  • Jamu Wanita – Women’s Jamu; traditional Indonesian herbal concoction meant for a woman’s overall well-being
  • Talbinah – A prophetic dietary tradition from the Arab culture; made from barley cooked with milk and sweetened with honey. It is believed that this dish soothes the heart and treats sadness.
  • Sourdough Waffles – Unlike the usual waffle made from plain flour, the sourdough waffle is made from the addition of a sourdough starter to the waffle mix. Sourdough is believed to have benefits for the human digestive system and is a good alternative to commercial bread or dough.