Women who give birth via c-section are statistically less likely to breastfeed. So does delivering via a cesarean negatively affect a women’s breast milk supply? The short answer is no.
Women who give birth naturally or via cesarean have the same hormonal shift that prompts a woman’s breasts to start producing milk. While the biological process is the same, postpartum care often differs. Less skin-to-skin contact, a delayed start to breastfeeding and added postpartum stress may lower a women’s breast milk supply after a cesarean.
The good news is that women who are committed to breastfeeding after a c-section can address and account for all three potential stumbling blocks.
The process of breast milk production begins in the first weeks of pregnancy. (This is why aching, tender breasts are notoriously an early clue of conception!) When an embryo is just 6-weeks-old a rush of estrogen causes current milk glands to swell and grow. As estrogen and progesterone levels rise in pregnancy so do the number of milk ducts found in a woman’s breasts.
By the time a woman’s due date rolls around the ducts in her breasts have been producing colostrum for weeks. (Pregnant women might notice a stain in their bra from their breasts leaking drops of colostrum each day.) The hormone prolactin uses protein, sugar and fat from blood supply to produce colostrum and eventually breast milk. However, the estrogen and progesterone produced by a baby’s placenta keep prolactin levels low.
Once the placenta has been delivered (whether vaginally or through cesarean) a woman’s estrogen and progesterone levels immediately drop. This allows prolactin to shift into overdrive and begins the production of breast milk. On average, milk production surges three of four days after delivery.
From a hormone standpoint, mothers who delivery via c-section receive the same biological cues as mothers who deliver vaginally. So why are fewer cesarean babies breastfed? The answer lies in postpartum care.
Skin-to-skin in the first 90 minutes of life after a cesarean birth dramatically reduced formula supplementation, as found in a 2011 study published by the US National Library of Medicine.
“Healthy infants born by cesarean who experienced skin-to-skin in the operating room had lower rates of formula supplementation in the hospital (33%), compared to infants who experienced skin-to-skin within 90 minutes but not in the operating room (42%), and those who did not experience skin-to-skin in the first 90 minutes of life (74%). We concluded that skin-to-skin contact was feasible after cesarean and could be provided for healthy mothers and infants immediately after cesarean birth. Perinatal and neonatal nurses should be leaders in changing practice to incorporate early STS contact into routine care after cesarean birth.”
Mothers who wish to breastfeed should prioritize this special time by working with their hospital and doctors to ensure that they can safely bond with their baby immediately after delivery. But, it’s not easy to change a common medical procedure.
Dr. Sarah Francis, OBGYN from Asheville, NC outlines her care plan for keeping mothers and babies together after a cesarean birth:
While it might take effort to get your medical team on-board, the result speaks for themselves if you want to boost your milk supply after a cesarean birth.
A study published in the American Journal of Obstetrics and Gynecology in 2004 found that while breastfeeding initiation rates were lower in cesarean births, at 3 months and 24 months after delivery, breastfeeding rates seemed not to differ by mode of delivery.
This indicates that fewer mothers who have a cesarean birth try to initiate breastfeeding but those who do have the same success rate as women who undergo natural deliveries. (It should be stated that several factors could obstruct breastfeeding after a cesarean birth. If a mother is not physically able, HIV positive or if her child requires specific medical attention then breastfeeding should not be prioritized over a care plan put in place by medical professionals.)
But for the majority of cesarean babies, a separation from mother and the immediate use of infant formula supplementation may be the cause for lower breastfeeding rates.
Breastfeeding Basics covers the advantages of breastfeeding for cesarean mothers stating:
“Nursing as soon as possible after birth has advantages for mothers who have had cesareans just as it does for mothers who deliver vaginally. It promotes bonding, provides stimulation to bring the milk in sooner, releases the hormone oxytocin to help the uterus contract, provides the baby with the advantages of colostrum, and takes advantage of the fact that the newborn’s sucking urge is strongest in the first couple of hours after birth. There is an extra advantage for the cesarean mother: nursing during the brief period of time before the regional anesthetic wears off provides a time of pain-free, more comfortable nursing during the baby’s first feedings at the breast.”
Stress exacerbates most medical issues and breastfeeding is no different. Both physical and mental stress has been shown to inhibit the release of oxytocin (the love hormone) that allows a woman’s body to relax and produce milk.
In 1989 the American Academy of Pediatrics published a study conducted by the University of New Mexico that focused how stress negatively affects breast milk output. Their study found that after one week of enrollment, mothers listening to an audiotape with relaxing music and visual imagery produced 63% more breast milk than a randomized control group without relaxing stimuli. This study found that fatigue and stress negatively affected lactation and milk production.
Even in the best case scenario a planned cesarean is still major abdominal surgery. Considering many women undergo unplanned cesareans after traumatic or high-risk labors it’s no wonder that stress is at an all-time high.
Here are specific solutions for lowering stress after a cesarean delivery:
1. Allow your body to heal. That means not pushing yourself to get up too early and resting as much as possible after delivery. Work with your doctor to find a breastfeeding-safe pain medication. Responsibly managing your pain will lower overall stress.
2. Find your happy place. Listen to relaxing music, enjoy a hot mug of tea or use essential oils to put you in a relaxed mood before nursing or pumping.
3. Lean on your support network. Line up a network of people to help out in the days following your cesarean. Even if you plan on delivering vaginally it’s a good idea to think through who you could lean on if things don’t go as planned.
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Folate and folic acid play a vital role in embryo development, healthy pregnancies, and infant survival rates. Up to 50% or more of neural tube defects could be prevented with proper folic acid supplementation prior to conception, reports The American Academy of Pediatrics. Read more about this important micronutrient for women of childbearing age and learn the recommended daily intake as well as foods that provide folate.