Caesarian birth and breastfeeding

How does a Caesarean birth affect breastfeeding?

Mothers who have had a Caesarean birth are less likely to start breastfeeding than other mothers. If they do breastfeed, they are more likely to breastfeed for a shorter time. This may be due to many reasons, including illness, pain medication, separation from the baby, and difficulty finding a comfortable position to breastfeed. Mothers who are facing a Caesarean birth should consider delaying delivery until at least 39 weeks, using skin-to-skin contact as much as possible, and breastfeeding as soon as possible after delivery. The under-arm and the laid-back breastfeeding hold can be used to keep the baby away from the tender tummy. Mothers who have had a Caesarian birth may benefit from extra help.

A) The impact of Caesarean birth on breastfeeding

Babies born by Caesarian birth are at higher risk of developing a less healthy gut bacteria (microbiome). Breastfeeding, and in particular exclusive breastfeeding, helps the microbiome to improve (Hoang 2021).

Unfortunately, compared with mothers who have had a vaginal birth, mothers who have had a Caesarean birth are (Chen 2018; Hoang 2019; Hobbs 2016; Wu 2018; Yisma 2019; Zhao 2017):

B) Reasons for a Caesarean birth affecting breastfeeding

Many factors play a role in lower breastfeeding rates in mothers who have had a Caesarean birth including:

Mothers who have general anesthesia during childbirth instead of epidural analgesia for pain control, have been found to have less success breastfeeding over the long term (Kutlucan 2014; Lie 1988).

C) Support for mothers facing a Caesarean birth

While the reasons for a Caesarean birth vary, all mothers and babies in this situation benefit from extra support. If you are facing a Caesarean birth, consider the following:

  • Delay delivery until at least 39 weeks to prevent breastfeeding and health problems common in early-term and premature babies (Wilmink 2018).
  • Keep the baby in skin-to-skin contact and avoid unnecessary separation between you and your baby.
  • Breastfeed after delivery as soon as you can and the baby shows signs of hunger.
  • If the baby cannot breastfeed effectively, express colostrum or breast milk whenever the baby needs to feed in order to establish a good milk supply and use this to supplement the baby.
  • The laid-back and under-arm breastfeeding holds allow you to keep the baby away from your tender tummy.
  • Make sure you are well supported and in a relaxed position while breastfeeding. This may mean extra pillows and being a little creative.
  • Ask for help for yourself and in caring for the baby.
  • Use appropriate pain medication as needed (Martin 2018).
  • Make sure the baby is getting enough milk and is not getting too sleepy or irritable.
  • Ensure you have support from others.
  • If you have concerns or are struggling, ask for help from your health-care providers or from a breastfeeding specialist.

Breastfeeding babies born by Caesarean birth tend to lose slightly more weight than those who have a vaginal birth. It is important to monitor the other signs that the baby is taking in enough milk.

References

Cakmak H, Kuguoglu S. Comparison of the breastfeeding patterns of mothers who delivered their babies per vagina and via cesarean section: an observational study using the LATCH breastfeeding charting system. Int J Nurs Stud. 2007 Sep;44(7):1128-37

Caglar MK, Ozer I, Altugan FS. Risk factors for excess weight loss and hypernatremia in exclusively breast-fed infants Braz J Med Biol Res. 2006 Apr;39(4):539-44. Epub 2006 Apr 3
 
Chen C, Yan Y, Gao X, et al. Influences of Cesarean Delivery on Breastfeeding Practices and Duration: A Prospective Cohort Study. J Hum Lact. 2018 Jan 1:890334417741434
 
Deng X, McLaren M. Using 24-Hour Weight as Reference for Weight Loss Calculation Reduces Supplementation and Promotes Exclusive Breastfeeding in Infants Born by Cesarean Section. Breastfeed Med. 2018 Mar;13(2):128-134
 
Guala A, Boscardini L, Visentin R, et al. Skin-to-Skin Contact in Cesarean Birth and Duration of Breastfeeding: A Cohort Study. Scientific World Journal. 2017;2017:1940756
 
Hoang Nguyen PT, Binns CW, Vo Van Ha A, et al. Caesarean delivery associated with adverse breastfeeding practices: a prospective cohort study. J Obstet Gynaecol. 2019 Sep 4:1-5

Hoang DM, Levy EI, Vandenplas Y. The impact of Caesarean section on the infant gut microbiome. Acta Paediatr. 2021 Jan;110(1):60-67
 
Hobbs AJ, Mannion CA, McDonald SW, et al. The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum. BMC Pregnancy Childbirth. 2016 Apr 26;16:90
 
Kutlucan L, Seker IS, Demiraran Y, et al. Effects of different anesthesia protocols on lactation in the postpartum period. J Turk Ger Gynecol Assoc. 2014 Dec 1;15(4):233-8
 
Lie B, Juul J. Effect of epidural vs. general anesthesia on breastfeeding. Acta Obstet Gynecol Scand. 1988;67(3):207-9
  
Martin E, Vickers B, Landau R, et al. ABM Clinical Protocol #28, Peripartum Analgesia and Anesthesia for the Breastfeeding Mother. Breastfeed Med. 2018 Apr;13(3):164-171
 
Prado DS, Mendes RB, Gurgel RQ, et al. The influence of mode of delivery on neonatal and maternal short and long-term outcomes. Rev Saude Publica. 2018 Nov 29;52:95
 
Sakalidis VS, Williams TM, Hepworth AR, et al. A comparison of early sucking dynamics during breastfeeding after cesarean section and vaginal birth. Breastfeed Med. 2013 Feb;8(1):79-85
 
Scott JA, Binns CW, Oddy WH. Predictors of delayed onset of lactation. Matern Child Nutr. 2007 Jul;3(3):186-93
 
Taha Z, Ali Hassan A, Wikkeling-Scott L, et al. Prevalence and Associated Factors of Caesarean Section and its Impact on Early Initiation of Breastfeeding in Abu Dhabi, United Arab Emirates. Nutrients. 2019;11(11):E2723
 
Wilmink FA, Pham CT, Edge N, et al. Timing of elective pre-labour caesarean section: A decision analysis. Aust N Z J Obstet Gynaecol. 2018 Apr 26
 
Wu Y, Wang Y, Huang J, et al. The association between caesarean delivery and the initiation and duration of breastfeeding: a prospective cohort study in China. Eur J Clin Nutr. 2018 Apr 18
 
Yisma E, Mol BW, Lynch JW, et al. Impact of caesarean section on breastfeeding indicators: within-country and meta-analyses of nationally representative data from 33 countries in sub-Saharan Africa. BMJ Open. 2019 Sep 4;9(9):e027497
 
Zhao J, Zhao Y, Du M, et al. Does Caesarean Section Affect Breastfeeding Practices in China? A Systematic Review and Meta-Analysis. Matern Child Health J. 2017 Oct 10