Making decisions about birth after caesarean

Bonding, feeding and support after previous CS

The first few weeks after a baby is born can be a testing time even for mothers who have an uncomplicated birth experience. Support from health professionals, friends and family during the time after birth can make a real difference in helping women adjust to the changes. For all but one of the women we interviewed, their first experience of caesarean was also their first experience of motherhood. So they faced the challenge of coming to terms with the emotional impact of having had a caesarean, recovering from a major operation and adjusting to their new role as mothers all at the same time. Unsurprisingly, some of them struggled.

Virtually all the women we spoke to had planned to breastfeed their babies. Many women had heard about the health benefits of breastfeeding - as one woman said, “It really gets drummed into you by the midwives”. Many women also were keen to breastfeed because they regarded it as part and parcel of bonding with their baby.

Some women we talked to managed to breastfeed without problems. One mother described the very positive experience of breastfeeding her son as 'a form of redemption' after her traumatic caesarean delivery. A few mothers who struggled with breastfeeding initially, persevered with their efforts and found that things became easier after the first few weeks.

Statistics show that women who have had a caesarean are less likely to breastfeed their baby, or to breastfeed for a shorter period of time. Several reasons may contribute to this. Some research suggests that a caesarean can delay the breast milk coming in. Delay in putting the newborn onto the breast after birth because the mother is too unwell can make it harder to establish feeding later on. Also, pain from the caesarean scar might make it difficult for women to get comfortable while feeding and make them more likely to stop trying. 

However, some of the things that made breastfeeding difficult for women were unrelated to having had a caesarean, among them tiredness and exhaustion from a long labour and feeling unwell from the side effects of drugs. The drugs given to women after a caesarean birth are generally considered safe for breastfeeding. Nevertheless, a few women in our study who had received antibiotics after the operation worried about passing on harmful substances in their breastmilk. A few women said they just felt too exhausted or demoralised to struggle on after the first few days of feeding and eventually switched to formula milk. A few women who were unable to breastfeed experienced feelings of guilt and failure. Others blamed the hospital care and lack of support from staff. One woman blamed the painkillers she was given during her labour for her initial difficulty in getting her son to breastfeed. 

For several women, their feelings about how they had given birth were mixed up with worries about how it might have affected the initial bonding with their baby. This was particularly the case for the three women whose babies had to be kept in hospital because they were born prematurely. They felt helpless that there was not much they could do, but also terrified to handle a small baby. Being separated from their newborn for several weeks after the birth was difficult to cope with. Women who had been very unwell after the operation were similarly concerned that they might have missed out on a crucial stage of bonding because they didn't get to see their babies immediately after the birth. 

Women who were lucky enough to have their partners or other family members at home with them after the birth acknowledged the importance of that support in helping them cope. However, several women said they had found it quite difficult to be so dependent on the support of others even for minor tasks. They had expected to do the caring rather than be the ones who would need to be cared for.

Experiences of support from hospital staff were mixed. Not all women had the support they would have liked to help them cope. A couple of women felt very let down by the lack of support with handling and feeding their baby during their hospital stay. Another woman said she found it difficult to ask for help from busy staff. At the same time though, she thought being left to her own devices at hospital had prepared her well for coping by herself once she returned home. 

Around half of all new mothers experience what is commonly known as 'baby blues' in the first few days after a birth - they will feel very emotional and weepy or might get very anxious or upset about relatively minor things. These feelings usually pass after a week or so. A much smaller number of women may develop postnatal depression - continuous low mood, feelings of anxiety and restlessness, difficulty sleeping, loss of appetite or loss of interest in sex. However, many women experience disturbed sleep and a lack of interest in sex immediately after having a baby. So it can be difficult to recognise postnatal depression when it happens, and some women may only recognise that they suffered from it once they have recovered.

Last reviewed April 2015.
Last updated November 2010.

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