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Through the Window, Instead of the Door: Breastfeeding After Cesarean Delivery

Updated: Jan 4

A woman breastfeeding her child in a nursing tank top using a football hold in a hospital bed

Over 30% of deliveries in the United States are via cesarean section. A number that seems to be continuously rising. Cesarean section, or c-section, is one of the most common surgeries performed every year. While c-section should not prevent or compromise your ability to breastfeed – studies show breastfeeding rates and duration are about the same when compared to vaginal delivery – cesarean delivery can create some challenges.

Cesarean delivery has revolutionized safe birthing practices and saved countless lives of both mothers and babies. Generally considered routine, a c-section should still be recognized as major abdominal surgery. It is the only major abdominal surgery after which you are expected to recover while sustaining the life of a newborn baby. Balancing your own recovery with caring for a newborn contributes to why cesarean delivery is always listed as one of the “risk factors” or “complicators” to breastfeeding. However, with a third of babies being born via c-section, there are several ways to improve your breastfeeding journey and outcomes.

Best Breastfeeding Position for Post-Cesarean

Getting a new baby in the right position to breastfeed can be challenging for any new mom, and working around an incision and the pain that comes with it can make it even harder. The football hold is the most commonly recommended position for breastfeeding post-cesarean. It puts the baby and their body away from the incision, along the side of the mom’s body. Here are some tips for the football hold and proper positioning post-cesarean.

  • Make sure mom is comfortable! No craning or straining. Sit in a supportive chair, couch, or on the bed. Give proper back support and place your feet on the ground or a stool for core support. You can always use pillows to help prop up.

  • For a proper football hold, baby should be alongside the mother's body. Place baby’s head in the same side’s hand with their body resting along your forearm. Use pillows to support that arm and incline the baby as needed. Baby’s body should face up with shoulders and hips in line. Baby’s face should be facing your nipple, nose to nipple, coming up and over for a deep latch. This hold avoids pressure on the incision and still allows for the opposite hand to help with positioning.

  • If you prefer a cradle or cross-cradle hold, use a pillow (nursing or regular) to protect the incision from the baby's weight. Add pillows on the sides to support mom’s arms.

A woman in an opened button down shirt breastfeeding her baby using the football hold

What to Expect with Milk Supply Post-Cesarean

Secondary lactogenesis or the onset of copious milk production can be delayed after cesarean section, as can initiating breastfeeding. Recovery from major surgery is painful and stressful. A delay in latching and regular suckling will lead to a delay in milk production. The following tips can help promote milk supply following a c-section:

  • Practice skin-to-skin between mom and baby as soon as safe following birth.

  • Continue to latch regularly or pump frequently. A new breastfeeding mother should latch or pump at least 8 to 12 times every 24 hours after delivery.

  • Learn proper hand expression techniques to provide colostrum to the baby who may be lethargic after a long labor or traumatic birth. Hand expression will also support milk production.

Managing C-Section Pain While Breastfeeding

As one might anticipate or expect, with major abdominal surgery most women need some sort of pain management post cesarean. But is it compatible with breastfeeding?

  • Ibuprofen (Motrin or Advil, etc.) and acetaminophen (Tylenol) are both considered safe to use as directed by a health care provider or as instructed on the bottle post-cesarean. In a review of Hale’s Medications and Mothers’ Milk, one of the leading resources of medication use during lactation, both are listed at L1, meaning there is extensive data on use in breastfeeding, and they are compatible with breastfeeding. The only major infant concern is liver toxicity if the mother overdoses or exceeds the recommended dosage.

  • Narcotics are also often prescribed in the hospital and for home use in the case of cesarean delivery. These should be used at the lowest dose for the shortest course. Codeine should be avoided if possible or used with extreme caution as some people are rapid metabolizers and levels in their blood will exceed the targeted therapeutic dose. Here is a resource from the Academy of Breastfeeding Medicine about opioids and other substance use.

  • A combination of multimodal pharmacological and nonpharmacological pain management interventions should be used to manage pain in the postpartum period. Make sure to discuss your plans for breastfeeding with your provider and your infant’s provider and any concerns that you may have. Educate yourself on the potential side effects for you and for the baby with any medications that you take while breastfeeding.

  • Reach out for help if you feel that your pain is not well controlled. Do not self-medicate. If you find that you are experiencing signs or are having concerns about opioid dependency/addiction, reach out! You can safely get help during your breastfeeding journey. CDC Resource

Overall, while cesarean section can be a breastfeeding challenge, women who deliver surgically can and will go on to have breastfeeding success. If only there was a way to predict how every labor and delivery would result in order you to better prepare yourself, your home, and your family for breastfeeding success. Since that is not the case, having background knowledge to jump the hurdles can be invaluable in reaching your goals. Remember if you're one of the 1 in 3 women in the United States who deliver via cesarean to take care of yourself! You just had major abdominal surgery and are now in charge of keeping a human alive. Allow your village to help you set up your home for comfort and to prevent too much up and down the stairs. Take safe medication for pain as needed. Finally, reach out early and frequently to a lactation consultant if you are struggling with meeting your breastfeeding goals after cesarean delivery.

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