C-section birth and/or a NICU stay? Plus breastfeeding or providing breast milk? Um, yeah. It can totally happen. Breast milk is magic. Breastfeeding is magic. I know not everyone chooses to do it, or wants to, or can physically due to medical conditions or adoption. But I realized early that breastfeeding is 90% a confidence game. Part of that confidence game is knowing that even when things are challenging, that old ‘where there’s a will, there’s a way’ adage mostly applies. It’s not saying it will be easy, but it’s certainly not impossible for the vast majority of people. With formula readily available, many mothers choose to go that route for a wide range of reasons. I do not feel that formula is evil in the slightest, and if women want to do that instead, that’s fine with me. But for those who don’t want to go that route, having an extra wrench thrown into “the plan” can be so intimidating. Being fully supported by others in the first weeks does wonders, something culturally we don’t prioritize. A large part of “success”, though, is plain old perseverance. Plus knowledge that others have been there before you, and are rooting you on. Here’s a bunch of words about it.
ESTABLISHING THE NEW WORLD
Much of what we read about moments immediately following baby’s birth involve the importance of establishing contact with the mother as soon as possible. Establishing this contact has many physical and emotional benefits for both mother and baby. With a cesarean birth, this experience can still happen shortly after birth, with a little tweaking from the original script.
Breastfeeding aside, moments of mother – baby contact are so important and can be such a welcome human touch to what may feel like a sterilized, mechanical procedure. Most hospitals will help you prioritize this contact by taking the strap off one arm so you can touch your baby, or by placing baby close to your face. Some mothers are able to have skin-to-skin contact during this time. Whatever happens here, it doesn’t mean that if breastfeeding doesn’t happen right away, or even hours later, all is lost. It is important to know that breastfeeding can happen and continue for months even if these “first moments” (be it minutes, hours or even days) are disjointed or missing altogether. Many, many women have been where you are, and many of them have gone on to provide breastmilk or breastfeed (in part or completely) to their baby for months to come.
How quickly you can breastfeed your new baby will depend on the birth circumstances and your hospital’s practices.
I had a c section but I delivered at a baby friendly hospital so I was given skin to skin contact and was breastfeeding almost immediately after he was delivered.
Your partner, doula, midwife or nurse may need to assist you, as Sandra, mother of two, experienced:
My midwife came to the birth and collected Esmee after she was born – so several of the tests/procedures were kind of delayed until after I was nursing her in recovery (thank you, midwife). Also, my midwife advocated for me to not wear the hair net in the OR so that when they brought Es to me I was more natural, less clinical. The midwife dimmed the lights in the recovery room and kind of set the place up with her stuff before I was wheeled in. I just remember being wheeled in and midwife saying: she is ready for the breast let’s get her on. With help I had baby on breast (with help of midwife and partner) even though my arms weren’t quite working. Doctors/nurses might resist, but if you have others with you who can support baby and help with latch it can be done.
Katherine, mother of Zane, says
Although this wasn’t how I had imagined my ‘birth experience’, nothing will take away from the wonder that was my sons entrance into the world. My hospital didn’t allow breastfeeding in the surgical ward, however were supportive of breastfeeding and gave my son the opportunity to attach as soon as I had come back from recovery.
Whatever your hospital’s policy, you will eventually be able to breastfeed your baby, probably sooner rather than later. It will be a wonderful chance to re-connect when it happens. Make it known that breastfeeding is a priority, and bug everyone about it until that baby is in your arms, whether it is in recovery, in your room, or after you feel up to it. Depending on your situation, it may be a while. Even if your baby had to get formula at some point shortly after birth, remember: it is rarely, if ever, “too late.”
REGARDING DRUG USE
I wanted to bring the drug issue up because I feel they are misunderstood. Before my son was born, I was convinced that he would be ruined by an epidural, and when I ended up in the O.R., I was convinced everything in the breastfeeding arena was doomed. I was convinced that if a mother used pain drugs from labor (like an epidural), a higher dose epidural during a c-section birth, or general anesthesia it would be extremely difficult, if not impossible, to breastfeed. This simply isn’t true. Yes, it may be more likely that there will be a sluggish baby with prolonged use of an epidural, but that alone isn’t going to ABSOLUTELY mean your baby can’t breastfeed.
Regarding my son. In truth, he WAS very sluggish and had difficulties, but he was also in severe distress as I pushed, did not breathe at birth, had an Apgar score of 2, and had a misshaped, blemished head from all the stress and pressure of his odd position. That wasn’t epidural aftershock, that was trauma. That’s my example. I’d love to see balanced statistics for breastfeeding difficulties after analgesics, epidurals or general anesthesia. They can’t be 100% easy to suss out because the things that bring us “to the table” (as it were), are as varied as:
- a planned cesarean birth (due to breech positioning, multiples, placenta previa, pre-ecclempsia, previous cesarean, previous cesareans plural)
- unplanned cesareans (due to sudden pre-eclampsia, distress, abruption, baby not fitting”/CPD, baby not descending, “failure to progress”, “failed induction”). Sometimes these are lumped together as “emergency cesareans”, although some are not true emergencies.
The things that happen once we are “off the table” is just as varied. Some babies are just fine, healthy and hollerin’ and ready to meet mama. Some babies are having trouble and need to be observed for as little as 2-4 minutes or as long as 24 hours. Some babies are having a lot of trouble and need to go to the NICU for a day, a week, a month, six months or more. Some babies die. All mothers need immediate surgical repair. Some mothers aren’t awake to see their baby born. Some mothers are awake. Some mothers are in-between lucid and absent. Some mothers cry and yell. Some mothers smile and laugh. Some mothers need blood. Some mothers need hysterectomies. Some mothers die.
It’s my (uneducated, some may rightly argue) belief although c-sections or pain drugs may hinder breastfeeding by delaying that birth-than-breast attachment, it is not in and of itself THE PROB.
Even knowing what I know (or, okay, feeling what I feel) about epidural use, I need to mention the dreaded GENERAL ANESTHESIA. When I was quickly wheeled into the O.R. with birth #2 (my daughter), right before I was put under, I thought, “Great, now the baby won’t breastfeed because of the drugs.” But guess what? She latched herself on my breast in the recovery room while I was still slowly, slowly gaining use of my arms. She was ready to go before I was. I did have the advantage of already having breastfed, so I didn’t have that initial ‘what am i supposed to do?’ hurdle. Still, it was like one of those videos I watched while waiting for my first child to be born, where the baby finds the way to the breast after a drug-free, “natural” birth by scooching and scooting and nudging up the mama. So that’s cool, huh? That after 2 days of dang hard labor, epidural for about 6 hours, pushing a bit before I abrupted, general anesthesia, c-section, she was doing what she was (ha!) born to do? I just need to stop and brag a second on all the supposed”doomed to fail” boxes I just exploded with the power of my breasts.
Drugs don’t mean that your baby won’t breastfeed. They just don’t. In a perfect world, we’d all have gentle, easy births with gentle, manageable labors less than 12 hours long. There are certainly reasons for avoiding epidurals, or birth by c-section if one can, but to say that they alone will make breastfeeding difficult or impossible is selling mothers extremely short.
NICU & SPECIAL CARE BOUND = MORE CHALLENGES & MORE IDEAS
Some babies born by cesarean enter with an air of emergency. Some may be whisked off to the Neonatal Intensive Care Unit (NICU) or Special Care and will not be able to spend much, if any, time with his or her mother. It is important to know that breastfeeding a baby in the NICU/Special Care is still possible!
Andrea, mother to Amity, is my sister in law. Andrea did not have a cesarean birth, but there was concern for her daughter after birth and she did a solid NICU stint. She was a full-term baby, but weighed only 4lbs 9 oz. She latched on Andrea’s breast shortly after birth and nursed well. Then things unraveled a bit. Andrea says:
Amity didn’t go into the NICU until Monday morning (she was born Sunday afternoon) because of a choking episode. She was then on an IV for the rest of the day so I couldn’t feed her that day. The following few days I was able to feed her but my milk hadn’t really come in so it was suggested that we supplement her with formula while my milk was coming in. None of the doctors were too pushy but because of her low birth weight it was recommended to try the formula. Of course I didn’t really want to give her formula, but I just wanted what was best for her and at that time I didn’t really know what WAS best for her. She was given some formula Tuesday. On Wednesday morning, when I would try to feed her, she just wouldn’t really latch on and would fall asleep. I was so scared that maybe she wouldnt ever breastfeed again! I was lucky enough to have my mom come that day and I had a lactation consultant come and talk with me that day too. She explained to me that since Amity was on phototherapy for her jaundice she was probably REALLY tired and didn’t have the energy to work for her food. She gave me some tips on how to stimulate my breast and help milk flow. I hadn’t slept AT ALL since she was born so I was encouraged to try to sleep that night. It was really difficult but I did end up geting 4 hours of sleep that night and the next day I was producing a lot more milk. Also, Amity did end up spitting up a feeding that was ALL formula so the doctors said since my milk and come in that I could just give her breast milk from then on….Of course Amity was born small but it was important for her to get what she really needed and not just gain weight for a few days only to lose it because it didn’t agree with her system.
If the baby is unable to physically breastfeed in the days after birth, a breast pump can be used to provide mother’s colostrum (the dense, nutrient rich pre-milk) to the new baby. The pump will also help stimulate mother’s milk production, and regular pumping will bring milk in effectively. Support and encouragement can work wonders.
Katherine, mother of Zane, continues:
His blood sugar was low at birth so needed to be given formula immediately (fortunately this was the only treatment required-he spent no time in the special care unit)….. Because of the initial comping with formula- I needed to increase my supply quickly to phase formula out- I had a nurse sit with my while a pumped and only gave my positive feedback- although I didn’t know it at the time the amount I was pumping was pitiful but all I got from her was “good job”, “look at it flow” “good girl”. I felt like a milk machine!
In my own experience, I needed to pump the last day in the hospital because there was concern for my son and possible jaundice. He kept testing okay, but was carrot-orange and had not pooped since his meconium expulsion during labor. My milk started coming in the night before discharge, and I pumped again the next day before I was discharged later that afternoon. Because the body’s pain response can suppress milk coming in, this may be an idea to consider.
If the separation continues, more steps may be taken to keep the breastmilk coming by tube, bottle or breast. Sandra says:
Have a milk delivery person. My milk came in at 2:30am. I was at home and my baby was in NICU. I pumped and generally dealt with the pain of milk coming in (and a fresh c-section), while my partner got up and delivered the milk to the hospital. I was in no shape to drive. What helped: directions to hospital/floor, money for parking, name of nurse looking after baby, etc. Security is tight in the NICU so call ahead (or have midwife/doctor call ahead for you) to let someone know pumped milk is arriving.
Louise, mother of two daughters, who shares so many good things in this post, says:
Formula is often used in the NICU or Special Care. It is used in other situations too: due to jaundice, weight gain problems, etc. If something happens and s/he is given formula on day one, or three or when you come home, that doesn’t mean you have to start doing formula and breastfeeding is tossed out the window. Even if you plan to continue formula, it doesn’t mean that you can’t keep providing breastmilk by bottle or breast. It’s not an ‘all or nothing’ scenario.
Jessica, mother of two boys, says:
I had both of my boys by c-section and the little one was in the NICU. I still successfully breastfed both of them. I had no problems with my first. He was a breeze once I got the hang of it. The youngest, however, could not eat for the first day because he was grunting and the NICU had him on TPN so his blood sugar wasn’t dropping and he didn’t feel like he needed to eat. I pumped for him. Only one nurse gave me a problem with that- she mixed the probiotic they were giving him with formula instead of my pumped milk. He was starting to get the hang of breastfeeding when we got transfered because they thought he had a seizure (which as things turned out was probably just a vaso-vagal episode brought on by constipation from the formula) I pumped and breastfed while he was in the NICU at Children’s hospital for tests. The nurses there were very supportive and much more knowledgeable. I really feel like they helped me to be successful in my attempt to breastfeed. Once home with the new baby my mom came over for the first week or so almost everyday to help me with the kids since I was still unable to lift my 20 month old son because of the C-section. My husband was very supportive as well, and took over diaper changes of the oldest whenever he was home. Logan has a touch of reflux as well and doesn’t tolerate formula as well either so I am VERY grateful that we were successful!
Amy, mother to Zuri, says:
I went into labor 2 months early, so I knew breastfeeding would be a challenge right from the start because my milk wasn’t in yet and the baby had come. On top of it all she was breech, so I also had a c-section.. Double hard start. Then Zuri had to stay in the hospital for over 40 days. Triple hard start! Sure she had to have formula the first few days till my milk came in. They said it could take a week or longer for my milk to come in, but it took me about 3 days because I took no breaks. I pumped every 2-3 hours around the clock (through the night as well) till my milk came in. I kept doing so for 2 months after, collecting milk in my freezer. Yes, it was hard. But what kept me going was looking at my beautiful baby girl and saying to myself… “this IS best for her. I need to do what I need to do as a mother to make sure she gets it”
My son was born 3 months premature at 1lb 4oz. We spent 5.5 months in the NICU. We breastfed for the first time at 5 months. I exclusively pumped before then. And now that we are home we are exclusively breastfeeding!
For other NICU moms..
Pump every 3 hours, including at night. Set alarms! When you get ready to chunk your pump through a wall, drop the night pumping. You CAN keep your production up long enough to start nursing. They are going to judge going home on continued weight gain. Many will want you to use bottles so they can measure intake. Tell ‘em to get over it! Diapers and weight gain can still be measured & depending on how long you pumped you maybe able to tell them how many oz they got anyway.
CONNECTING & RECONNECTING
One of the most helpful things we can do as mothers is give ourselves over to holding our babies as much as we can, and offering the breast as often as possible. The most helpful advice I ever received about breastfeeding was to spend the entire first day of my son’s life doing skin-to-skin contact. Also called kangaroo care, skin to skin contact helps organize mother and baby and stimulate oxytocin, the love hormone. It helps mother feel a connection to her baby, if there was a bit of a disjointed feeling there. In my own experience, holding my son skin to skin was the only thing that really helped me feel better, physically and emotionally. His head was in rough shape from his odd position while I pushed. He had trouble getting latched, staying latched, staying awake. He hated having his head touched and would sort of shut down when I held his head. This sounds nuts, but it’s true. It was nearly a month before a IBCLC Lactation Consultant told me that some babies who have abnormal pressure and trauma to the head can have “disorganized nerves” in the face or head. No one will no for sure if that was true in our case, but it really, really rings true for me. I had problems nursing him that I never had nursing my second child, who did not go through the same experience.
Andrea, mother to Amity ,shows the power of skin-to-skin contact at a time when her daughter was being evaluated due to her her low birth weight. Down’s syndrome was suspected at that time, but Amity eventually tested negative.
On Sunday night, after Amity was born, a (hospital staff) doula came in and showed me how to do the kangaroo hold/skin to skin contact and Amity fed for an hour! This was when we thought Amity had Down Syndrome. and the doula told us not to go down a path we don’t have to. Wait until you hear those results to really go down that path. Thinking about that now, it was really great advice. When the doula looked at her she didn’t think she had Down’s but either way she thought she could be successful at breastfeeding. Amity had latched on soon after she was born and when the doula showed me the kangaroo hold–with the skin to skin contact, she told me that when Amity was hungry she would root around and sure enough she did!! I think those two bonding moments went a long way so that when Amity went in the NICU and we had our breastfeeding setback with the formula we had already established that she could breastfeed. All things considered Amity is just a pro at breastfeeding. She has been from the start and I feel so blessed!
POSITIONING AND PILLOW TALK
You need pillows. You need a lot of ‘em, especially in the first few days. It’s good to have a boppy pillow (or its non-slip competitor, my brest friend, although I fear the snapping strap would be uncomfy with a c-section – I’m curious what other c-birth mamas think). A nursing pillow is a good thing to have around anyway, but if you had a c-section birth, it becomes so necessary that it may follow you around in the car for a while. It really is great for positioning baby just right. Have someone buy you one if you didn’t get one at a baby shower. You’ve earned it, lady.
Make sure every bit of you is supported. Here’s what I did if I was in a deep, lay-z-boy style chair. Firm pillow behind my back, firm pillow behind my back, baby on the boppy, boppy on another firm pillow, pillow on my lap, pillow under each arm. That’s if I was doing cradle hold (across the body). With my son, I could only do the football hold due to the pain on my abdomen. Then it was like, back pillow, neck pillow, boppy + another pillow, pillow under my arm with baby on pillow. Plus pillows on the side of me.
Nursing lying down will change your life, and c-section birth moms may want to attempt as soon as they good latch going. With my son, I mastered this around 6 weeks, when I was (mostly) healed. With my daughter I did it faster, but that was only because I had been doing it for a year and a half beforehand. It really will take pressure of the incision and help you rest, which is so needed. But it can be awkward and tricky for a while. Have patience and keep trying. It will eventually click and be awesome.
WALK, REST, TAKE CARE OF YOURSELF, TAKE YOUR MEDICINE, GET HELP
I talk a lot a lot about physical and emotional c-section birth recovery here, so please read because the postpartum period is rocky and you need all the info possible.
Amy, mother to Zuri, says:
Yes, the c-section is hard to deal with, but I found getting up and walking as SOON as possible to be helpful. Whenever you feel down just look at your baby and you will feel better. Hold your baby as much as possible. I wasn’t able to but this helps a lot with milk production. I hope this helps. There is success at the end of it all. My baby is not 10 months and has not had formula since and latches like a sure pro!
Andrea, mother to Amity, says:
TRY — even though it is the hardest thing when you are emotional and stressed — to get some sleep and drink plenty of water. That will help your milk supply to come in too.
Sandra, mother of two, says:
Know that if you can’t get baby on breast right away, all is not lost. I couldn’t get my first baby on for 2 weeks after a c-section and we still went on to nurse for almost 19 months. I point this out because a part of me was like “why bother I didn’t get baby on within an hour?” It can still happen even when situation is not ideal.
LET’S DO THIS.
These are my stories, the stories of others, our ideas in type transmitted into the internet void. Of course it doesn’t make them gospel any more than anyone else’s idea or story about birth, breastfeeding, formula feeding, parenting, any of that. I just really, really needed to write up what I “know” and feel. Mostly because I really, truly believed that if I had a c-section that everything would all apart and I would never be able to breastfeed or properly care for my baby. Where I learned that, I don’t know. You know what I doknow? I wanted to breastfeed my baby. I had plenty of chances to quit. I had plenty of reasons to quit. And you know what? I didn’t. I wanted to breastfeed my baby. The only time I really, really, really wanted someone else to “take care of it” was when my husband had surgery to remove his cancerous thyroid when I was THREE FRIGGEN WEEKS POSTPARTUM. I was wiped that day, and then a few weeks later when he had radioactive iodine and we had to be separated for a week so he wouldn’t wreck our newborn’s newborn thyroid – that’s another time I was on the fence, wanting “someone else to do it.”
But I didn’t have any formula in the house, so I guess I had to do it. But like I’ve said in other posts : only the mama can nurse her babies. Only the mama. Yes, some other people can deliver the baby surgically, and grab that golden thread of glory in the final hour. But in the afterglow, there’s the sore, sutured mama trying to latch that baby on with like 64 pillows surrounding her, awkward positioning she hadn’t panned for, hadn’t practiced with a doll. There’s that lady, holding the little 5, 6, 7, 8, 10 pound wonder. There’s that sore-bellied mama, doin’ her thing.
Other people can put the newborn baby in an isolette, hook her up, help her breathe, keep her warm and help her live. But on the outside of the plastic, out of the beeping, dim room, there’s That Baby’s Mama. There’s that Mama, visiting her Baby in the NICU. There’s that Mama shuffling back to her room or back to her car, back to her house, to hook herself up to a hospital-grade pump, squelching away for her Baby.
At the end of the day, it comes down to us. Not everyone nurses their baby, or can, or wants to, or should. But truthfully, with support and help, most of us can. It isn’t easy to deliver the milk, especially the first few weeks. You will want to give up a billion times, especially if you are sore. Especially if you are separated from your baby.
And yes, really, it is one tiny bit of our mothering story. That’s true.
But for a few days, weeks, months, years, we as mothers can deliver something to our new child something no other person can. Our milk. Your doctor can’t do it. Your husband can’t do it. Your partner can’t do it. Your boyfriend or girlfriend can’t do it. Your parents can’t do it. Your friends can’t do it. Your boss can’t do it. Your day care provider can’t do it. Your child’s future teacher can’t do it. No one can. No one but you. There is no other expert. There’s just you and your baby. In a chair. A lot.
The thing that differs between birth and breastfeeding is that birth only happens, really, for a few minutes when the baby comes out, however s/he comes out. With breastfeeding, if something goes “wrong” or someone “can’t do it” or “it’s too hard”, the baby has to eat like 2 hours later and it’s time to try again. There is a huge opportunity to heal offered here. Just because one portion of this making-a-newborn-baby plan didn’t go perfectly smooth doesn’t mean you can’t keep going and power like hell after part B of the baby plan. Breastfeeding is awesome for many reasons, but a huge reason is that there are many, many, many people to help you.
Certified Lactation Counselors
Websites – especially kellymom.com
Your mom, sister, sister-in law, mother-in-law, friend, old co-worker, neighbor.
ACCEPT and ASK for help. It really does make all the difference. You do not have to go through the bumpy times alone. You need someone to call that will say “You can do it!” Cause you can.
You don’t have to figure it out alone. Yes, it’s really hard to figure out at first. Yes, it is very draining when you have other unexpected challenges thrown at you at the final hour, be it a c-section, a baby whisked to the NICU, an awful tear. But that’s part of what this parenting gig is about. Doing something that’s really hard, and really uncomfortable (heck, downright painful to start, for many people) that you’ve never done before — at least not with this kid.
There’s space to learn. And fail. And learn. And grow. And fail & learn some more and try again. There’s help, if one accepts it, or seeks it out. Providing breast milk to your wee one is one part of the journey. One that you can do clumsily with great difficulty for a while. And then, suddenly, it becomes graceful and easy. Parenting is hard and easy exactly the same way. We stick it out when it gets tough, even when it is unexpectedly way more difficult than we thought. We can persevere. We can ask for help. We can keep going when we don’t want to keep going anymore. Like Rosie the Riveter once claimed, We Can Do It. Bring it, baby. Bring it.
I’m wrapping up the See Birth series today at long last! If this is the first installment you have read, you can go read about my own thoughts and experiences here, read my advice for planning (just in case!) for a cesarean birth here. I was also lucky enough to have two contributors, Leslie and Louise, share their stories and advice. Thanks also to the ladies in this article: Amy, Andrea, Jessica, Katherine, Krysta and Sandra. More stories and discussion can be read in the comments area on this post. Please, if you have anything to share that you learned with a NICU baby or c-section birth, share!