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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,”

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