Breastfeeding after cesarean section: features of lactation, taking antibiotics. Rules for breastfeeding after a cesarean section After a cesarean section, you can feed your baby breast milk

Reading time: 6 minutes. Views 639 Published 03/31/2019

A caesarean section causes a lot of anxiety for expectant mothers: the operation itself, how it will affect the baby and their own health, and how the recovery will proceed.

One of the most pressing issues: when does milk come after cesarean? Possible difficulties with breastfeeding after surgery only add to the worries.

Basic myths

Breastfeeding after caesarean section surrounded by many myths.

They mainly relate to the characteristics of lactation:

it is believed that after the operation the mother will not produce milk at all;
there will not be enough milk, the mother will not be able to feed the baby;
The milk will disappear quickly, it will last for a couple of months at most.

Such beliefs oppress a woman. And problems with lactation arise not because of the operation, but because of stress and psychological pressure.

Actually the question breastfeeding after cesarean section is now well studied. It practically does not differ in duration and frequency, but has some features that need to be taken into account.

It is important to understand that the operation will not interfere with breastfeeding. However, it may take a little longer for the process to normalize.

Milk doesn't come...

A slight delay in the arrival of milk - normal phenomenon after caesarean section. It takes several days for the body to “ripen”.

The duration of this period is individual and depends on many factors: the mother’s health, the frequency and duration of the newborn’s breastfeeding, and the medications used.

The average time until milk comes in is 3-7 days.

There is nothing wrong with delayed lactation after a cesarean section; the body’s reaction is completely justified.

This happens for a number of reasons:

the birth took place over several days ahead of schedule, the body has not yet had time to fully prepare for motherhood;
reaction to the operation performed, medications used;
later latching of the newborn to the breast;
mother and baby are in different rooms;
In the first days after birth, it is not possible to frequently put the baby to the breast, stimulating lactation.

To speed up the flow of milk, you need to try to spend more time with your baby. It is good if it is possible for mother and newborn to stay together in the room. It is advisable to try to put it to the breast, even if the mother is still weak and the baby is lethargic. The glands, sensing even the slightest stimulation, will begin to work.

Pain

After any surgery, the body needs some time to recover. Pain and stress inhibit the production of the hormone oxytocin, the “motherhood hormone.” Thanks to it, milk is formed and easily separated.

With a lack of oxytocin, the process of milk production and outflow is disrupted. There will be difficulties with pumping and feeding. Most often, problems arise during emergency surgery.

You can use simple measures:

massage the breasts before feeding and pumping, it’s good if the nurse shows how this is done correctly;
back massage, special attention should be paid to the neck and collar area. This procedure can be performed by a spouse;
Before feeding or at the very beginning, drink a mug of warm drink: water, drink, tea. This will increase the content of oxytocin, which will facilitate the outflow of milk;
at severe pain You may need to take painkillers; it is necessary to select medications that are not contraindicated during breastfeeding.

As the discomfort subsides and the sutures heal, the lactation process will become more active.

Newborn lethargy

The first time after a cesarean section, children are lethargic, sleepy, inactive, and are not interested in the breast. This occurs due to prolonged exposure to strong medications. If the baby is premature, then sucking becomes too difficult for him.

Don't be afraid of these first difficulties. Mothers also face them after natural childbirth.

A slight delay will not determine the entire fate of breastfeeding. If the mother shows enough patience and persistence, the baby will sooner or later take the breast.

What to do to stimulate your baby's interest in the breast:

Spend more time on skin-to-skin contact, be with him skin to skin: lay him next to you, carry him in your arms, etc. This will allow him to adapt to new conditions, awaken his instincts and reflexes, and after a while he will be strong enough to take the breast.
Attach baby to breast not only according to the schedule, but also during the rest period. A calm baby is more inclined to learn how to breastfeed correctly. More frequent feedings contribute to more fast learning mother and baby: the woman learns to attach the baby, control it, and the baby gets used to taking the nipple and areola, holding them in the mouth and extracting milk.
To stimulate the newborn's interest in the breast, it is recommended to squeeze a few drops of colostrum into the baby’s mouth or lips.
If the baby is still weak, you can spoon feed him or a syringe without a needle. It is important that it is an object that prevents sucking. Otherwise, the child will develop an incorrect motor stereotype; it will be difficult for him to take the breast and “relearn” to use it.

While the baby is not able to empty the breast well, the mother will have to establish lactation on her own: express every few hours manually or using a breast pump.

You need to start doing this as early as possible, as soon as your condition after childbirth allows.

Help from other family members

In the first days after surgery, the mother needs help. We need a person who will bring and pick up the baby, help put him to the breast, hold the baby while the mother settles into a comfortable position.

In addition, during the postoperative period, a woman needs help with household chores. There are a number of restrictions: lifting heavy weights, certain movements. Some of the household chores are usually taken care of by relatives: mothers, grandmothers, spouses.

They resort to the help of friends less often. This help allows the woman to recover faster and pay more attention to the baby.

Choosing a feeding position

Need to pick up correct posture for breastfeeding after cesarean section. It is advisable to resolve this issue in the maternity hospital.

During feeding, the baby's weight should not fall on the incision area, otherwise the unhealed suture may come apart. You can ask the nurse to help with choosing a position.

Feeding position requirements:

be comfortable;
do not create stress on the seam;
do not cause physical discomfort;
let for a long time hold the baby at the breast;
give the opportunity to control the baby's nipple latching.

Basic safe options:

sitting in a chair, using a special pillow for feeding, which creates a kind of cradle for the baby;
sitting, in the position of a newborn from under the arm;
Lying on your side, you can surround yourself with pillows so that they support the correct and comfortable position of your back, head, and neck.

Of course, you can choose another option or change them periodically. The most important thing is that mother and baby feel comfortable and safe.

Conclusion

Breastfeeding after a CS is practically no different from feeding a child after a natural birth. Some mothers have no problems with lactation at all, while others have to deal with delayed milk release after cesarean section.

However, if you take into account some features of the postoperative state, the process will improve and proceed successfully. Nowadays, in the first hours after a caesarean section, mothers feel well enough to put their newborn to the breast for the first time. This has a beneficial effect on milk production processes.

The operation only affects First stage breastfeeding, its formation. How things will go further is decided only by mother’s persistence and desire to breastfeed.

Is it possible to establish breastfeeding after a caesarean section? Many women who have undergone surgery or are just preparing for it ask a similar question. How to properly organize feeding a newborn after a caesarean section?

Every woman knows about the benefits of breastfeeding. Nature provides that better nutrition For a newborn and a child in the first months of life, exclusively breast milk is used. Not a single modern and balanced formula can replace breast milk. This is why it is so important that every woman can breastfeed her baby, regardless of the method of delivery.

Beneficial properties of breast milk:

100% satisfies the child's needs for proteins, fats and carbohydrates (up to 6 months of age);
contains maternal antibodies that allow the baby to fight infections;
contains everything essential vitamins and minerals;
has a pleasant taste for children;
is in optimal condition (ideal temperature and consistency suitable for feeding a baby).

Breastfeeding isn't just about food. Breastfeeding allows you to establish contact with your baby and help your baby adapt to a new world. During sucking, the baby communicates with the mother, receiving the care and affection he needs. The newborn feels protected. He feels calm, cozy and good - isn’t this a reason to start breastfeeding, no matter what?

During the feeding process, human milk goes through three stages of development.

Colostrum is the primary milk produced in the first 3 days after birth. Thick yellowish liquid contains everything useful material in concentrated form. In fact, this is a high-calorie protein mixture that a child eats in the first days of life. Very little colostrum is released, but this is enough to feed the newborn in the first days of life. Many women begin producing colostrum during pregnancy.

Transition milk synthesized in the first three weeks. It has less protein than colostrum, but more fat and carbohydrates. This composition allows the baby to quickly adapt to new conditions and receive all the necessary nutrients for further development.

Mature milk begins to be produced towards the end of the first month of life. It contains a large amount fatty acids necessary for normal brain development.

There are two types of mature milk:

anterior (released at the beginning of feeding, contains a lot of protein and water);
posterior (comes at the end of feeding, contains fats and carbohydrates).

Make sure your baby empties the entire breast. This is the only way he will reach the hindmilk and receive all the necessary nutrients.

Features of breastfeeding after cesarean section

It is believed that it is quite difficult to establish lactation after surgery. Many women set themselves up for failure in advance, thereby dooming their baby to breastfeeding artificial mixture. In fact, almost every woman can breastfeed, regardless of the method of delivery. Lactation consultants say nothing is impossible. The problems that a young mother faces after a cesarean section are completely solvable. Similar situations are faced by women who are forced to spend some time in intensive care after a difficult birth and pregnancy complications.

Let's describe possible problems and ways to solve them.

First application

Most maternity hospitals practice early breastfeeding. IN natural childbirth this aspect does not raise any questions. After the baby is examined by a neonatologist, he is immediately applied to the mother’s breast and left for 1.5-2 hours. Such contact helps the baby adapt to unusual living conditions, and helps the woman establish lactation in accordance with the program given by nature.

After a caesarean section under epidural anesthesia, early breastfeeding is also possible. The mother's belly is protected by a screen or diaper, the newborn sits next to it and quickly finds the mother's breast. If the operation was performed under general anesthesia, you will have to wait some time. In this case, the baby will be brought in for feeding only when the woman has completely recovered from anesthesia and is able to breastfeed her baby.

Sluggish sucking

Babies born by caesarean section end up in new world without preliminary preparation. In the first hours of life, such children do not always latch well, behave lethargically and refuse to eat. There is no need to panic: “Caesarean babies” need a little more time to adapt and find their mother’s breast. The entire process can take up to 2 hours. A young mother should be patient, help the baby find the breast and receive colostrum, which is so beneficial for him, immediately after birth.

What should I do if the problem persists? Breastfeeding experts recommend the following course of action.

Feed your baby as often as possible. Offer your newborn the breast at least 12 times a day.
Feed your baby only when he is calm. If the baby cries, calm him down, otherwise he will not be able to take the nipple.
Make sure your baby is latching onto the nipple correctly. Your baby's chin should be pressed tightly against your chest. The nipple and most of the areola should be in the baby's mouth.
Feed your baby in a calm and relaxed state. Feeling your anxiety and lack of self-confidence, your baby may refuse to take the breast. Mental stress can also reduce milk production and even lead to lactostasis.

Lack of milk

Lactation after cesarean section can be difficult due to the use of various medicines in childbirth. The problem often occurs in women who have had emergency surgery after prolonged and unsuccessful stimulation labor activity. In this case, milk may come later, and the baby will need to be supplemented with formula. It also happens that obstetricians groundlessly prescribe supplementary feeding to all babies born by caesarean section - to prevent weight loss.

What to do in such a situation? Feed your baby as often as possible. Milk comes on demand. The more often a woman puts her baby to her breast, the more milk she will produce. On the contrary, supplementary feeding with formula significantly reduces the likelihood of successful lactation, especially when using bottles and pacifiers.

Supplemental feeding with formula should be prescribed only according to strict indications and only when the baby is not gaining weight well. In other cases, frequent breastfeeding is enough for milk to begin to flow in the required volume. If supplementary feeding is unavoidable, special systems for supplementary feeding should be used. In this case, the baby will not get used to the bottle, and it will be much easier to convince him to take the breast. In the first days of life, you can supplement the baby's feeding with a regular spoon or a syringe without a needle.

Before each formula feeding, be sure to offer your baby the breast.

Separation

In many maternity hospitals The woman spends the first day after surgery in the intensive care unit. At this time, the baby is in the children's department and receives formula instead of breast milk. This point should be clarified with the manager maternity ward. If separation from the child is inevitable, care should be taken to preserve the milk. To do this, starting from the second day after birth, you need to pump regularly (every 2-3 hours without stopping at night). This approach will preserve breast milk and make it possible to continue lactation after meeting the baby.

Collect the milk in a sterile bottle if the hospital allows you to feed your newborn with expressed milk.

Taking antibiotics

For the prevention of postpartum infectious complications often prescribed after caesarean section antibacterial drugs. Most of them use products that are compatible with lactation. If for some reason a young mother is prescribed medications that are not approved for breastfeeding, the baby will have to be fed with an artificial formula. To preserve milk, you also need to express every 2-3 hours, including at night.

Choosing a feeding position

Immediately after a caesarean section, feeding your baby in the classic cradle position can be difficult. To reduce pressure on the fresh seam, you can feed the baby in the under-arm position. For convenience, you should use special pillows for feeding.

It is possible to establish breastfeeding after a caesarean section. It is only important to take your time, do everything consistently and maintain self-confidence. If you have any questions or concerns, please contact your pediatrician or lactation consultant.

It is believed that breastfeeding after a caesarean section is a very difficult task and is invariably associated with difficulties and problems. In fact, the impact of surgical birth on subsequent lactation is somewhat exaggerated, although a lot will depend on how well the young mother is able to properly organize the process of breastfeeding the baby. In this article we will look at the features of milk production after a cesarean section and tell you how to establish feeding.

Peculiarities

During pregnancy, the mammary glands almost double in size. Under the influence of certain hormones (progesterone, estrogen), the milk ducts grow, the lobules become heavier, and only a couple of days before the onset of labor, the maturation of the glands is completed completely. A drop in progesterone levels, characteristic of all women before childbirth, triggers the production of immature milk in the mammary glands.

But a caesarean section is not always performed on the expected day of birth, and the body is not always expected to be fully ready for labor. It is for this reason that after surgical childbirth, lactation may occur with a slight delay, because hormonal changes require a certain time. The rate of milk production is also affected by the drugs used for anesthesia during surgery. They slow down a bit natural processes in a woman's breast.

It is clear that the closer to the due date a cesarean section is performed, the fewer problems the postpartum mother will have with lactation. If there was a premature cesarean section for health reasons and the readiness of the mammary glands is far from optimal, more problems arise with milk production.

For the successful start of feeding, the level of a special hormonal substance prolactin in female body. To stimulate its production, it is important to place the baby on the mother’s breast as early as possible. Today, when up to 90% of operations are performed under epidural or spinal anesthesia, when the woman remains fully conscious at the time the baby is removed, breastfeeding in most maternity hospitals is practiced right in the delivery room.

Problems are likely if it was not possible to immediately put the baby to the breast, if on the first day the woman is in intensive care in in serious condition or the baby is in serious condition in the pediatric intensive care unit. In this case, there is no question of the mother and baby being together, or of bringing the child in for feeding.

But even if all of the above negative factors took place, this is not a death sentence. It is quite possible to promote the establishment of normal lactation. Only postpartum mothers who have no milk or colostrum due to a disorder do not have the opportunity to feed their baby. hormonal levels, and such disorders (prolactin type) occur extremely rarely.

What should you pay attention to?

The best time The first hour and a half of his life in this world is considered to be the time to put a baby to the breast. It’s okay that milk is not yet fully understood; even a drop of colostrum will be enough for the baby to receive a large supply of proteins, vitamins, fats and carbohydrates. Nutritional value colostrum is incredibly high. But even if there is no colostrum, it still makes sense to attach the baby to the breast for an hour and a half.

This will help the development of his sucking reflex, will have a beneficial effect on uterine contractions after surgery, and will also be an excellent stimulus for the production of prolactin. Not every maternity hospital tries to carry out the application in the first hour and a half, and therefore this issue needs to be resolved with the doctors in advance, and the time of application must be agreed upon, unless unforeseen circumstances occur.

Supplemental feeding with formula is not the best start to nutrition. After the baby sucks the nipple, from which nutrition flows relatively easily, without resistance, he may then refuse to take the breast, because the baby will need to make some effort to suck it. This issue should also be discussed with your doctor in advance. A woman has the right to demand no complementary feeding on the first day. It will be administered only if colostrum does not appear within 24 hours.

Today, long-term separation of mother and baby after surgical birth is not accepted. If there are no contraindications regarding the well-being of the mother and baby, after 8 hours, when the woman begins to get up, the baby can be brought to her to stay together. From this time on, the main measures to establish lactation will begin. Breastfeeding will benefit both the woman and her baby.

How to improve milk production?

Don’t worry if there is no milk in the first day or two after surgery. This is completely normal; for many women, after a cesarean section, even colostrum begins to be released late. Multiparous women begin to breastfeed earlier, because their nipples are more adapted to this and have the corresponding experience. If the birth was the first, then the breast has yet to be developed. This is exactly what the woman will have to do in the maternity ward after the child is transferred to a shared stay.

Expressing increases milk production. It should be done every 3-4 hours to stimulate the production of full breast milk. Even if all the efforts of the postpartum mother are limited only to obtaining a couple of drops of colostrum, you should not give up this activity. You can express your breasts with your hands in the intervals between feeding the baby (attaching to the breast), you can use a breast pump.

There are several types of such devices - manual, pump, electric. Which one to choose is a personal matter for each mother and a matter of the family budget. The principle of action is the same for everyone - the nipple is irritated, the production of prolactin is stimulated, and the volume of breast milk increases. It is quite possible to strain the breast to a state suitable for feeding a newborn within 2-3 days.

If the baby does not take the breast, you need to find out the reason. IN mandatory you should consult your doctor children's department. It is possible that the mother’s nipple is small and anatomically inconvenient. In this case, a special silicone nipple shield may be required.

If there is already enough milk and the baby is eating well, you still need to continue to express the excess. The baby will grow and its nutritional needs will increase every day.

If the remaining breast milk is removed from the mammary gland, the inhibitor that inhibits the production of a new portion of breast milk will be eliminated in a timely manner.

In addition to pumping, there is a whole range of measures that will help a woman breastfeed her baby after surgery.

Massage

Special lactation-stimulating massage techniques are not difficult. Any woman can do them. A properly done massage will not only stimulate milk production, but will also help prevent it from stagnating in the mammary glands.

Take the breast in the area of the upper part of the gland and open palm Make circular movements from top to bottom, towards the nipple. After massaging one breast for five minutes, move on to massaging the second.

Lightly massaging the nipples with slight pressure with your fingertips also helps. Massage each nipple clockwise and counterclockwise for 1 minute.

Massage should be done 4-5 times a day after each feeding of the baby.

Medicines

There is a separate group of drugs that can help establish lactation after surgery. Before use, you should definitely consult your doctor, since in addition to the benefits, they may also cause side effects. These products are the most popular among nursing mothers.

"Lactogon"– 1 tablet 3-4 times a day, an hour before feeding the baby. The general course is 30 days.
"Mlekoin"- Dissolve five granules half an hour before meals in the morning and evening. The duration of the course of treatment is unlimited, the drug is homeopathic.

Special formulas for nursing can also help - “ Milky Way", "Femilak". It is also recommended to take folic acid. If a woman has hormonal problems that interfere with the establishment of normal lactation, she will be prescribed hormonal medications.

Nutrition

Nutrition should be balanced, but not meager. In the first day or two after surgery, a woman is recommended to follow a strict diet; on the 4th day, she can eat everything that is provided at the common table for lactating women. The main thing is to prevent constipation. If you have difficulty defecating (it’s scary to push, your stitches hurt), you need to take a laxative in the form of rectal suppositories or microenemas to gently cleanse the intestines of feces.

Porridge, milk, dairy and dairy products, stewed and boiled vegetables, it is recommended to drink more liquid. Women after surgery need fluid doubly, because it is necessary to replenish the reserves of lost fluid, but you should be very attentive to your well-being, because stagnation and swelling of the mammary glands against the background is possible. large quantity drinking.

You can add special teas for nursing mothers with fennel to your diet; they will help increase the production of breast milk.

Effect of medications

Often women after surgery wonder how the medications that are made in postoperative period mother, can affect the baby. It should be noted that a woman must be given painkillers in the first 2-3 days, since contractions of the uterus with sutures placed on it can be quite painful, and the anterior abdominal wall is quite noticeably disturbing. Contracting drugs are administered separately, since the contractility of the uterus after surgical childbirth leaves much to be desired. These medications will not harm the baby.

Antibiotics today are prescribed only if there is reason to suspect an infection. Just like that, for prevention, as was done before, antibacterial drugs are not prescribed after cesarean section. Modern drugs in most cases are not dangerous for the child, but if a woman is prescribed quite toxic antibiotic, she will definitely be warned about this.

During therapy you will have to stop breastfeeding. To prevent the milk from disappearing and to be able to feed the baby later, the woman will need to continue to pump and massage her breasts.

There is a common belief that breastfeeding after a caesarean section is difficult to establish, as the woman faces many problems. However, any woman in labor finds herself in similar situation, problems can arise even with traditional childbirth. The main difficulty in this situation is the presence of complications, difficult childbirth, stay in intensive care - a huge stress for the body.

With a planned caesarean section, the chance of artificial feeding, and during natural birth, women are less likely to switch to formula nutrition. In any case, it is necessary to develop optimal mode for mother and child.

It is very important to put the baby to the breast immediately after birth

How does lactation develop?

Scientists have long proven that the amount of breast milk directly depends on the frequency of the baby’s attachment to the breast. It is better to do this immediately after birth - this way lactation will normalize faster.

International experience shows that breastfeeding after cesarean section occurs almost immediately after the baby is born (see also:). Sucking activity may be low, then you need to wait. With each urge of the newborn, he is given the breast until he begins to actively suck.

There are nuances to feeding a baby:

The time depends on the anesthesia. If gentle medications were used, you can let them approach the breast immediately. When using general anesthesia, you should wait until all harmful substances are removed - it is better to discuss the timing with your doctor.
Sucking activity appears within six hours. When the baby begins to suckle, the mother’s body will be able to establish lactation and establish the optimal production of milk necessary for feeding (we recommend reading:).
Put your baby to your breast (we recommend reading:). You cannot use substitutes, pacifiers, nipples, bottles; the newborn should try the natural taste (we recommend reading:). If this point is not met, the chance of breastfeeding will decrease.
Use comfortable positions. It is optimal to feed the baby from under your hand so that there is no pressure on the stomach. The chosen position should be comfortable for both you and the child.

IN medical institutions high level services, the child and mother are allowed to stay in the same room even after a caesarean section. This increases the chances of normal feeding, so when elective surgery It is worth discussing the possibility of leaving the child with you.

What to do if early feeding is not possible?

World practice is disappointing: early latching of babies is extremely rare, so breastfeeding a child after a caesarean section is difficult. Women and their babies are often in different rooms; the mother may be prescribed antibiotics. What to do in such a situation? Is there an optimal solution in this situation?

Staying in intensive care

Typically, after surgery, the woman is placed in the intensive care unit for a couple of days. Breastfeeding a child is impossible - he is simply not nearby. The behavior of a woman in labor in such a situation should be as follows:

Demand that the child be brought to you immediately. There is an International Convention, according to which staff are obliged to arrange for the mother and child to stay in the same room, even if this applies to the ward intensive care. Exception from of this rule There is only one thing - the child needs an artificial respiration apparatus.
The child needs to be spoon-fed (we recommend reading:). If you long time If you are in a hospital and cannot participate in feeding, ask close relatives to feed the baby with a spoon, a special sippy cup, or a syringe without a needle. It is important that he develops a sucking reflex - breastfeeding can be established faster even after a cesarean section.
. Typically, milk arrives on the third day; during operations, this period increases to 5 or 10 (we recommend reading:). It is necessary to organize pumping, doing it as early as possible. Optimal time– 10 minutes every 2 hours, at night you need to take a break and get a good night’s sleep. It doesn’t matter that there will be little milk at this time, your goal is not to express a large amount, but to send a signal to the body that it is already necessary to feed the baby. The procedure can be done with your hands or.

This tactic leads to the fact that lactation quickly improves. Food appears, the baby gets used to the breast.

To start lactation faster, express milk by hand or with a breast pump.

Taking antibiotics

To avoid complications after surgery, women are always prescribed antibiotics. If cesarean delivery occurs without complications, it is possible to use gentle medications, such as those that are compatible with lactation.

You can check with your doctor to find out how safe the drugs are. If these remedies are acceptable, do not be afraid to feed your baby. Through the chest harmful substances will not be passed on to the baby, they are simply not absorbed by the body and cannot cause harm.

If antibiotics prohibit feeding, you should act as if the baby is separated:

Feed him with a spoon. The medications will have to be taken for 3-7 days, during which time the baby will have to be fed with formula. If he is in your room, administer supplemental food yourself from a spoon.
Pump. Do this with your hands or using suction. This way, the fluid will come faster, and lactation after a difficult cesarean section will be normalized. By the time the medication is stopped, you will be able to feed your baby without any problems.

Actions to take if there is a lack of milk

Often, even after resuscitation is a thing of the past, and you put the baby to the breast, the milk supply stops. The situation is standard, even if you complied with all the requirements and pumped regularly. Why is this happening? There are several reasons:

Expressing is not as effective as sucking. However, it is this procedure that allows you to ensure a minimum when there is no milk at all.
Milk comes within 9 days after surgery. If you have little natural food for your baby, there is no need to introduce formula feeding. A small volume is enough for the baby, especially in the first days of life.

If breastfeeding is not possible, try spoon-feeding or syringe-feeding

Does the child need supplementary feeding?

The wet diaper test developed by WHO helps determine whether a child is getting enough nutrition. What activities does it include? You should monitor how often your baby urinates. In the first two days of life, the amount should be two times daily, from the third day it increases to four, from the sixth to six. If “going to the toilet” occurs at exactly this level, additional feeding is not needed. The minimum amount will be enough for 10 days of life.

When is supplementary feeding necessary? Its introduction is necessary in the following cases:

The baby is premature. These little babies have an impaired sucking reflex; they cannot suck out enough milk on their own, so pumping and regular feeding are required.
Your milk is not enough. If the wet diaper test fails, supplemental feeding must be introduced immediately. The child does not receive the necessary food, he is weakened, nervous, and cannot stimulate lactation. This leads to defective development, deviations, diseases, the baby does not sleep, and constantly wants to eat.

You can use the wet diaper test to determine if your baby is full.

Supplementary feeding rules

To stabilize feeding after a cesarean section, introduce supplementary feeding correctly. To do this, follow a few rules:

Choose the right method. In the maternity hospital, they usually use bottles with nipples, but you should refuse them; use a spoon, pipette, or syringe if the child is in the same room with you.
Be consistent. At the beginning of the procedure, put the baby to the breast, then feed him with a spoon or pipette, and complete the process with the same attachment.
Volume is also important. Regardless of how much milk is produced, in the first 10 days of life you should not give more than 30 mg at a time. Exceeding the volume is also harmful; digestion and general well-being of the baby can be disrupted.
Switch to natural feeding. A diaper test should be carried out once every three days; as soon as the number of urinations returns to normal, reduce the amount of supplementary feeding. If your milk is enough, you need to completely abandon formula.

Normalizing lactation after cesarean section is a hot topic for mothers who gave birth this way (more details in the article:). If you believe the reviews and recommendations of doctors, the problem is easy to solve. Just follow the established procedure, which will stabilize the situation within a week. With early supplementary feeding, the problem can be brought under control within two weeks.

We present to your attention a chapter from the book by the famous obstetrician Michel Auden “Caesarean section: a safe option or a threat to the future?” Does birth method affect a baby's health? What can cause difficulties with breastfeeding after a caesarean section?

A woman is designed in such a way that the birth of a child occurs due to the release of a large amount of hormones. The same hormones ensure breastfeeding. Since the process of childbirth and the onset are closely related, questions about feeding children born by cesarean section are of particular importance.

Lactation begins before the baby is born

There is an obvious connection between the physiology of childbirth and physiology, and this is confirmed by many examples.

Mammals in general and women in particular are helped to cope with labor pain by morphine-like substances, endorphins. It is known that they, in turn, stimulate the release of prolactin, a key hormone that ensures lactation. Today we can explain the chain of events that begins with physiological pain during contractions and leads to the release of a hormone that is necessary for milk secretion.

The same hormone, oxytocin, causes contractions of the uterus during contractions and the contraction of special cells in the mammary glands - this is the so-called milk ejection reflex, which occurs during breastfeeding. The question arises: can women who have “given birth without giving birth” secrete oxytocin as actively as those who have given birth physiologically? The answer to this question is provided by a study by Swedish scientists. They took into account that oxytocin works most effectively if it is released rhythmically, in a frequent pulsation mode. The study found that two days after vaginal birth, women experienced a pulsating release of oxytocin when the baby was latched to the breast, thereby ensuring the hormone's effectiveness. The release of oxytocin was less rhythmic in those who gave birth by emergency cesarean section. In addition, scientists found a correlation between the pattern of oxytocin release two days after birth and the duration of exclusive breastfeeding. In other words, the duration of breastfeeding appears to depend on the nature of the birth. The same group of Swedish scientists found that in women who gave birth by cesarean section, there was no significant increase in prolactin levels in the blood within 20-30 minutes after the start of feeding.

I would like to comment on the results of studies by Italian scientists, from which it follows that mothers who gave birth vaginally have much higher levels of endorphins in milk in the first days of feeding than those who had a cesarean section. Apparently, one of the functions of morphine-like substances is to induce a kind of attachment to the mother's breast and breast milk. That is, we can expect that the stronger the baby’s craving for the mother’s breast, the longer and easier breastfeeding will be.

To summarize, we can say the following. The hormones released by the mother and baby during childbirth remain in the body or their levels rise during the first hour after birth. Each of them has a special impact on the behavior of mother and baby and on the establishment of relationships between them, and, consequently, on the process of the onset of lactation. It is at this moment that the baby can find the breast on his own for the first time.

Today we have more and more data confirming that a child born by cesarean section (especially before the onset of contractions) is generally physiologically different from children born vaginally. Those born by Caesarean have different lung and heart function and tend to have lower blood glucose levels. Those born by elective cesarean section usually have a lower body temperature in the first hour and a half of life than babies born vaginally or by cesarean section during labor. In addition, there are differences in immune reaction; the system that regulates blood pressure works differently; Erythropoietin levels and blood cell mass are usually lower; lower levels of activity-regulating hormone thyroid gland; the amount of enzymes secreted by the liver and the acidity of the stomach also differ from the norm.

Waiting for scientific evidence

These theoretical considerations lead me to assume that after a cesarean section, especially a planned one, difficulties arise with breastfeeding and its duration is reduced. This is confirmed by countless cases from practice and stories passed down orally. However, we have no right to rely on “life stories”. By skilfully choosing such stories, you can prove any statement. After all, there are women who breastfeed quite safely for several years after a planned cesarean section, and there are also those who face serious difficulties in feeding after vaginal birth without medical intervention. As for statistical data, they are difficult to interpret due to the impossibility of random sampling - after all, it is impossible from the very beginning to divide women into two groups by lot, “prescribing” a cesarean section for some and a vaginal birth for others.

Apparently, the quality and duration of breastfeeding is also affected by the method of pain relief during childbirth. Danish scientists compared two groups of women who gave birth by Caesarean section: 28 women gave birth under an epidural and 28 under general anesthesia. Women in the first group were able to breastfeed longer: 71% and 39% of mothers, respectively, breastfed for up to six months.

Let us turn once again to the realities of Brazil, a country where the number of caesarean sections is expressed in astronomical figures, and childbirth through surgery has become part of the accepted cultural stereotype. However, breastfeeding support organizations have been created in the same country. It is obvious that one is connected with the other, and this is suggestive. In 1981, the country adopted the National Program for the Promotion of Breastfeeding PNIAM (Programa Nacional o Incentive ao Aleitam-ento Materno), which was included in the Brazilian Constitution in 1988. It is noteworthy with what scope and with what original solutions this program was implemented. Training courses were organized in each state for both all categories of medical professionals and traditional healers and other representatives of alternative medicine. Superstars have joined the massive breastfeeding campaign, and laws have been passed regarding the advertising of breast milk substitutes and the length of maternity leave. Brazil also became active in the Baby Friendly Hospital Initiative, and by 1998, 103 hospitals were eligible for the program. This combination of a huge number of caesarean sections and the universal encouragement of breastfeeding only fuels curiosity: how are little Brazilians fed now?

Almeida and Couto conducted an interesting study regarding lactation in Brazilian medical women whose job was to promote exclusive breastfeeding for the first six months after birth. When these lactation consultants gave birth to their own babies, the average period of exclusive breastfeeding was only 98 days! And this is with a guaranteed four-month parental leave! There is one curious detail in the report of this study: 87% of specialists with higher education and 66.7% of nursing staff gave birth by cesarean section. In general, Brazilian statistics are more interested in the overall percentage of women breastfeeding than in the duration of exclusive breastfeeding. A weaning study conducted in northeastern Brazil (where 99% of women breastfeed at hospital discharge) found that the average time to introduce supplementation was 24 days. These data support the conclusions drawn from the physiological approach. The conclusion is that long-term breastfeeding is difficult to achieve in a country where more than half of children are born" the upper way".

Scientists saw a completely different picture in the city of Jeddah (Saudi Arabia), where 40% of children are breastfed for at least a year and where the rate of cesarean sections is only 13%. Caesarean section is one of the main factors leading to early cessation of breastfeeding. It is also worth mentioning the Scandinavian countries, where a significant percentage of children are breastfed and the number of caesarean sections is low.

In an era when a significant proportion of the world's children are born by caesarean section, there is an urgent need for detailed research into the relationship between birth circumstances and lactation. Repeat endlessly "There is nothing better than breasts" - not enough. Today it is much more important to understand how the ability to breastfeed develops.

A look from a practical point of view

Breastfeeding after caesarean section is a relatively recent practice. Most women who gave birth the “upper route” before 1980 did not breastfeed. British scientists estimate that in 1975, only 2% of women who gave birth by Caesarean section breastfed their children. This was a time when the production of “adapted” milk formulas was developing, breastfeeding was devalued, and caesarean sections were usually performed under general anesthesia, and the number of such operations was relatively small. In such circumstances, there was nothing to encourage the refutation of the widely held belief that a woman could not breastfeed after abdominal operative delivery.

Today, in many countries, the majority of women breastfeed their children even after caesarean section. The mechanism for “starting” lactation in them cannot be the same as after physiological childbirth. In most cases, after vaginal birth without medical intervention, you should intrude as little as possible into the process of starting feeding: it is much more important to give the mother time alone with the baby in an atmosphere of complete peace and privacy. On the contrary, after a caesarean section, mother and baby understandably need help.

In emergency situations, the easiest thing to do is general anesthesia, but in this case the mother is unconscious during childbirth and experiences some time after it. However, as my own experience, many children can latch on their own two hours after a caesarean section under short and shallow general anesthesia. Today, with the widespread use of epidural and spinal anesthesia, many women can breastfeed their baby directly on the operating table. Concerning future ability mothers breastfeed, my own experience and everything I have heard leads to the following conclusion: it is much more important whether the caesarean section was performed during labor or before the onset of labor than what type of anesthesia was used. There is evidence to suggest that cesarean section without labor increases the likelihood of breastfeeding difficulties. The explanation for this is quite simple: when the time of birth is planned by the doctor, neither the mother nor the child is given the opportunity to secrete the hormones that are responsible for both childbirth and lactation. Oddly enough, I came across only one study devoted to this issue. This study, conducted in Ankara, Turkey, assessed the association between timing of breastfeeding initiation and daily milk supply in several groups of women following a repeat cesarean section. It was found that, compared with women who had surgery during labor, those who gave birth by elective cesarean had both a delay in the onset of lactation and less milk production.

In the first days after surgery, most women need help, at least until intestinal motility is restored, which allows gas to escape. As after any organ surgery abdominal cavity, this is turning point in terms of comfort and well-being. A woman needs an assistant to bring the baby, adjust the pillows, and properly attach the baby to the breast. At first, it is usually most convenient for mom to feed while lying down. The nurse or nurse who brings the baby can help the mother get comfortable and turn around to give the other breast. After a few days, the woman may be adventurous and look for other comfortable feeding positions. Perhaps because there is no perineal pain after a caesarean section (this does not imply that perineal pain is inevitable after a vaginal birth), many women feel comfortable feeding while sitting in a low chair or cross-legged. Compared to the situation after a vaginal birth, maintaining breastfeeding after a caesarean section will require more determination and persistence for both mother and baby. Those breastfeeding after a caesarean section can find understanding and help in a local mutual support group. Tell your mother what opportunities there are for this in your city.