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 #33: Mother’s Sharing – New Baby, New Beginnings

By Stacey Tham, BMSG Volunteer
Photos courtesy of Stacey Tham

From an exclusively pumping mother-of-one to a fully latching mum, Stacey tells us about her rollercoaster breastfeeding journey breastfeeding her two children.

Stacey Tham is a mother of two who managed to switch to exclusively latching her second baby after exclusively pumping for her first. Throughout both her deliveries, she also succeeded in providing excess breastmilk to many babies in need.

Facing Unexpected Challenges

When I had my first child, I knew that breastfeeding was what I wanted. I was surrounded by other mothers, some of whom were already breastfeeding, and I also felt that breastfeeding should be the norm. However, I did not know what to expect; I was not part of any support groups for mothers online or offline and nobody told me breastfeeding could be challenging.

Breastfeeding was not at all what I had expected. Although my supply kicked in really fast by Day 5, I was soon down with engorgement, mastitis and also blocked ducts caused by milk blisters which I was totally unaware of. It was indeed depressing for me as a first-time mum. At first, I remember feeling annoyed that everyone around me was telling me not to give up and to endure for the baby. I felt that everyone was focusing on the baby and not on my well-being as a new mother. I cried almost every day during my confinement because I always woke up with engorged breasts; it was happening about 80% of the time! It would dampen my mood for the rest of the day, especially since I was experiencing some sort of baby blues. I visited my gynaecologist, lactation consultant and also a breast specialist every other day for the first month. Everyone told me my problem was due to oversupply and it was a happy problem. But I felt embarrassed that I totally did not enjoy motherhood, and sad about how my life took a 180 degree turn from what it was before.

I felt that everyone was focusing on the baby and not on my well-being as a new mother.

Finding Support

When I decided to open up about my plight with my friends, I came to know of several breastfeeding groups and I read about other mummies’ experiences there. It is definitely more comforting when you realise that there are also other mummies who are in the same shoes as yourself. Reading more about the benefits of breastfeeding also helped me to remember the reason I was breastfeeding – that it would benefit my kids, rather than trying to keep up with other mums.

Turning to Pump Exclusively

As my nipples were extremely sore, and I never managed to successfully latch my baby, coupled with all the other issues I had, I ended up exclusively pumping. I am very pleased to share, though, that I managed to bless my excess milk supply to two other babies during my first breastfeeding journey which lasted one year.

However, I was determined to exclusively latch my second child when I discovered that I was pregnant again.

Stacey with her little family, while breastfeeding her second child on-the-go. Her second baby will be turning two this year.

The Start of a New Chapter

When my second child was born, I was eager to latch my baby. I was experiencing sore nipples but was determined to bear with the pain so that I can continue latching. Little did I know that I was suffering from open wounds on my nipples. I had four episodes of fever during my confinement because of that, visited the breast specialist and subsequently infectious disease specialist before I got the nipple treated.

During this period, I exclusively latched on the other breast, while pumping the affected one as pumping was less painful. However, the pain was still very unbearable due to the open wound, especially since it rubbed against the flange of the pump. The wound took about one month to recover.

Despite the rough start, I went on to breastfeed my baby, who will be turning 2 in July 2019.

Stacey and her children, all smiles 🙂

Blessing Excess Milk

This time round, I was also really pleased to bless my milk to other babies again, especially a preemie who was born at just 28 weeks. The baby’s mum shared with me that she was not able to keep up with her baby’s needs, and when her son had been discharged from hospital, she was not able to obtain breast milk from the milk bank for her baby anymore as he was over the age limit. She tried feeding formula milk exclusively but as her son’s digestive system was not matured yet, he tended to regurgitate after every feed. I supplied her with my milk stash for a few months and I was really happy that my milk was able to help a baby in need.

My past experience on breastfeeding definitely help managed my expectations this time as a second time mum. That also helped me to manage my emotions and I enjoyed the journey right from the start. It was much better when I was mentally prepared for it.

Family support is what kept Stacey going during her arduous journey in the early days of breastfeeding. Having a supportive husband and family members made the journey a little bit easier.

Advice for New Mums:

  1. Support is Crucial

For a pleasant breastfeeding journey, any kind of support helps, especially from the family! For example, my husband helped to wash my pump parts while my mum very gladly emptied up her freezer space for my pumped milk when my standalone freezer was full.  Such acts made me feel that I was not alone on this journey.

To the husbands, your support and companionship do a lot for the relationship between you and your wives. I once joked with my husband that he was always getting a good night’s sleep while I wake up frequently to latch our second baby throughout the night. After that, however, he ended up carrying the baby to me for every feeding throughout the night. I was very touched as he was also already back at work while I was still on maternity leave. As a man of a few words, his actions meant a lot to me. He was willing to have interrupted sleep just to show his support for me on this journey.

My family members also helped me in supporting my breastfeeding journey; they were such a great help and understood the importance of helping a nursing mum out. Once, my freezer compartment broke down and my brother- and mother-in-law drove by to our house to bring my milk stash to be stored in their freezer temporarily. I really appreciated that gesture very, very much.

To the husbands, your support and companionship do a lot for the relationship between you and your wives.

2) Gaining as much knowledge about breastfeeding as possible

Reading up on breastfeeding is one of the best things you can gift yourself as a new mother. It really helps when one is equipped with the basic knowledge of breastfeeding. The infographics in the BMSG online support group and website are extremely useful!

3) Share your concerns with other mothers

Don’t be afraid to seek help and share your problems! I always feel so much better speaking to fellow mummies when they can totally relate to what I have been through.

4) Determination

Don’t give up easily. I share my experience to let fellow mummies know that they are not alone when they face breastfeeding problems. Maintaining mummies’ well being is very important and I believe a mummy needs to be happy so that she can enjoy motherhood. However, it is also equally important for them to put in their best if they want to breastfeed their babies.

I am honest with my friends by telling them that the best way to boost milk supply is to constantly remove milk from the breasts. As we all know, a mother’s milk supply is highest at night and if the baby is not nursing at night, then they will need to pump to boost supply. It can be really difficult when you are very tired but we know that the midnight pump yields the best supply.

Being a mother really makes you realise the strength that you never thought you had. Most of the time, it is really about biting the bullet and moving on. Things will get better!