By Yvette O’Dowd
Surgical delivery of babies has evolved from a last chance attempt to save mother and child to common practice in less than a century. In 2021, 38% of all women giving birth in Australia had a caesarean section.
Most parents facing a surgical delivery of their baby would prefer a natural vaginal birth. Despite the media, very few elective (planned) caesareans are because of the preferences of the parents or doctors. Quite simply, nobody undertakes major abdominal surgery unless medically indicated.
Emergency caesareans are a topic for another day. Here we are looking at births which are planned in advance due to known risks. Some of these include:
- Issues with the position of the baby and/ or placenta:
- Breech (backwards) or transverse (sideways) presentation
- Placenta previa (some or all of the placenta is positioned on or
close to the cervix) - Multiple births (twins or more!)
- Previous caesarean sections
- Medical conditions or infections of mother or baby
Planned (elective caesareans) are booked for babies who have reached “term”, with evidence showing that closer to the due date is preferable. Around 39 weeks gestation is ideal for healthy pregnancies.
Most parents begin their pregnancy with plans for a natural birthing experience in a gentle and supportive birthing space. Being told this is no longer possible can be devastating. The loss of an anticipated experience is real, even though everyone recognises the optimal health of mother and baby matters most. It’s okay to grieve. Planning for a surgical birth experience can be an important part of processing this grief. Here are some things to consider:
Skin-to-Skin
While routine for medical professionals, childbirth is a rare event for parents. Fortunately, modern practices are shifting away from unnecessary separation of mother and baby. When planning a C-section, it’s appropriate to communicate preferences like immediate skin-to-skin contact.
Immediate and uninterrupted skin-to-skin contact is recognised for its benefits to both mother and baby. Far from being just a nice thing if it can happen, skin-to-skin helps regulate the newborn temperature, stimulates important steps leading to initiating the first breastfeed and supports the uterus to contract naturally after the placenta is removed, reducing bleeding.
In a review of 13 studies from around the world, researchers found that skin-to-skin care after caesarean has a positive impact across cultures and across healthcare settings.
Lactation Support
Although there may be short-term effects, such as a slight delay in your milk supply increasing, the way your baby is born generally doesn’t make a difference to how well you can breastfeed.
Post-Caesarean Breastfeeding Positions
- Hold your baby in the underarm or football position with their
feet towards your back. - Place a pillow on your lap to support your baby and shield
your wound. - Lie down on your side.
- A laid-back position with your baby slightly off to one side.
- In every position, make sure your baby’s body is close to you, chest to chest, chin to breast, and nose away from the breast.
Whatever position you find most comfortable, the basics of positioning and attachment for your baby still apply. You will probably find you need help to get your baby in the right spot – some mums are hesitant to keep calling for busy midwives to attend every feed but in the long run this will help you learn. It can also be helpful for your partner or support people to learn how to help you with this, so they can be with you when staff are unavailable. You can also ask if there is an IBCLC lactation consultant available to help you.
If Breastfeeding Needs to Wait
It is beneficial for both you and your baby to have immediate skin-to-skin contact and for your baby to breastfeed within the first hour of birth. However, there are occasions when breastfeeding may be delayed. Factors such as receiving general anaesthesia or the need for your baby to be placed in a humidicrib for stabilization can necessitate a wait.
In such situations, expressing colostrum is crucial. Colostrum, your very first breastmilk, is rich in concentrated protein and immunity factors compared to mature breastmilk. It works as a natural laxative for your baby’s first poo, known as meconium. A midwife can help you hand express your colostrum within the first hour after birth or as soon as you are stable. As well as collecting this important first milk for your baby, this will stimulate your milk supply and signal to your breasts to begin production. If you are unavailable to directly feed your baby at the breast, they can be given your colostrum by syringe or a small cup.
Antenatal Expression of Colostrum
In recent years, expressing colostrum in late pregnancy and freezing it has become popular. While generally only advised for known risks of baby needing supplementary feeds in the first few days (eg: babies born to mothers with gestational diabetes), many people choose to store colostrum “just in case”.
If expressing antenatally is comfortable for you, you are at least 36+ weeks pregnant and you have been given the all-clear by your midwife or doctor, then go for it! Be aware that the variations between mothers in the amount they can express at this stage varies and averages just a few millilitres. Again, this is not an indicator of your milk supply. If expressing colostrum is stressful or frustrating, don’t feel you must continue. Your milk will be there when your baby feeds and/or your midwife will help you express postnatally if needed.
Delayed Onset of Milk Production
Research has shown that mothers who have planned caesarean births without experiencing natural labour are more likely to experience a delay in milk production compared to those who have unplanned caesarean births after going into labour. All caesarean deliveries are associated with a higher likelihood of delayed onset of lactation compared to vaginal births.
When you are booking in for your surgery and again when you are admitted to hospital, discuss your plans to breastfeed and how you would like any delay to be managed. If you have expressed colostrum antenatally, make sure you have it with you on admittance, it is clearly labelled and that everyone caring for your baby knows where it is stored. Your partner or support person can take responsibility for this and – if you or your baby need to be transferred to a different facility, for example – make sure it stays with your baby and isn’t overlooked.
Keep your baby close – skin-to-skin is optimal – and offer the breast frequently. This is especially important on the second, third and fourth day. The baby stimulates your milk production by feeding almost constantly. You might need extra support on those days, with someone to reassure you and give practical help like nappy changing, soothing your unsettled baby while you eat or use the bathroom, and passing you the baby to feed.
If your baby is sleepy following drugs used in labour and delivery, you should be supported to hand express your colostrum frequently. Little and often will trigger your supply in the same way a newborn cluster feeds. If needed, you can feed this concentrated milk to your baby by cup or syringe. Once your milk begins to transition to mature milk, you can begin using a breast pump if needed.
Rest and Recovery
Rest is crucial for all new mothers, especially for those who have undergone a caesarean birth. Breastfeeding is a good reason to relax and take the time to recover. Since a caesarean birth is a significant abdominal surgery, it can lead to a slower regain of energy compared to those who have had a vaginal birth. It is important to give your body the necessary time to heal. Refrain from lifting anything heavier than your baby for a minimum of 6 weeks or until after your postnatal check-up.
It is normal to feel frustrated by your restricted movement, abdominal pain and discomfort and fatigue. You might be tempted to have others feed your baby with a bottle so you can sleep or catch up on household tasks. Keep in mind that breastfeeding helps you rest and heal, with hormones doing a lot in the background. Try to prioritise rest and breastfeeding and let others step up for everything else.
If you have other children, are parenting alone or do not have family support, you might need to seek help from your community or outsource some things to commercial services.
Recovering from surgery, adjusting to life with a new baby and establishing breastfeeding can be a lot to deal with. Having a different birth experience to one you might have expected can also take its toll, as you grieve a lost experience. It’s normal to feel a bit overwhelmed by it all and it can help to talk to someone who you trust about everything which has happened. Family, friends, your child health nurse or a counsellor can help you work through your feelings and process it all.