Early Initiation Of Breastfeeding After A Complicated Birth
UNICEF and the World Health Organization recommend exclusive breastfeeding in the first six months of life starting within the first hour of birth. Looking at the South African statistics on caesarean sections, it’s important to consider how we can help with the early initiation of breastfeeding after caesareans and complicated births.
Early initiation of breastfeeding is the key to a successful breastfeeding journey but so often mothers are separated from the baby in this critical time. Putting the newborn to the breast within the first hour will give the baby the best chance to survive, thrive and have a successful breastfeeding journey.
Having a caesarean section or a complicated birth can play havoc with the breastfeeding relationship and may lead to disappointed and frustration in the mother. Mothers often feel like failures and that their body has failed them. They might be scared that their body will fail them with breastfeeding. Mothers need to be reassured and receive help because breastfeeding can be successful.
Initiation of breastfeeding might be problematic after these births for various reasons, many of which are totally out of the control of the mother’s hands. Separation often happens after a C-section or complicated birth, due to hospital policy. Mothers need to be educated beforehand and know to ask for their baby to be placed skin-to-skin. Mothers must be informed to insist on zero separation. This is their right!
These babies are also often drowsy and lethargic after these births, which can affect suckling. (Even an epidural or spinal may influence the sucking reflex of the baby.) Inform the mother about the effects. If the baby is a little lazy to suckle, gently massage the palm of the baby’s hand or stroke his cheek. If the baby doesn’t want to drink within an hour, the mother should start to hand-express in a teaspoon, or do colostrum catching with a syringe and hand expressing. This can be given to the baby. Because of the small volume and stickiness of the colostrum, a breast pump is not the answer.
Mothers should encourage Baby to stay alert during feedings, and feed often and on demand (eight to 12 times in a 24-hour period). Try to keep the baby skin-to-skin, which will keep him warm, keep his blood sugar up and help the initiation of breastfeeding.
Ditch the newborn hat when baby is in skin-to-skin because the mother must smell her baby. The olfactory sense after birth is extremely sensitive, and smelling her baby will cause Mom’s oxytocin or love hormone to increase, helping with milk supply.
Find a position that is comfortable to feed from. The laid-back method is usually a very easy way to get the baby to the breast even after a C-section. Get Mommy to lie at a 45-degree angle with the baby’s stomach on her stomach. Baby will bob his head round, and when the chin touches the lower part of the areola, he should open his mouth wide and start sucking.
Moms can also feed in a side lying position. The mom lies on her side with Baby next to her tummy, tucked into the mother’s contours. Place Baby’s chin underneath the nipple or areola and wait till the baby opens his mouth wide. As soon as he opens his mouth wide, the nose will go over the nipple, pointing slightly upwards and generally a nice deep latch will be achieved.
Mothers who’ve had complicated births may need pain medication, and this also influences the baby’s sleepiness. Inform the mom to drink only as much medication as needed to keep the pain at bay.
If the mother is a smoker, she must be informed about the risk smoking imposes on the baby. If she is receiving any pain medication with codeine, she needs to be informed that smoking enhances the effect of the codeine on the baby through the breast milk and she should look out for extreme sleepiness.
If mothers are struggling or their nipples are sore, they must contact a certified lactation consultant to help with whatever the problem might be.
A C-section or a complicated birth does not mean the mother can’t breastfeed. With skilled help and persistence, she will be able to breastfeed successfully even if it is a rocky start. The most important things to remember are:
- Do skin-to-skin as soon as possible after birth and continue doing skin-to-skin as much as possible in the days and weeks following the birth
- Start massaging the breasts and hand-express within the first hour if Mom and Baby are separated
- Feed the baby the colostrum with a syringe or a teaspoon
- Be positive!
Author: Hettie Souman Gove, Midwife and South African Certified Lactation Consultants (SACLC) educator, International Board Certified Lactation Consultant