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If you've had a cesarean and are worrying that it might affect your ability to breastfeed, relax. You can still nurse your little one after giving birth by cesarean. William Sears, M.D., and Martha Sears, RN, authors of "The Birth Book," suggest that "the best postoperative pain reliever is frequent doses of seeing, holding and feeding your baby."

Tips for Nursing after a Cesarean

• Discuss anesthesia and analgesia choices ahead of time. If you're scheduling a cesarean, you'll have time to discuss options with your doctor. When you have a choice, regional anesthesia is best for breastfeeding. You'll be able to nurse sooner, which is good for both you and your baby, and your baby will feel more alert. Even if you have an emergency cesarean with general anesthesia, you can nurse as soon as you're awake and are no longer groggy. It's also good to discuss post-birth pain-relief options.
• Check out the hospital routines. Find out if your hospital's policies support breastfeeding (24-hour "rooming in," a private room where your partner can spend the night, no routine bottles or pacifiers, no extended observation for healthy babies born by cesarean, staff IBCLC, availability of automatic electric breast pumps). If your hospital has policies that can interfere with breastfeeding, ask your doctor about waiving their requirement in writing; bring a copy or two with you to the hospital.
• The earlier to breast, the better. If all went well, you can usually put your baby to your breast to nuzzle and nurse soon after you give birth. Nursing within the first hour is optimal for many reasons: you'll still be under the effect of anesthesia and won't feel pain; your baby will receive immunological protection from your colostrum; you'll begin stimulating your milk supply; you'll become less engorged; your uterus will contract, which will lessen the chance of postpartum hemorrhage; and you'll take advantage of your baby's very strong sucking urge that occurs in the first hours after birth. Early breastfeeding also contributes to your confidence and desire to continue. If you're not able to breastfeed within the first four to six hours, begin regularly expressing your milk with an automatic electric double breast pump.
• After giving birth, use medication if needed for pain. Consult your doctor for her opinion about this matter, but generally, pain medications pass into your milk in small amounts and right after birth you produce only tiny amounts of colostrum, so your baby will receive very little of the medication. It's always wise to use the least medication possible, while keeping yourself comfortable enough to enjoy your new little one.
• Keep your baby with you. It's best for you and your baby to stay together after birth. Researchers found that moms who chose rooming in needed less pain medication and slept as well as moms whose babies were kept in the nursery. Babies who stayed with their moms cried less, their vital signs stabilized more quickly, and they had lower blood pressure (Anderson, G.C., "Journal of Nursing Scholarship," 1989). Nighttime nursing, which is easier with rooming in, plays an important role in increasing your milk supply because secretion of the milk-making hormone prolactin is 10 times higher during nighttime feeds. To make rooming in easier, ask your partner, a parent, or friend to stay with you to help out.
• Nurse frequently. The American Academy of Pediatrics recommends breastfeeding at least 8 to 12 times a day. Nursing frequently increases your milk supply, and in turn, your baby's stooling, which helps prevent normal newborn jaundice. It also helps protect against severe engorgement. Babies born by cesarean may be sleepy. Skin-to-skin contact and frequent feeds will help stimulate your sleepy newborn.
• Get in a comfortable position. Not surprisingly, finding a comfortable position to breastfeed can be more difficult after a cesarean. Bringing a few favorite pillows from home may help. (You'll need one of these to protect your incision.) Get help from the staff lactation consultant (IBCLC) so you'll breastfeed comfortably right from the start. Your partner can be a great help to you now, and later at home, by watching the lactation consultant assist you in getting your baby properly positioned and latched on. Whatever position you choose, remember that breastfeeding should not be painful!
  
  Following are a few positions that work well after a cesarean:
  • Lying flat on your back -- If you nurse immediately after your cesarean, you'll most likely be flat on your back. Protect your incision with a rolled up towel, blanket, or pillow and have nurses help to position your baby, draped across your chest. Your newborn may latch on spontaneously or just nuzzle. Either is fine.
  • Clutch (football) hold -- Bring the hospital bed into an upright position, or sit in a comfortable, wide chair. Use pillows under your baby to bring her to breast level and for support under your arm. Your baby will be lying alongside you, upper back resting on your forearm with her neck supported by your hand. She will be facing you, hips flexed, bottom against the chair back and feet pointing to the ceiling. Your opposite hand will support your breast, with thumb above the nipple and fingers cupped below, keeping back from the areola. Your baby should not be so far forward that she has to bend her neck to latch on.
  • Side lying -- This may be the most comfortable position in the first days, and it allows you to lie down to nurse and get some rest. It can be a bit tricky getting your newborn latched on, until you get the hang of it, so get the help you need while you're in the hospital. Start with the hospital bed in a flat position and have the side rails raised. Slowly roll onto your side while holding onto the side rail and relaxing your abdominal muscles. Use a pillow or rolled up towel to protect your incision while nursing. Your baby will be on her side, next to you at breast level. Have a pillow tucked behind your back and your baby's back, under your head and under your upper knee, for comfort and support. Your bottom arm can be up or held slightly below shoulder level, cradling your baby's head. Your baby's ear, shoulder, and hip should be in a straight line, with her knees pulled in close. To latch your baby on, pull your little one toward you. Use the side rail to help you roll over when you're ready to nurse from the other breast.
  • Cross cradle (transition) hold -- Bring the hospital bed into an upright position or sit in a comfortable, wide chair. Support your baby with a pillow on your lap, to protect your incision and raise your little one to breast level. Use pillows as needed to support your arms and hands. Your baby will be lying on her side, facing you. Support your breast with the hand on the side that you will feed your baby (left breast, left hand). Use your other arm to support your baby's body. Guide her to your breast, placing your hand on her neck, the palm of your hand between her shoulder blades.
• Get the support you need once you're home. Hopefully your partner can take some time off, or you have a relative or friend who can regularly help with the housework and your other children at first. If you have visitors, take them up on their offers to help out around the house. You might also consider hiring a mother's helper and/or a cleaning service for the first few weeks. You'll need to get lots of rest with your baby, enjoy healthy meals, and get enough to drink. When you're not in bed, get some help setting up a "nursing nest" at your most comfortable chair. Have everything you need within arm's reach. And be sure you have the breastfeeding help you need. Before leaving the hospital you may want to find out if the staff IBCLC makes home visits. If not, you can get referrals for an IBCLC in private practice.
• It's normal to feel sad or disappointed after an unexpected cesarean. You may feel like your body has failed you and may even find it difficult to bond with your new baby. Breastfeeding not only helps you to connect with your new little one, but can help you to emotionally heal from a difficult birth and regain trust in your body. If you feel depressed, it is important to talk to your doctor and get the help you need.
• Your commitment to breastfeeding matters. It may surprise you to know that your commitment has a very strong positive affect on your ability to breastfeed, resulting in a longer duration of nursing (Janke, J.R., "Journal of Nurse-Midwifery," 1988).

Safety Notes

• It's normal to lose more blood with a cesarean than with a vaginal birth. Excessive blood loss can lead to anemia, which can compromise the milk supply (Willis and Livingstone, 1995). If you experience extreme fatigue, weakness, or dizziness after giving birth, have your iron levels checked.
• Keep an eye out for thrush. Because antibiotics are routine after a cesarean, new moms can experience an overgrowth of yeast that can impact breastfeeding. Yeast can cause not only a vaginal yeast infection, but sore, itchy and/or irritated nipples, thrush in baby's mouth (white patches) or a red, irritated diaper area. If you suspect thrush, it's important to treat it early and treat you and your baby at the same time to prevent re-infection.