I got so annoyed yesterday...RE: C/S and BFing

pepomntpat

At my La Leche League meeting. There was a woman there faced with the possibility of a RCS. She is hoping for a VBAC, but her doctor is not optimistic. She doesn't seem overly concerned either way.  Her question was whether or not her body had to go through some sort of labor to ensure she could produce milk. I responded that the milk production is stimulated by the hormone release that happens when the placenta detaches. That is a fact.

One of the leaders told her she'd better go for a VBAC because that is what all women should do and that the anesthesia will negatively affect her milk supply. I cannot find ANYTHING anywhere in any LLLI materials or elsewhere that says that anything about a c/s will affect milk. I know it can be more difficult sometimes due to delaying BFing and because the incision makes positioning difficult, but I can't find anything that the surgery or anesthesia itself can do this. I know that I have not had any c/s related issues BFing and I know from reading posts on here that most women don't have issues simply because of the c/s.

I was so upset for the woman. It is crap like that that makes women not successful because they expect to have trouble. I really want to respond via the yahoo group, but I need facts to back myself up. Does anyone have any reputable information that specifically refutes what this leader had to say?

 

JG362009

That's terrible to tell someone that.  I know you're right about the placenta thing and I also know that the AAP approves basically any medication they'd give as compatible with breastfeeding.  I would maybe try the AAP website for information.  I've never heard of milk supply having anything to do with anesthesia. 

Daisy22

I feel so sorry for that poor lady. Definitely look at the AAP to see if you can find anything.

I had 2 c/s and neither affected my supply. I had an oversupply from day 1 with both my boys.

magdalina.h

That annoys me too! I was going to a bf support group. Some people had to switch to pumping or formula because of different issues. One of the LC's said "Well you might as well switch to formula instead of pumping because all of the good milk fat stays on the side of the bottle." I was livid! I along with plenty of other women were there for having a difficult time BFing and she made me feel guilty for having to give him a bottle of expressed milk.

pepomntpat

magdalina.h:

That annoys me too! I was going to a bf support group. Some people had to switch to pumping or formula because of different issues. One of the LC's said "Well you might as well switch to formula instead of pumping because all of the good milk fat stays on the side of the bottle." I was livid! I along with plenty of other women were there for having a difficult time BFing and she made me feel guilty for having to give him a bottle of expressed milk.

That is terrible! You should not feel guilty unless you decide to just not feed your baby. For goodness sake! 

magdalina.h

pepomntpat:

magdalina.h:

That annoys me too! I was going to a bf support group. Some people had to switch to pumping or formula because of different issues. One of the LC's said "Well you might as well switch to formula instead of pumping because all of the good milk fat stays on the side of the bottle." I was livid! I along with plenty of other women were there for having a difficult time BFing and she made me feel guilty for having to give him a bottle of expressed milk.

That is terrible! You should not feel guilty unless you decide to just not feed your baby. For goodness sake! 

Exactly! I stopped going to that support group and went to a different one. 

capulet

I would be really annoyed too.  I hate when people insist that c-sections inhibit bonding and BFing, because it's so contrary to my experience, and a good hospital will facilitate nursing no matter how a mom gives birth.

There's a page on this at Kellymom:

https://www.kellymom.com/bf/start/concerns/c-section.html

I'm glad I looked at this, actually, because I didn't BF DD in recovery and I have kind of been wondering since then how I could have nursed her flat on my back.  It all turned out well and the nursing support at the hospital where I delivered her was generally really good, but I didn't get help with nursing in recovery and since it was an emergency c/s I was kind of out of it at the time.

pepomntpat

I'll probably be banned for speaking up. I am disappointed, because until yesterday I have always felt very supported there. 

iris427

That's awful.  I can't believe they told her that.  I've read information that c/s itself doesn't affect breastfeeding but that a traumatic deliver--c/s OR vaginal--can affect it.  Let me see if I can find it.

iris427

Also, even if c/s did create breastfeeding problems, the mother still should make the best choice for her delivery and LLL should support that and help her address any problems if they do arise.  

I remember opening The Womanly Art of Breastfeeding after my daughter was born because I was having BFing issues, and the first thing I read was how I should have a natural birth blah blah blah.  Tried that and it didn't work out, but thanks.  Now can you help me with the feeding my baby part? 

pepomntpat

iris427:

Also, even if c/s did create breastfeeding problems, the mother still should make the best choice for her delivery and LLL should support that and help her address any problems if they do arise.  

I remember opening The Womanly Art of Breastfeeding after my daughter was born because I was having BFing issues, and the first thing I read was how I should have a natural birth blah blah blah.  Tried that and it didn't work out, but thanks.  Now can you help me with the feeding my baby part? 

Same with the Dr. Sears book!  I still really like both books, but I think it is awfully short sighted to make moms feel like they are going to fail because the birth day doesn't go as planned. 

iris427

pepomntpat:

iris427:

Also, even if c/s did create breastfeeding problems, the mother still should make the best choice for her delivery and LLL should support that and help her address any problems if they do arise.  

I remember opening The Womanly Art of Breastfeeding after my daughter was born because I was having BFing issues, and the first thing I read was how I should have a natural birth blah blah blah.  Tried that and it didn't work out, but thanks.  Now can you help me with the feeding my baby part? 

Same with the Dr. Sears book!  I still really like both books, but I think it is awfully short sighted to make moms feel like they are going to fail because the birth day doesn't go as planned. 

Yeah, exactly.  I was already feeling like crap about how the birth went, so that was just like turning the knife, you know?  

HBaylies

Wow.  Way to make the woman feel like she's a failure in advance!  I wish I had some stats on hand to share, but I don't.  No one has ever mentioned abything like this in my BF support group that I went to with my son for a year and it was run by an LC from our hospital that's also a L&D nurse.  I had problems with BFing my DS after my unplanned c/s, but it wasn't related to the c/s and had nothing to do with supply.  I'm really irritated at that lady right now!

akayf

I can't believe she told that poor woman that!   I wound up needing to formula feed for other reasons(was unable to to pump to maintain my supply when I got moved to CCU after all my complications and then wound up being put meds that you can't take while BFing) but I did get to BF my little guy a few times before everything went downhill even though

1. I did not get initial bonding time.   He had to go to special care.   I didn't get to hold him until the next day.

2. He was on IV nutrition for 2 days and didn't get his 1st oral feeding until he was a day old.

3. The 1st time I BF him was when he was 2 days old.   He latched on perfectly and we had no problems.   The LC came in to see how we were doing on day 3 and her only suggestions were positioning in case my incision was bothering me(which it wasn't at that point)

If I had been able to continue BFing, we would have been fine.   

I hate people like your leader.  I bet she would most likely think I'm a selfish witch who put her own needs first because I stopped pumping because I needed to focus my energy on getting better rather than stressing myself out over pumping every 3-4 hours and then chose to take meds.  

RumbleLina

The Kelly Mom states pretty much the same thing but I found this is through Abbott Nutrition.

https://abbottnutrition.com/Downloads/BF_After_Cesarean.pdf 

The production and flow of your breast milk should not

be affected by your C-section or by the anesthetic used

during delivery. The chain of hormone messages that tells the breasts to start producing milk is no different after a cesarean birth than after a vaginal birth.

 

The time at which a baby can begin breastfeeding

after being born by C-section depends on the mother?s

and the baby?s condition. It is recommended that

breastfeeding begin as soon as possible after delivery.

 

With either a regional or a general anesthetic,

the pregnant woman should tell both the doctor and

the nurses in advance that she plans to breastfeed.

A woman receiving a spinal epidural anesthetic can

usually breastfeed immediately. A woman who is given

a general anesthetic may not be able to breastfeed

her baby quite as soon. But she can probably begin

to breastfeed when she is fully awake.

 

On rare occasions, the condition of the baby or the

mother may delay the start of breastfeeding. Generally,

the mother can start and increase her supply of breast

milk by expressing milk every few hours with an electric

breast pump. The nurse can provide details about this

technique. When the mother?s milk is collected, the

mother or someone on the nursing staff can feed the

breast milk to the baby or freeze it for use at a later time.


ETA: FWIW, I had a GA c-section and I had no problem with milk supply. I pumped because I couldn't emotionally and physically handle BFing at the time but I was pumping a ton of colostrum and my milk came in 4 days later.  I would definitely correct that leader. Even if it wasn't her intention, how dare she "scare" a woman one way or another.

pepomntpat

She sent me this article which is regarding epidural medication during a vaginal birth. What she fails to realize is that in cases of Cesarean the exposure to the medication is generally much shorter, so the effect would be less. This does not really make her case.

The Effect of Labor Pain Relief Medication on Neonatal Suckling

and Breastfeeding Duration

Jan Riordan, EdD, RN, FAAN, Aimee Gross, RN, MSN, Judy Angeron, RN, BA, Becky Krumwiede, RN,

and Jeri Melin, RN, BSN

Abstract

We examined the relationship of labor pain relief medications with neonatal suckling and

breastfeeding duration in 129 mothers delivering vaginally. Suckling was measured using the

Infant Breastfeeding Assessment Tool (IBFAT). Controlling for infant age, birthweight, and

gender, infants of unmedicated mothers had higher IBFAT suckling scores than those of

medicated mothers (x = 11.1 vs. x = 8.2 respectively, P=.001). IBFAT suckling scores for

intravenous and epidural groups were similar (x = 8.5) while those who received a

combination of both intravenous and epidural medications were lower (x = 6.4 ? 2.96,

P=.001). Mothers evaluated their breastfeeds similarly to nurse evaluators (Z = 9.39, P=.001).

Breastfeeding duration did not differ between unmedicated and medicated groups; however,

dyads with low IBFAT scores weaned earlier than those with medium or high scores. Labor

pain relief medications diminish early suckling but are not associated with duration of

breastfeeding through 6 weeks postpartum. J Hum Lact 2000; 16(1) 7-12.

Keywords: epidurals, intravenous, breastfeeding, labor, childbirth, pain relief

https://www.janriordan.net/documents/riorlabor.pdf

follow the link below

https://www.internationalbreastfeedingjournal.com/content/1/1/24/ 

iris427

pepomntpat:

She sent me this article which is regarding epidural medication during a vaginal birth. What she fails to realize is that in cases of Cesarean the exposure to the medication is generally much shorter, so the effect would be less. This does not really make her case.

The Effect of Labor Pain Relief Medication on Neonatal Suckling

and Breastfeeding Duration

Jan Riordan, EdD, RN, FAAN, Aimee Gross, RN, MSN, Judy Angeron, RN, BA, Becky Krumwiede, RN,

and Jeri Melin, RN, BSN

Abstract

We examined the relationship of labor pain relief medications with neonatal suckling and

breastfeeding duration in 129 mothers delivering vaginally. Suckling was measured using the

Infant Breastfeeding Assessment Tool (IBFAT). Controlling for infant age, birthweight, and

gender, infants of unmedicated mothers had higher IBFAT suckling scores than those of

medicated mothers (x = 11.1 vs. x = 8.2 respectively, P=.001). IBFAT suckling scores for

intravenous and epidural groups were similar (x = 8.5) while those who received a

combination of both intravenous and epidural medications were lower (x = 6.4 ? 2.96,

P=.001). Mothers evaluated their breastfeeds similarly to nurse evaluators (Z = 9.39, P=.001).

Breastfeeding duration did not differ between unmedicated and medicated groups; however,

dyads with low IBFAT scores weaned earlier than those with medium or high scores. Labor

pain relief medications diminish early suckling but are not associated with duration of

breastfeeding through 6 weeks postpartum. J Hum Lact 2000; 16(1) 7-12.

Keywords: epidurals, intravenous, breastfeeding, labor, childbirth, pain relief

https://www.janriordan.net/documents/riorlabor.pdf

follow the link below

https://www.internationalbreastfeedingjournal.com/content/1/1/24/ 

Did she even read that article?  It's not exactly compelling.  Send her this one back:

https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2009.06136.x/full  

No significant association between delivery method or epidurals, and breastfeeding rates. 

pepomntpat

Thank you, iris. I did send that on. I am glad we have opened up this discussion. I was a little afraid the group would be put off, but it's actually turned into a rather lively discussion, so I am glad I spoke up!

floflo1981

I am a little late replying to this but try kellymom.com. There is infinite amount of info regarding surgeries and what is safe as far as medications for BFing. I had my first via c-section and ebf for 13 months...

 LLL can be very biased and condescending toward "non-natural" birthing moms...but it is VERY possible to have a wonderful breastfeeding experience with a c-section...

cottonlily84

You're right about the placenta and not needing labor.  However, for whatever reasons my RNLC can't even tell, milk usually comes in later for c/s mothers than those who delivered vaginally.  A c/s is a surgery, it's a serious event and the body responds to it as a trauma.  Then of course if something goes wrong during the surgery there's more to hamper a good BFing start. 

I don't get the notion that the incision interferes with BFing.  I've never understood why ppl say this.  The incision is so so low, way down at your bikini line.  It's no where that my baby has ever touched while I've nursed her.  I nursed her a day and half after my c/s, before I could even walk from the pain, in the NICU hooked up to all her wires and leads.  I had zero problems with the incision or positioning. 

And as far as the anesthesia goes, there was a certain type of strong pain relief med that's normally given with the spinal.  I couldn't have it because it causes itching and the meds they give to counteract that dry up secretions, including.  Since you only have thick colustrum in the beginning and c/s moms take longer for milk to come in that would have been too much hindrance for BFing.  And let me tell you with that second bag of pitocin post surgery I was begging for some other kind of pain meds!  But other than that my milk came in the second full day after the c/s and I had plenty of milk to feed the baby. 

stephaniebuzzella

Personally I just want to say that I think its awesome that you're sticking up for her ( and other women who had to sit there and hear this woman spew crap "knowledge" ) I've had two c sections and produce like a milk cow so I'd love to see where SHE got HER facts good for you for being proactive!!!!

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