Breastfeeding After a Caesarean

The first hour, if you can have it

The HSE's opening instruction is the same as for any birth: "Have skin-to-skin contact as soon as possible after the caesarean birth." That is often possible in theatre. Your arms are usually free, and the anaesthetist and midwife can settle your baby on your chest above the drape while the surgery is completed.

NICE's guideline on caesarean birth covers early skin-to-skin and support with feeding as part of routine care, so this is something to ask for rather than something to hope for. Put it in your birth preferences even for a planned caesarean — especially for a planned caesarean, in fact, since there is time to discuss it in advance.

If you are unwell or your baby needs help with breathing, skin-to-skin can happen later, or with your partner first. Tommy's notes that the first couple of hours is when babies are often most alert, but a delayed first feed is not a lost cause.

Positions that keep weight off the wound

This is the practical heart of it. The HSE names three: "The laid-back position, side-lying position or football hold are good breastfeeding positions to try."

Side-lying is often the most comfortable in the first day, because you are not holding your baby's weight at all and nothing rests on your abdomen. Tommy's notes that in many UK hospitals you are positioned on your side once you are moved back onto the bed after a caesarean, with your baby tucked in beside you — which is already the position.

Rugby ball, or the underarm hold, tucks your baby along your side with their feet behind you, so their body never crosses your scar. It is the classic caesarean position for sitting up.

Laid-back feeding works if you recline enough that your baby lies diagonally across your chest rather than on your belly. Drape them away from the wound rather than over it.

The cradle hold is the one that usually hurts, because the baby's legs land exactly where the incision is. A folded towel or a firm pillow over the wound gives useful protection if you want to use it.

Getting into position when you cannot move easily

Ask for help lifting your baby. Tommy's advice is specific: ask your midwife to help you position yourself and lift your baby out of the cot on the first day, and gather plenty of pillows and towels before you start rather than mid-feed.

Practical asks that make a difference: a bed that can be adjusted electronically, a side-car cot if the ward has one, your baby's cot on the side you can reach, the call bell within reach, and water and snacks where you can get to them one-handed. If your partner can stay, night one is when that matters most.

Pain relief and breastfeeding

Untreated pain is itself a barrier to feeding — it stops you positioning well, and it interferes with the let-down reflex. The HSE's reassurance is that "you can take most commonly used medicines during breastfeeding", that "the medicines you take pass into your milk in very small amounts", and that medicines given in hospital are checked to be compatible with breastfeeding.

We do not give medication advice on this site. If you are unsure about a specific painkiller, ask the ward pharmacist, your midwife, or a specialist medicines-in-lactation service — that is what they are for, and they can answer for the exact drug and dose you have been given.

Take the pain relief you are offered on schedule rather than waiting until it hurts. Being on top of the pain in the first 72 hours does more for feeding than any technique on this page.

Milk coming in may take longer

The HSE is honest about this: "Your milk coming in may be delayed by a day or so because of the caesarean birth." It follows immediately with the important part: "your colostrum will meet all your baby's needs until your milk comes in."

The response to a slower start is more frequent milk removal, not less. Feed responsively, and if your baby is sleepy or not attaching, express. The HSE's instruction where a baby will not attach properly is to express and give it by syringe, and to "express every 2 hours until your baby is latching on and feeding well."

This is also the reason antenatal colostrum harvesting is often suggested before a planned caesarean: having a few frozen syringes takes the pressure off the first day.

Afterpains and other surprises

Breastfeeding releases oxytocin, which contracts the uterus, so period-like cramping during feeds is normal and usually strongest in the first few days and with second or later babies. It is a sign things are working, though that is small comfort at 3am.

Wound pain when you laugh, cough, sneeze or shift a baby is expected. Supporting the wound with a folded towel helps. NHS guidance on caesarean recovery covers what is normal and what is not, and the signs of wound infection are worth knowing before you are discharged.

When to get help

Ask your midwife, health visitor, public health nurse or a breastfeeding specialist if:

• Your baby will not attach, or every feed hurts.
• You are unable to get into any comfortable position for feeding.
• Your milk has not come in by around day four to five and your baby's nappies are not increasing.
• Your pain is not controlled by what you have been prescribed.

Seek urgent medical advice if your wound becomes red, hot, swollen or leaks fluid, if you have a high temperature or feel hot and shivery, if your bleeding becomes heavy or smells offensive, or if you have calf pain, chest pain or breathlessness.

Where to get real help

In the UK the National Breastfeeding Helpline is 0300 100 0212, run by the Breastfeeding Network and the Association of Breastfeeding Mothers, and open every day of the year. La Leche League GB runs local groups and a helpline. In Ireland the HSE offers an "Ask our breastfeeding expert" live chat and email service. Ask your ward for the infant feeding team before you are discharged.