In the United States, nearly one in four births is a cesarean birth. Many of these cesareans are unexpected, so it is a good idea for the expectant mother to become informed and educated about the procedure before her baby arrives.

An operative birth versus a vaginal birth can impact the breastfeeding experience in several ways. Initiation of breastfeeding is often delayed, because mothers who have delivered via c-section often need some extra time to recover before they physically feel like nursing. As soon as they are fully conscious and alert, they can begin breastfeeding. Mothers who have epidural rather than general anesthesia are generally able to nurse sooner and for a longer period of time initially.

Nursing as soon as possible after birth has several advantages. It promotes bonding, provides stimulation to bring the milk in sooner, releases oxytocin to help the uterus contract, and provides the baby with the important immune factors in the colostrum. 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.

Babies born via c-section may be somewhat drowsy due to the exposure to anesthetics during labor. This may mean that the milk may take a little longer to come in than it would after a vaginal birth, and the baby may need extra stimulation in order to stay alert during early feedings.

Both the antibiotics and the medication used for pain relief after a cesarean are safe for nursing mothers. Although these medications do pass into the milk in very small amounts, the volume of colostrum or milk produced during the first few days of nursing is small, so the amount ingested by the baby is minimal. Mothers should be encouraged to take whatever medication they need in order to stay as comfortable as possible in the post-operative period.

Since antibiotics are routinely given after cesarean birth, mothers may develop not only a vaginal infection, but yeast may also be present in the baby's mouth or diaper area, as well as on the nipples. Mothers should become familiar with the symptoms and treatment for yeast so that if the problem does develop, they can treat it promptly.

Mothers who have had surgical deliveries often find it difficult to find a comfortable position in which to nurse without putting pressure on their incision. If epidural anesthesia is used, they are usually awake during the birth and can nurse on the delivery table. In this case, they will need help in positioning the baby because they will be nursing on their backs and one or both arms may be restrained due to the placement of the IVs.

The side lying position is often preferred during the first day or so after surgery. A rolled up towel placed behind the baby can help keep him from pulling off the breast as he relaxes during the feeding, and a towel next to the incision can protect it if the baby kicks. Putting a pillow under the knees can help reduce the strain on the stomach muscles and support the back. Side rails can be used to help the mother roll over when she is ready to offer the other breast.

The football hold can be a more comfortable alternative to the traditional cradle hold. If the cradle hold is used, the baby can rest on a pillow that covers the tender incision.

It is just as important to make sure the baby is latched on correctly after a cesarean birth as it is after a vaginal birth. The mother should make sure that the baby opens wide and latches on well behind the nipple and not just on the tip.

If she knows that she will be delivering via c-section before the birth, the mother can make choices in advance that will facilitate breastfeeding. She can choose a hospital that has policies supportive of breastfeeding, such as not routinely giving bottles and allowing rooming in. She will need extra help in caring for her baby, so she should investigate the option of a private room that allows a family member to stay with her and the baby around the clock.

Some hospitals have policies that require that babies born via c-section spend the first 24 hours in the nursery under observation. If the hospital has such a policy, and the baby is healthy, she can discuss the possibility of waiving this requirement with her doctor. If the baby has medical problems that require observation after birth, she should ask about the availability of electric breast pumps on the maternity floor, and pump as soon after birth as possible and every couple of hours after that. Pumping will help stimulate the milk supply, prevent engorgement, and provide valuable colostrum that can be fed to the baby in the nursery until mother and baby can be together again.

Mothers can also discuss the options of general versus regional anesthesia. Even if general anesthesia is used and putting the baby to the breast is delayed, there is no reason that the mother and baby can't make up for lost time once they are together.

The hospital stay will be longer after a cesarean delivery. The mother should use this extra time to get help with finding a comfortable position to nurse, and get as much rest as possible. Once she returns home, she should set up a nursing station with all the supplies she needs in one place. She should try rest, limit visitors, and take advantage of family members and friends who offer to help. There is no reason that she can't nurse her baby successfully and for as long as she wants, even though she will have to overcome some additional challenges in the beginning after a cesarean birth.