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advice and support please

Posted by on Mar. 16, 2007 at 1:07 PM
  • 9 Replies
hi everyone,

i am due to have my 2nd child via c-section on 4.19.07.  i really want to breast feed this baby.  i did my best with my son, but unfortunately he was in the NICU for 3 weeks due to Merconium Aspiration Syndrome, and I was in a very deep depression due to that.  I was at the hosp all day everyday and breast fed as much as possible but they did supplement with formula.  once he came home i breast fed for a month but then decided that it was becoming that that's all i did and decided to feed him formula.  i don't know if i wasn't producing enough or he was satisfied enough it seemed.

Anyway, I really want to give this my best try again this time around.    i plan to breast feed and pump as well.  i just don't want to get totally frustrated and tired and give up.  with having a soon to be 3 year old and an infant i'm thinking will I ever get to rest?  i really need to as much as I can, especially after have a c-section delivery, and with breast feeding they eat more frequently.  I would like to know if anyone can offer some advice and support on this situation.  also would like to hear if anyone has breast fed after a c section and how that worked out.  one more thing, if anyone has toddlers as well as infants i would like your opinion and advice too.  what do you say to your toddler about the way you fed your baby?  i guess thats part of the reason i want to pump also.

have a great day everyone............hope to hear from you all.   TraceySmile 
by on Mar. 16, 2007 at 1:07 PM
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by on Mar. 16, 2007 at 1:20 PM

Nursing after a Cesarean Birth

By Kelly Bonyata, BS, IBCLC

These are a collection of suggestions for nursing after a cesarean birth. You can do it!

Educate yourself and arrange for breastfeeding help

Find a La Leche League group near you! Try to attend at least one meeting before your baby is born. Ask questions!

Talk to the lactation consultant (LC)--assuming your hospital has one on staff--and ask that she meet with you as soon as you get out of the operating room. She can help you position your baby as painlessly as possible. If an LC is not available, ask one of the nurses and/or have your partner or another helper available to help out.

What about anesthesia and medications?

The anesthesia and any pain meds you are given should not affect your milk. There are many pain meds that are compatible with breastfeeding, so be sure to ask your doctor for one that is commonly used for breastfeeding mothers.

Do try to use medications only as needed, to reduce the amount of sleepiness in you or your baby. Excess sleepiness can make breastfeeding challenging in the beginning. Here are suggestions for waking a sleepy baby.

A low grade fever in the mother is common during the early days after a cesarean birth, and should not be a reason to separate the mom and baby. As long as the mother washes her hands well before touching the baby, there is no reason for separation, even if the mother has an infection.

First nursing after birth

If possible, the time immediately after your baby is born is a great time to start breastfeeding. You will still be under the effects of the spinal/epidural and probably not yet feeling any discomfort. You will likely have to nurse lying on your back, because of the epidural. Since one arm may be restrained, it may get a little tricky. Try positioning baby lying face down across your breasts (similar to cradle hold, but baby is higher up and away from your incision, and mom is lying flat). When nursing in this position with a newborn, have someone nearby to make sure baby's nose doesn't get blocked, since you both may be groggy from the meds. Have your partner or a nurse help position the baby, and use lots of pillows around you to help with support.

Nurse early and often

Ideally, you'll want to put your baby to breast within the first hour, but definitely no later than the first 4-6 hours. Studies show that when time to breast is longer than this, babies have more difficulty breastfeeding and engorgement is more severe. If something prevents the baby from being put to breast within the 4-6 hours, you should begin pumping with a hospital-grade breastpump.

Breastfeeding at least every 2 hours during the day with a nighttime span no longer than 4 hours is highly recommended--you're aiming for 10-12 feedings per 24 hours during the early weeks. As long as baby is nursing well, there should be no need for any supplements of any kind (i.e. formula or sugar water).

Nursing positions

Once you can turn over, try turning to one side and nursing in a side-lying position (see below). Have your partner or a nurse help you with positioning pillows.

Another position that may be more comfortable is the football hold. Sit somewhat upright in the bed and place the baby on a pillow, between your arm and your side, with your hand cupping the underside of his head.

You may find at first that it’s difficult to find a “comfortable” nursing position. Try experimenting as much as possible to get the most comfortable position, and don't hesitate to ask for help getting positioned from your partner, nurses, or the hospital lactation consultant. Whichever position works best, make sure the baby's tummy is towards you. You might want to bring a few extra pillows from home (or a nursing pillow), as hospital pillows are pretty small and flat.

Many moms find the side-lying position the most comfortable during the first day or so. It’s an easy way to nurse and rest at the same time. Using a small blanket, or pillow - even a rolled up towel - can help protect your incision while you nurse lying down.

Below are step-by-step instructions on getting into the side-lying position (in a hospital bed) after a c-section:

  1. Begin with the bed in a flat position and side rails up.
  2. Use extra pillows behind the mother's back for extra support.
  3. Carefully roll to one side while grasping the side rail and relaxing the abdominal muscles. Move slowly to avoid strain.
  4. To protect the incision from the baby's kicking, cover the abdomen with a small pillow or towel.
  5. Place a pillow between the legs to minimize the strain on the stomach muscles.
  6. Lean back into the pillows behind the back.

When using side-lying position, baby should be placed on his side, facing your body, chest to chest, so he doesn’t have to turn his head to nurse. Baby’s feet should be drawn in close to your body with his head either lying on the bed, or on your arm, whichever feels most comfortable to you. You can either roll your body forward to latch, or pull the baby toward you.

(Thanks to Kathy Kuhn, IBCLC for these tips)

Avoid supplements

Be sure to let the hospital staff know they shouldn't give any supplemental bottles or pacifiers, as these artificial nipples can cause problems with breastfeeding. If you are told that supplements are medically necessary, request that they be given via cup or feeding syringe rather than a bottle to avoid the risk of nipple confusion.

You can request that your doctor provide written orders that the baby is to be breastfed, and have no artificial nipples of any kind (no pacifiers or bottles) and that IF supplements are medically required, they should be given by an alternative method rather than by bottle.

When will my milk come in?

The abrupt hormonal shift that occurs at the separation of the placenta from the uterus is what signals your milk to come in. Thus mom's body will get the same signal whether she has a cesarean or vaginal birth. Moms who have stressful births (cesarean or vaginal) tend to have their milk come in a little bit later.

Your milk may come in anywhere from day 2 to day 6 (usually around days 2-3). If your milk is slow coming in, try not to worry, but put baby to breast as often as possible and stay in contact with your lactation consultant so she can monitor how baby is doing. Using these tips on how to be sure baby is getting enough milk will also reassure you. Baby can do quite well on colostrum alone in the early days, as nature intended.

To encourage an abundant milk supply:

  • Nurse as soon after birth as possible. If something prevents the baby from being put to breast within the 4-6 hours, you should begin pumping with a hospital-grade breastpump. Get the okay from your doctor/midwife ahead of time to nurse your baby in the recovery room - this shouldn't be a problem unless you or baby are having medical problems.
  • Nurse frequently. Breastfeed your baby at least every 2 hours (from beginning of nursing to beginning of the next nursing) during the day, with no more than 4 hours between nursings at night. You're aiming for at least 10-12 nursings per 24 hours. More frequent nursing results in greater milk production at one week and thereafter.
  • Avoid unnecessary supplements. Do not supplement baby with anything (formula, water, etc) unless it is medically indicated. Supplementing will do two things - missing feedings will reduce breast stimulation and milk removal (both needed to increase milk supply), and babies who are supplemented tend to need to eat again later than if they had nursed - so again you're losing much-needed nursing time.
  • Ensure that baby is nursing well. If baby is not latching well and transferring milk well, then it can affect milk supply and the speed that your milk comes in.

Going home

If all is going well, some moms prefer to ask for an earlier discharge so they are not at the hospital an extended length of time. If you do this, be sure that you have some help at home, and try to get as much rest and nourishment as possible - especially fluids. Do see if there is a lactation consultant (IBCLC) at the hospital (or another local lactation consultant) who will make at least a couple of home visits to be sure all is going well with breastfeeding, and help you (if necessary) to fine-tune positioning and latching.

Get help around the house postpartum. If possible, have your partner take a few days to several weeks off work (as much as you can afford!) to help out. You won't be up to housework at ALL at first. Even accomplishing basic tasks for your own and your baby's needs will be tough. This is major surgery.

Your body will need time to recover. If taking time off is not an option for your partner, look into getting others to help. Do you have friends or family who can check in on you? Someone to help with the laundry, dishes and cooking? Can you pay a professional to clean up once a week (this will make you feel better)? You could hire a local 13+ year old to help out. Ask at church (if you attend), your local school, or even your local Girl Scout troop. It will be very helpful if you can find someone who can come for an hour or two every afternoon to do dishes, laundry, straighten up, and maybe even keep an eye on the baby while you shower or potty or nap.

by on Mar. 16, 2007 at 6:40 PM
My examples are a bit different then your situation... My sister-in-law had to have an emergency c-section with her daughter but she went on to successfully bf afterwards, just make sure you have lots of support and know that it is the best gift that you can give your child. When my son was 3 weeks old I had to have my appendix removed I was in so much pain afterward and I had to pump-n-dump for 4 days post surgery... but I was determined to continue breastfeeding as soon as I was able. My husband really helped me out and I had a great support system that let me know how important it was for my son. I only have one child so I can only imagine how difficult it is to manage two at a time. I feel like I'm always feeding my little guy... my mom gave me some good advice for my next one though... she said when I was born and she was breastfeeding me my brother who was a little over 2 years old would just play with his books or toys while she was feeding me and he would even cuddle with her while I was eating... just make your son feel like he's helping you take care of the baby. Good luck!
by on Mar. 16, 2007 at 6:44 PM
Having support is the biggest thing, I was able to bf my daughter where I wasn't my son mostly due to support and knowledge.  I plan on nursing when my third comes in October via c-section.
by on Mar. 16, 2007 at 8:40 PM
Just know all you will due is breastfeed. My daughter was attached to me for months it felt like I was always nursing her. Its just something you have to deal with. I know its hard but you just have to push through its worth it.
by on Mar. 16, 2007 at 9:24 PM
I breastfed both of my kids.  My oldest is 3 and I breast fed him for 12 and 1/2 months.  My youngest is going to be 1 on the 23rd, and I'm still nursing her.  I just told my son when I was feeding her that she was eating.  He really didn't ask too many questions about it.  (He was almost 2 1/2 when she was born)  Now he really could care less. 

The only thing I can tell you is to not give up.  I felt like nursing was all I was doing, but after about a month they both got into a pretty good routine, and ate at more predictable times.  Just don't be afraid to call your local lactation consultant, they did a wonder with me and my son.  We both learned from them. 

Nursing was and is the best thing I could have ever done for my kids.  Please try your best to do the same for yours.
by on Mar. 17, 2007 at 2:37 PM
I had c-sections with both my children and nursed both of them.  So I personally don't know if it's a lot harder than nursing after a vag birth.  All the books say it is. 

I didn't have too much trouble nursing.  In the very begining it was hard to get the baby into position because the incision hurt.  But that was mostly in the hospital where I had the nurses to help me.  It was getting better by the time I went home.  Finding a comfortable postion was my biggest problem. 

Having good support is the key.  You'll probably want someone around to help for the first few weeks after you come home.  Even if you weren't nursing you would still need the help taking care of both kids while you are recovering.  Make sure that all of your helpers know that you want to nurse.  Tell them that you may need to vent sometimes and that you may even say you want to quit. (almost every mom has said that at one point or another)  Ask them to try to be supportive and not say things like "do you want me to go out to buy some formula"

As for your older son, don't worry about what he will think.  Just tell him that baby is eating.  You can make up a cute name for nursing if you like.  We call it nummies.  I tell my daughter "Ok the baby is hungry, it's time for her nummies."  Most importantly, don't try to hide it from your son.  If he gets the feeling that it is something wrong or shameful, he'll feel like he should be ashamed too.  Kids can pick up on these things easier than you think.  Even if you never say anything bad about nursing, he will be able to tell if your body laguage is saying something different.
by on Mar. 17, 2007 at 3:39 PM
Hi There,
I can't imagine how hard it would be to have a c-section. I can say that I have a 3 yr old and an 8 month old who is breastfeeding, and it is completely managable. You need a good pump if you are going to pump milk, first off. Try to get an electric one, Medela. It was nice in the beginning to be able to pump so that others can feed the baby while you give you older child attention while they are getting used to a new one in the family or so that you can take a well deserved break. After a few months my older one could care less that I was breastfeeding as long as he was occupied with doing something. Don't stress, seriously. With my first I wouldn't do formula. With my second I always had a can around the house so that in somewhat rare cases if someone needed to give Hannah a bottle and there was no milk expressed we would make her up a bottle of formula. You will get through it! Jessica
by on Mar. 17, 2007 at 3:53 PM
It is completely do able.  I breastfed both my children after c section it is just a matter of finding a position that works for both of you.  As everyone else said you will be nursing often and that is just the way breast feeding is.  My boys are almost exactly three years apart.  I started to read to my older son when I was nursing and playing easy games.  Just anything to keep him busy.  And if necessary find a tape or show that your older child loves to keep them occupited or if you just needs a break.  We also loved family naps when I first got home.  Relax and you will find what works for you.  also look into the pograms for your older one to do so that he has something special.
by on Mar. 17, 2007 at 8:56 PM
My mom breastfed all of my siblings. When my brother was born, my mom would have me sit next to her and "help" feed my brother. She would tell me to rub his feet and such while she fed him. I was about 4 at that time. I dont have a toddler, so i cant say too much, but you will get it figured out. If you do pump, pump at the same times everyday. I take warm baths with my lil one if i am running kinda low, that always helps me fill 'em up! good luck!
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