Booby Traps Series: The c-section rate is at a record high. What does that mean for breastfeeding?

This is the 12th in a series of posts on Booby Traps,™ made possible by the generous support of Motherlove Herbal Company.

According to the CDC, the cesarean birth rate in the U.S. is at an all-time high.  It increased 71% between 1996 and 2007, rising from 21% to a record 32%.  During roughly the same period, the rate of vaginal birth after cesarean (VBAC) declined from 28% to 8.5%.  The World Health Organization recommends a cesarean rate no higher than 10-15%.

Back when the founders of La Leche League were having their babies mothers were sometimes told that breastfeeding after a cesarean was impossible.  Of course we now know that to be wrong, but the truth is that breastfeeding after a cesarean comes with particular challenges which can make it harder for mothers to meet their personal breastfeeding goals.

What are those challenges?  Linda Smith, in The Impact of Birthing Practices on Breastfeeding cites research showing that the following breastfeeding-related outcomes are associated with cesarean birth:

  • Significant delays in initiating the first feeding
  • Increased risk of separation from mother following birth, and increased risk of baby being admitted to the NICU
  • Delayed onset of mature milk supplies (“milk coming in”)
  • For babies:  altered sucking patterns, decreased neurological responses in the first two days, increased risk of respiratory problems in babies born by cesarean without labor, respiratory distress, low blood sugar, higher risk of infection in babies born by cesarean before 39 weeks gestation
  • For mothers:  a longer and more painful recovery, lower oxytocin and prolactin levels in the early postpartum period, increased risk of rehospitalization and infection, higher rates of anxiety and stress, higher risk of exposure to medications of concern
  • In elective cesarean without labor, reduced fetal endorphins and less endorphins (which act as pain killers) in breastmilk

And possibly as a consequence, research has found that mothers who have had cesarean births:

  • Are more likely to have stopped breastfeeding within the first two weeks postpartum
  • Are more likely to not be breastfeeding at 2 months

Cesarean section itself isn’t a Booby Trap,™ and there is no doubt that cesarean births are sometimes necessary to preserve the health of the mother and/or baby.

But birthing practices contributing to our record-high cesarean birth rate – practices like early elective birth and being denied the option of attempting a VBAC – are indeed institutional barriers to our breastfeeding success.

The good news is that with the right support, many mothers can overcome these challenges and meet their breastfeeding goals.  If you’re not sure how to get great support to both decrease your chances of a cesarean birth and to increase your chances of breastfeeding success if you do have one, please see our tips for assembling your A-Team.

I can speak from personal experience, having had one cesarean birth and one vaginal birth (VBAC).  Recovery from my cesarean birth was far more challenging both physically and emotionally, but both of my births were followed by wonderful breastfeeding experiences.

Did you have a cesarean birth?  Did it impact your breastfeeding experience?



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22 Comments | Last revised on 07/12/2011


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22 Responses to Booby Traps Series: The c-section rate is at a record high. What does that mean for breastfeeding?

  1. Anna says:

    I had a c-section, and my sister had 2. We both nursed our babies for at least a year. We had a great support system from friends and family. However, this is not the norm. My daughter was not brought in to me for a few hours afterward and she had a major issue that prevented me from being successful immediately and a DOCTOR told me to try formula. I refused to do so and we were able to move forward with great success. Until hospitals ignore all the propoganda given to them by formula companies and agree to train the staff properly to give support to new mothers, this will continue!

  2. Erin says:

    I had two c-sections. While I was not happy that I was in the situation where I had to have a c-section I have accepted it and realize the I have two healthy babies. I get irritated when I see these studies that say c-sections affect breastfeeding. I breastfed both of my kids for 1 year successfully and did not run into any of the problems this post talks about. It was not true for either of my kids the “delayed time” to have the opportunity to feed your child. I was holding and nursing both of my kdis very quickly after my c-section. I think the key to successfully nursing after a c-section is to have a lactation consultant on your side and with you immediately after. I found the lactation consultant was SO helpful to me, she really facilitated making sure I had the baby as quickly as possible.

    I know a lof of people who have had c-sections and nursed successfully. I do not think a c-section is an impedement to successful nursing. I do think people quit nursing and then want to find a reason to make themselves fee better about it.

  3. Laura says:

    I was induced and ented up having a c-section and my baby spent 2 days in the NICU. Breastfeeding in the beginning was very hard. We supplimented with formula, but I never gave up. Am now proud to say at 7 months PP we are still going strong and baby hasn’t had any formula in almost 2 months. Just keep working at it.

  4. Jamie says:

    I had a c-section in April and nursed immediately after coming out off of the operating room. I had no problem nursing and my little girl is only on breastmilk. She is only 3 months but we are committed to it so we didn’t even consider any other option. It does help that our little one came out ready to feed and latched on with no problems. We did not intend on having a c-section but it was the safest thing for me and the baby. I have great support – wife and friends.

  5. Emily says:

    My baby #2 was born with fluid on his lungs so he was sent to the NICU & I didn’t get to nurse for the first 24 hrs, but after that finding out he was tongue tied at 3 months, we’re still nursing at 7 months. A few months ago my sister sent me this video & I’m sure you will love it. It’s called “Natural C Section”. I wish my c section was done this way. The results are amazing. http://www.youtube.com/watch?v=m5RIcaK98Yg

  6. Alanna says:

    I had a c-section due to a breech baby. I was able to bf my son right away and was encouraged to because he had low blood sugar. He latched on immediately and did very well until he was circumcised, then he didn’t eat very much and I was told he will need formula if it continued. I refused and really worked on getting him to eat and he did. I was hospitalized 4 weeks later and had an emergency surgery from and infection. The doctor said it had nothing to do with his birth but who really knows. He took a bottle when I had the surgery and latched right back on when I was back home. I love nursing!

  7. Min says:

    I had a c section and my daughter is still breastfed nine months later. I was with her within an hour of the birth. The only problems we had with breastfeeding were due to inverted nipples, but with perseverence and the assistance of nipple shields milk came in on the fourth day no problems. I was ready to go home then and have bonded beautifully with my bub. Nothing soothes her or gives her more comfort than being on the breast.. It never even entered my mind that a csection could impact on breastfeeding, so it was never an issue..

  8. Erlind a says:

    I had to have an emergency c-section despite having laboured for 19.5 hours without any drugs at all. The C-section was necessary because the doctors discovered, after trying forceps, that the opening to my pelvic bone was too small and my baby could never come out naturally. Both baby and I developed infections (because my water burst) and she had to be taken from me to have an IV put in. When the doctors did this, they had given her a pacifier to calm her before I had a chance to try latching her onto me. Also, my milk did not come in for a week after she was born and I had to supplement her with formula. Despite all these obstacles to breastfeeding, I’m happy to report that she and I were able to breastfeed, with support from an excellent doctor, and my baby stopped using the pacifier within a couple of weeks of birth and we are still breastfeeding 10 months later with no plans to ween until she is ready.

    I will likely have to have another C-section with my next child, but I know that I will still be able to breastfeed as long as I am dedicated to it and seek the support I need.

  9. Megan says:

    I had an emergency c-section with my son after planning a natural, unmedicated delivery. It was necessary, but devastating. Perhaps the only thing that made it a tolerable experience, though, was that I WAS successfully able to breast feed for over a year, even as a full-time working and pumping mom (nursed at home, pumped while away after 12 weeks). I am planning to have a VBAC with the child I am currently carrying, but if I have a c-section, I have no doubt that I will have as positive a breast feeding experience this time as I did the last time. Maybe even better!

    I think it is preposterous to insinuate that c-sections preclude breast feeding. If hospitals are equipped with well-trained nurses and lactation consultants, the delay or the first feeding should not be too great, and there should be plenty of help with those first critical days of nursing.

  10. Kelly says:

    I had a c-section and my experience was great! My husband went with our son while the nurses cleaned him up and did his examination, while they stitched me up – I was in the post-op room just as he was finishing up and I put him right to my breast and he latched immediately. My milk came in so much so that by the third day home I had to pump because I was producing so much milk. I am at seven months and still breast feeding exclusively and my son is in the 90% for weight and 97% for height – so he is definately not in need food wise. I had a great support system and was very determined to breast feed only. Good luck to all those moms out there – it’s not easy but definately worth it!

  11. Mel says:

    I had a csection, a genuine problem. I did not have any trouble breastfeeding as I had wonderful support. The baby was put on my skin minutes after he was born. he was on my chest while they finished the op, and my midwife stayed with me for a while after the birth and helped us get started breastfeeding. Then the other nurses in the maternity unit were all midwives too and trained in helping a mama breastfeed and I got help all night as I tried to figure out how to feed him, he kept falling off! Funny BF seems like the easiest thing in the world to do now, but at first it was really tricky! Then a community breastfeeding volunteer came around the next day and checked on me. She helped adjust LO’s latch which was starting to cause some bruising. When I went home my midwife visited me every day for a week even though I live rural and an hour and a half away from her. Then she visited weekly. I had the phone number of these volunteer bf supporters to call at any time if I needed help, no charge! It was truly wonderful. I have now trained to be a BF supporter myself as I found them so helpful and I would like to support other women to continue BF, so now I can be called at any time! The NZ system is run by midwives and every hospital dictates skin to skin asap, no pacifiers and lots of money is spent training midwives and volunteers how to help with BFing. Love it!

  12. Mary says:

    I had a C section and I never could produce enough milk. I did everything I was told to do and I could never produce more than a few milliliters, at least when I pumped. My daughter lost too much weight and I was forced to supplement. I had clogged ducts and suck blisters but I still tried. The lactation consultants were baffled. I cried for a week when I could not produce more. I did give up and never knew why it happened. Now I am thinking it was due to the C section. This would not have changed the outcome but it would have eased the pain.

  13. Rebecca says:

    I have had 4 c-sections, I tried v-bac with number two only to never dilate OR efface, even after nearly 24 hours on pitocin. With baby number 3 I would say the c-section affected our BF relationship since I had a really bad spinal headache and she learned to nurse incorrectly, cutting me open pretty bad on the left side but I still BF her until 15 months. With my last child I wouldn’t say the c-section hindered me at all, it was the MEDICATION they gave me that did (throwing up for nearly 6 hours), my daughter DID end up in the NICU for a variety of reasons. But again, I was determined to BF for a long time and here we are, 26 months later and STILL BF!

  14. vanou says:

    Breastfeeding saved my mom’ life after she had to have an emergency c-section.
    She kept bleeding out but making me breastfeed while she was still on the operating table made her uterus contract, and stop the bleeding.

    A c-section should not infringe on your breastfeeding plans.
    All mothers should breastfeed, it has nothing to do with how you deliver your baby.

    I was bf until 20 months old.

  15. Sara says:

    3 babies, 3 c-sections, 3 ubersuccessful nursing relationships. Exclusively breastfed for 7 or 8 months, weaned at 13 to 16 months. I had plenty of milk and could have fed twins. My body was made for nursing, not birthing.

    My first baby refused the breast at first, but we got through with the help of a good LC and lots of patience. The first baby turned out to be Asperger’s, so I think that the breast refusal was probably caused by her discomfort with touch, and because it was tough for her tiny self to get used to the abundant milk supply. But the other babies took to nursing well. My middle baby got to 20 pounds by 5 months, all on my milk. The c-section did not affect the nursing relationship at all.

    Haven’t breastfeeding rates gone up at the same time as c-section rates?

  16. marsha says:

    4 kids: 3 c-sections, breastfed all, even the adopted one, even though I didn’t get a milk supply established. First c-section after 15 hours or labor; b’fed for 9 months; weaned gradually. 2nd scheduled c-section – b’fed for a year, weaned gradually, 3rd c-section scheduled, baby decided to arrive 10 days early, labored until the power came on in the hospital, then had the c-section. 4th child- adopted, used a Lact-Aid to try to stimulate breasts while she was given donated breastmilk and when that ran out, formula. Fortunately I didn’t know b’feeding was so difficult after a c-section so just carried on! :-)

  17. Thanks to everyone who has commented on this post!

    I’m glad to hear that so many of you have had great breastfeeding experiences after having c-sections. That was the case for me, too.

    This post shares the available research about the effects of c-section births on breastfeeding, including breastfeeding rates of mothers who have c-section births. While our personal experience is obviously valid and important, it may or may not match what is happening among mothers in general, which is why it’s important to look at what the research says. And I think it’s fair to say that we, as readers of this blog, may not be a representative sample of all mothers who attempt to breastfeed.

    Is this post saying that mothers who have c-sections can’t breastfeed? Of course not. Is it saying that breastfeeding is always more difficult if you have a c-section birth? No. It is sharing the evidence that c-sections are associated with things that *can* make it more difficult, and arguing that some mothers need support to make breastfeeding work. Not every baby gets a respiratory infection, for example, but when they do it can mean that extra help is needed to initiate and sustain breastfeeding.

    To get back to personal experience, my story illustrates this as well. As I mentioned, I had a great long-term breastfeeding experience with my baby who was born by c-section. But the birth ended in my son acquiring a serious respiratory infection. It was several years before I understood that this is more common among babies are born by c-section, and to see the connection between his infection and his birth. My baby required care in the nursery for ten days, and it was challenging to get breastfeeding going when I couldn’t get anywhere near him for the first few days (my breasts don’t stretch down hallways, I learned!). But I had good support, was very committed, and it all went quite well in the end. Not everyone is so lucky, and I as a lactation consultant I do see mothers struggle with breastfeeding issues related to their births (delays in milk coming in, infections) and need extra help to get things going well.

    So this is the message: Not that c-sections always make breastfeeding more difficult. But that the research points to breastfeeding problems associated with c-sections, and that mothers who require c-sections may need – and certainly deserve – support to make breastfeeding work.

  18. Jennifer says:

    I had my baby 9 weeks early by c section and was unable to breast feed for 6 weeks. I pumped while my baby was in the NICU to make this happen. I clung to breast feeding since I didn’t get the birth I wanted or the start I wanted.. but I wasn’t going to lose breast feeding too. I pumped every three hours. every day. and am still breast feeding my son at 4 and a half months and plan on doing it if I am able until he is 2. I consider myself very lucky that it worked out for us because I have friends that weren’t so lucky.

  19. Christie says:

    I had a c-section due to medical need. I knew I would have one, but never made it to the scheduled date, my son decided to come early.

    I had my son with me shortly after getting to the recovery room and instantly put him on my chest. He was exhausted and after attempting to nurse, fell asleep.

    I had a heck of a time getting him to latch. His mouth was just too small to properly latch without two people and 4 hands. The lactation nurses were great, even helping me eat my lunch after we sucessfully got him latched. Unfortunately, after two days, he was getting dehydrated and I had a nasty rash from the formula we were putting on my nipple to cause him to want to open his mouth wider. I made the decision to ask for a hospital grade pump and feed him a few ounces of formula.

    Luckily, my milk came in that night and I could pump to supliment. His urine went from orange back to a normal color and we got a nipple shield to help me out. I spent the better part of my 4 days in the hospital with him laying on my chest, skin to skin. I wonder if that had anything to do with my milk coming in so quickly.

    At about 5 days old, my milk came in full force. I pumped 7 oz after he ate one day. I continued pumping and freezing milk just in case something was to happen.

    At 2 weeks PP, I developed a nasty case of mastitis. I took my medications, pumped, nursed with the shield, and massaged my breast to push the infection out. I started calling lactation nurses to come to my house and help me out. I didn’t want to be tied to the shield, it was frustrating to both of us.

    At 3 weeks old I had a fantastic nurse come and help me out. She adjusted my hold and presentation to my son, and he latched on with no problem! We weighed him before and after the nursing session, and he had eaten over 2.5 oz!

    I continued lots of skin to skin time and had another engorgement that night. I felt like I was starting out all over again. I was determined to succeed breastfeeding and ignored all the naysayers that wanted me to just give him formula. They couldn’t believe that I was going through all this when there was “an easy solution” in formula.

    He is closing in on 5 months old now. We are still going strong with nursing. When I have another child, I know that I’ll need to have another c-section because of my medical problems, but I’ll gladly do it again. I’ll make sure to have a pump on hand to help stimulate my milk coming in and I won’t give up.

  20. Dominique says:

    I have had 3c-sections. With my first I was young, 18, I had a great support system and I am thankful to have had the staffs support.
    My second experiance was not supportive, she was born with a heart murmur and had to be hooked to a heart monitor. The staff tried to convince me that it would be best to pump and keep her on the heart monitor at all times. If I had not had the support from earlier I may have broke down. I fought tooth and nail and managed to get her every three hours for 30mins. When we finally left she clung to me and insisted to nurse every hour and a half, we worked through and I nursed her til she was one.

  21. Val says:

    I have had 7 c-sections (nope, not a typo). The first 3 were in a hospital in the midst of a medical “mecca” (numerous medical schools/hospitals within about a 50m radius). My babies were taken directly to the nursery after scores of 9 on the APGAR. My husband was whisked away with them and I was left to be stitched up. Babies were not allowed in the recovery room and I did not get to hold my firstborn until he was 3.5 hours old. This was not due to any health issues on his part, but by delays due to HOSPITAL POLICY. I did get to see babies 2 and 3 a bit quicker. Their ‘lactation consultants’ were encouraging pumping and supplementing (“because sometimes you just need a break”) and their advice sabotaged my 2nd bfding attempt (1st attempt was interrupted at 6 weeks due to a health issue on my part), but by baby 3 I was ‘older and wiser’ and ignored their advice and bfed her until she chose to wean.

    We moved to another state and smaller community before #4, 5, 6 and 7 were born. This hospital does not allow V-BACs at this time (although it IS changing), BUT they allow babies in the recovery room. Actually, they have a great set-up for delivery and recovery and my children and mother are even able to stand by the door into the surgical unit and see me being wheeled into recovery–it’s cute to see them all standing there excitedly waiting and the nurses love it. I get baby latched immediately and we are allowed to nurse/snuggle/ooh&ahh the entire time we’re there. They have even allowed my children to come in one at a time with Dad and get their first glimpse of baby–my mom, too. They have a team of lactation consultants who are fabulous.

    All that to say, I think it’s maybe more important that the hospital has a strong breastfeeding policy and support system. Our po-dunk hospital here no longer hands out free formula and strongly encourages rooming in to the point that the pediatricians now do the newborn exams in the rooms instead of having them all brought to the nursery. I see a huge difference in the numbers of bfding moms here vs the previous community we were in.

    I have become content with my c-section status and really am no longer bothered by it. I have found ways to make my recovery more pleasant (if you haven’t checked out arnica or the healing effects of pineapple, I highly recommend you do) and actually enjoy taking 3 weeks to relax and enjoy my newborn.

    I do agree that the statistics probably show that c-secs are the problem, but I think a contributing factor is hospital approach to both c-sec moms and breastfeeding.

    Wow! So much for a short reply! lol

  22. maggie says:

    I had an emergency c section (prolapsed cord) with general anesthesia (no time for a spinal). We had a rough time getting breat feeding going and eneded up supplementing with formual for a week or so. None of the nurses mentiioned that my milk would be delayed until 2 days into me feeling like a failure! I missed out on all the initial skin to skin time and early nursing, as well as being pretty ouut of it for the first 24 hours. We’ve learned from each other and are generally very succesful 5 weeks later, with little nipple confusion.
    Nursing staff support and LC availability are key, and lacking in some hospitals! I will definitely be looking at both before choosing a hospital next time!

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