Saturday, December 13, 2008

How A C-Section Affects Breastfeeding

Did you know that a woman who has a c-section is only half as likely to breastfeed her baby as a woman who has had a vaginal birth?

I was invited to speak to a group of new mothers about breastfeeding in public this last week. I met several great women and am grateful for the opportunity to be working with new moms. Nearly half of these women had had c-sections and only one of them (of the women that had a c-section) was breastfeeding.

First of all, the c-section rates in North Texas were well represented in this group -- about 50%. At a local Arlington hospital, holding steady at a 60% c-section rate, 2 out of 3 of the women that had delivered there had c-sections. The one that did have a vaginal birth said she almost had a c-section.

I was called Friday night to go visit a woman from Russia who is having trouble breastfeeding. She had a c-section. I had plans with my husband, so I have not seen her yet. I hope that by the time I see her she has not resorted to bottle feeding.

So why is this? To begin with, so many c-sections are performed at 38 weeks. If the woman would have been "allowed" to start labor on her own, she might have been pregnant for several more weeks, allowing her baby more time to be ready to suck. It would also ensure that her body gets the message that it is time to make milk for this new baby.

Labor serves a purpose. We pretend, in this country, that it doesn't. We do everything we can to just skip it all together, whether it's through a c-section or an epidural. Rarely do women actually experience labor. Labor is a bridge between pregnancy and being this baby's mother. It is so important! In fact, I always tell my students not to hope for a short labor, but rather a longer one that allows for them to enjoy the journey and process the event. You appreciate the baby so much more when you have worked hard through labor to get the baby here. You trust yourself to parent your baby and your breasts to provide nourishment. A woman who has had a c-section has just learned to not trust her body -- that, even though it is likely not true, even subconsciously, her body doesn't work right. Doctors are very much to blame for this occurance -- "failure to progress" being the number one reason for a c-section sums it up. They have just told this woman that her body has "failed."

There are hormones that occur when labor begins on its own. When a woman is induced with pitocin, these hormones do not occur naturally. Naturally occurring oxytocin crosses a blood-brain barrier that gives the laboring woman endorphins to help her cope with labor. When a woman is induced with pitocin, the uterus is forced to contract harder, longer, and closer together than it would with regular contractions. The baby knows the difference, as seen in so many fetal distress c-sections that occur because of the pitocin. A woman who is induced is twice as likely to have a c-section than a woman who starts labor on her own. Her body simply wasn't ready to give birth.

One of the purposes of labor is to send a message to the breasts that the baby will be here soon and it will be time to feed the baby colostrum. Obviously, in a woman that never experiences a single contraction and has her baby surgically removed from her body, her breasts didn't get that message. They will over the course of several days, but she may have given up breastfeeding by then. She will need lots of encouragement and support by other women who are knowledgeable about breastfeeding, and frankly, most women don't have this support system.

Some babies are not ready to nurse when born too early. The baby could easily have needed another month in the womb. This can contribute to a woman giving up on breastfeeding. A baby must work to breastfeed -- which is so good for them for so many reasons -- and with a bottle, they don't have to work nearly as hard. If they receive a bottle early on, they may not want to work later.

When a mother gives birth without medication, the oxytocin (love hormone) is the highest it will ever be in her life right after giving birth. This is the time that she falls in love with her baby. Mother and baby must be kept together to breastfeed and bond during this time. How sad to miss that opportunity, whether by drugs that inhibited the natural process, a c-section, or stupid nurses that thought the baby needed to be weighed and bathed immediately after birth. Fight for this critical time with your baby!

Many babies receive a bottle early on after being delivered via c-section. The mother is often not feeling well -- go figure -- and someone else takes care of the baby besides the mother, which means feeding the baby a bottle.

Ultimately, women need more information on breastfeeding. And why a c-section is so much more far-reaching than just a (bad) way of getting your baby out of your body. My number one piece of advice in avoiding a c-section? Do not get induced and do not have drugs in labor. I teach an entire class on avoiding a c-section, but none of it matters if you have drugs in your system. There are so many things you can do, but not if you can't move and have subjected your body to drugs that inhibited labor from progressing the way it needs to.

Ladies, trust your bodies to birth your babies and breastfeed them when they arrive. You were made to do this. And if you have trouble, there are so many women who want to help you succeed. If the first one doesn't help, find someone else. All lactation consultants are not created equal. Some are better than others. A La Leche League leader will be able to help you. Seek her out.


publichealthdoula said...

More people need to talk about the difficulties that c-sections cause for breastfeeding. As with everything, there's always some women to say "I had a c-section and never had a problem!" but we know that statistically, c-sections make a big difference.

I also like your advice on avoiding c-sections. I just wrote a piece on my blog on the evidence base against induction. It is so stark and simple. All you have to do is read article after article in the professional literature to see how little benefit and how much harm induction does.

Máire Clements said...

Thank you for bringing up this issue. Sadly in many urban settings, the c-section rate can be even higher than 50%.

I agree with both you and publichealthdoula that education and avoiding inductions would go a long way to reduce the incidence of unnecessary c-sections.

I realize your focus is on the birth process and mine is on the breastfeeding.

I have helped thousands of mothers overcome challenges with breastfeeding including those who have had completely natural deliveries, vaginal births with epidural anesthesia and c-sections.

You are so right that bottles and interruption in breastfeeding for rest are often part of the c-section experience. I've seen an increasing number of mothers who have had vaginal deliveries also being encouraged to do the same.

I prefer to encourage expectant and new mothers to focus on their breastfeeding as an empowering experience. It is a question of education and support.

It is the quality of their breastfeeding connection and not the method of delivery that will ultimately determine their success!

Donna Ryan said...

You are absolutely right -- all women can breastfeed, no matter how the baby was born. It will be more work for some than others... Again, support, support, support.

I had someone have a baby a few years ago - unmedicated - but the baby was so lethargic, she simply would not nurse. Her comment to me was, "Well, one out of two isn't bad" meaning she'd had the unmedicated birth, but breastfeeding just wasn't going to work out. I told her that if she HAD to pick, breastfeeding is the one she should have picked! Needless to say, she went on the breastfeed for 19 months! Yea! It's all about education and support.

Kenny and Chrissy said...

I appreciate your blog and the information you make available. However, I have to disagree vehemently about the following statements: "You appreciate the baby so much more when you have worked hard through labor to get the baby here. You trust yourself to parent your baby and your breasts to provide nourishment. A woman who has had a c-section has just learned to not trust her body -- that, even though it is likely not true, even subconsciously, her body doesn't work right." I HAD to have a C-section because my baby was 9 and a half pounds and was in the breech position. She wasn't budging. A C-section was the safest option for her (and for me). However, I certainly don't think I appreciated her less because I didn't push her out. I breastfed successfully, she doesn't have the health problems associated with C-sections, and, guess what? I fully and totally felt 100% connected to her at the beginning. So please don't demonize those of us who have had C-sections. We are every bit as much mothers as the rest of you.

Donna Ryan said...

Chrissy, this post sparked a fire!

First of all, I am sorry that you had to have a C-section. I am also sorry that it has been interpreted that I believe that every single c-section is unnecessary. I don't believe that. Dr. Bradley's C-section rate was 3%, and Ina Mae's is less than 2%. These are people that I totally respect who only do/did a c-section when it was/is absolutely necessary. I don't know what either one of them would have done for you. I believe that Ina Mae would have had you try a vaginal birth, but I am speculating. Personally, the doctors I know who do breech vaginal births will not do it if the baby is suspected to be over 8 1/2 pounds. In this day and age, I believe that you really didn't have any other options.

Statistics have shown that women who do not experience labor or birth are more likely to experience postpartum depression. Women who have a c-section are only 1/2 as likely to breastfeed when compared to those who experience vaginal birth. These are facts. I think women deserve this information before they jump into a c-section, thinking it's an easy way out of giving birth. This obviously was not your experience. It sounds like you were educated about your options and were determined to breastfeed. You likely have a good support system and loving husband.

I hold to the comments I made in this post and believe them to be true. I base my comments on either research or what I have seen over the years in dealing with new moms and babies, birthed either via c-section or vaginally.

I hope that you'll have the opportunity to give birth vaginally in the future. And congratulations for breastfeeding your baby. You sound like a wonderful mother who was excited to welcome her baby, no matter how she got here. I have loads of friends who have adopted babies, others who have birthed all of their children via c-section or with epidurals, and many of them are inspiring mothers. They all love their children. I believe women and babies deserve the best start possible on this crazy journey called motherhood, and life!