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Making decisions about birth after caesarean

Bonding, feeding and support after previous caesarean

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.

 

She had no problems breast-feeding after her caesarean. Her daughter seemed to know what to do.

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She had no problems breast-feeding after her caesarean. Her daughter seemed to know what to do.

Age at interview: 31
Sex: Female
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And how did you feed her?

I breastfed her.

And that was okay? That wasn't difficult?

Yeah, no, it was absolutely fine. Again, I mean, she, more because she seemed to know what to do than anything else, but no, I mean, I never really' she was a bit, she was a bit of a colicky baby, well, not so much colic, but just kind of a bit windy, so we had a few kind of moments with that, but generally speaking she was a very, you know, she still is a very good feeder. And'
 

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.

 

After some initial difficulties, breastfeeding her daughter was not a problem. Having her husband...

After some initial difficulties, breastfeeding her daughter was not a problem. Having her husband...

Age at interview: 42
Sex: Female
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And did it affect how you were able to feed your daughter at all? 

No, everything, that's the thing, I think I forgot, but I had a few tears for about two days and then she fed fine and to honest, I didn't think about it again, I just concentrated on her. So I've been lucky there because some people get a post-natal depression, this, that and the other and I didn't, even though I'd gone through that so, funny, isn't it?

You breastfed?

Yeah.

And that you didn't have any problems with the scar or anything, being able to pick her up or? 

No, I was lucky. Yeah, I mean a bit but my husband was home for two weeks and then after that it wasn't too bad, so I think the surgery was fine.

 

The first few days of breastfeeding her twins were terrible, but she was determined not to give...

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The first few days of breastfeeding her twins were terrible, but she was determined not to give...

Age at interview: 33
Sex: Female
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And how did you feed them?

I breastfed them.

And did you have any problems with that?

I did have at the start, yeah. I had about the first, well, the first few days were terrible and then the first couple of weeks were not great either, but after about three weeks it was okay. I just decided I wasn't going to give up really, so'

'and was that because of the section and having had the scar or was it just with having twins, or?

I think a combination of having twins, having the delivery I had and not having breastfed children before so'

Oh, well done for persevering, I guess that must have been quite a nightmare at times? 

I thought it was gonna be hard. It was once they got a little bit bigger it was, once they were past I'd say the first month, it was okay, but, I think, I could see why people gave up, would give up. I mean, if I hadn't been so stubborn, I think I probably would have given up [laughs].
 

Some statistics show that women who have had a caesarean are less likely to breastfeed their baby than those who had vaginal deliveries*. 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. 

 

She thought her caesarean caused her problems with breastfeeding. She felt awful when her...

She thought her caesarean caused her problems with breastfeeding. She felt awful when her...

Age at interview: 37
Sex: Female
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How do you feel now about having had a section? 

How do I feel now? 'well additional to just having a section, my daughter after a week of being born ended up going back into hospital having lost twenty percent of her body weight. So awful, terrible. I believe it's the cause of her inability to feed and' yeah, blame that on having a section.

Did you try and breastfeed?

I did, I tried to breastfeed.

And how did you get on with that?

I didn't, I don't think the milk came in. Despite having asked for loads of support and stuff, it just didn't come in, and it was just various different things. It was myself, I'd pushed myself too much, so therefore the milk hadn't come in, but no one explained to me that if you have a section it could possibly be quite difficult. They didn't actually explain that if it was a big baby it was going to be quite demanding as well. 

 

It was a struggle to breastfeed her daughter after the exhausting birth. She had to top up her...

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It was a struggle to breastfeed her daughter after the exhausting birth. She had to top up her...

Age at interview: 37
Sex: Female
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Did you have any worries or concerns after you had [daughter] about maybe the way that she delivered affected her or you at all? 

I had lots of problems breastfeeding and I did feel that that might be because there wasn't, because it, because I was absolutely exhausted because I'd been induced over two days. And it had made me very ill, being induced, and I found that really hard, then the sort of, you know, putting her on and breastfeeding straight away, that was difficult.

And was that something that you were able to do first time or did you not?

I gave up at six weeks, I couldn't. And she constantly needed topping up. She was a big baby. And I found breastfeeding really hard. I didn't find bonding with [daughter] hard but the actual sort of breastfeeding was difficult.

And was that with having a scar as well, did that, how did that affect'?

I think it did at night time, the night feeds, sort of getting up and moving around. I found that really difficult, but, I mean, I've got a very supportive husband, he was fantastic so we did give it the best try we could and she was a big baby as well, and I didn't ever seem to produce enough milk so, and I don't know whether'that's something I didn't know about before, whether or not having a section affects, affected any of the sort of, the milk coming through or anything like that, that's something I still don't know actually, but that was something I wondered about. Because it seemed to be a long time before there was enough milk' to satisfy her and then, by which stage she was being topped up with formula and preferred that option.
 
 

Her baby would not feed for the first 24 hours. She thinks this was due to the effects of the...

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Her baby would not feed for the first 24 hours. She thinks this was due to the effects of the...

Age at interview: 38
Sex: Female
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And what were your concerns or worries about having a section? 

Well, I was concerned that it would take a long time to get back on my feet. And I was very surprised that the very next day, I was up having a shower [slight laugh]. But, yeah, I was concerned how long it would take for me to, to get, as I said to get back on my feet, and about breastfeeding. I was very adamant that I wanted to breastfeed. So, I was hoping that it wouldn't obstruct any breastfeeding.

And how did you feel about having a section?

Sorry, whereas in fact, the fact that I had been induced for three days meant that at a certain point I was given Pethidine*. I accepted Pethidine because I was completely out of it and it was that, that led to me, I was pretty sure, having difficulties breastfeeding. Because it took about twenty-four, just over twenty-four hours to get my little boy to latch on because he was half-asleep. So, yeah, it was, it was not the caesarean but maybe the insistence of trying to induce.

*Pethidine is a strong pain killer that may sedate the baby.
 

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. 

 

Her son was born prematurely and had to stay in special care. Tube-feeding him with the milk she...

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Her son was born prematurely and had to stay in special care. Tube-feeding him with the milk she...

Age at interview: 22
Sex: Female
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And do you feel that having a section affected your son in any way? I mean, the fact that he was prem and you didn't spend time together, did that worry you at all?

Yeah, I didn't get any post-natal depression, but I did sort of' I didn't feel how I thought I would feel until I brought him home. For the first ten days I didn't really' it wasn't reality that I was a mum, if you see what I mean.

That must have been weird, having had a baby and not-, not being with him?

Yeah, because I come home after about four days, because obviously I needed to get premature things and everything ready.

So, you know, my bump was gone and I had no baby' and it was a bit strange.

Do you think it had any long-term effects on your son at all?

No.

And do you think it had any long-term effects on you?

No, no.

And how did you feed your son?

Breastfed, I breastfed him.

And how did you find that? 

I found it fine. I mean, when he was in special care, it was the only thing I could do, if you know what I mean, because I couldn't bath him or hold him much, so I used to express it off and take it down and they tube-fed it to him.

And did that make you feel closer to him?

Yeah, that's, I think that was the one good thing about it really.
 
 

She felt like her baby was not really hers for the first few weeks. She expressed milk for her...

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She felt like her baby was not really hers for the first few weeks. She expressed milk for her...

Age at interview: 33
Sex: Female
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It was... I really can't remember exactly how I felt. It just sort of' I, because I think back then, I was sort of quite a quiet, withdrawn person who did lack a lot of confidence that, you know, I just let the nurses, it felt like, you know, she wasn't mine until weeks had gone past when my confidence built up to change a premature baby's nappy and, you know, what with all the wires and the tubes and things, it was, it was quite a daunting experience, really.

And you said you didn't feel like a mum. Was that because you think it was worse because you went home without her?

Well, sort of, I don't know. I know the situation couldn't have been helped, you know, that all hands were on to save, to save her life really, and to sort of save mine, because it's quite a sort of life-threatening condition, and I think it was because she, you know, she didn't feel like mine because of how small she was and holding her body temperature, she could only come out of the incubator for so long and obviously get put back in. And we felt helpless, you know, when they're so tiny as well, you think they're going to break as well and all you want to do is just pick them up and cuddle them and, you know, nurture them and, you know, as time went on, you know you accept it and it becomes more natural and the bonding sort of begins and you know, the confidence builds up and, my nan had a field day of knitting dollies' clothes. I was going in, and I sort of started feeling more like she, she was mine, and when she came home, it was exciting, but still really nerve-wracking, because'

Did you have any long-term worries that she'd been affected by being delivered early?

Not really, no.

And what about feeding? Presumably you couldn't breastfeed her because she was in'?

I did try once to breastfeed. They'd advised me straight away to try and express, because obviously of what the breast milk contains, but they said they'd use donor milk, and that thought' I didn't like the thought of it, so I started to express and it came through, and I expressed every four hours for five weeks. And I tried to feed her the once, but confidence, again' she was too small and my mum was sat there, there was a nurse there and I think that if they'd put me into like a room on my own maybe [yeah] I perhaps would have, would have kept it going, but I think, still stressful situations, it suddenly, just suddenly, just dried up and that was it, so, you know, they had the sort of bottle premature milk there.
 

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.

 

Her baby had to stay in special care and she felt very ill. She was grateful to have support from...

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Her baby had to stay in special care and she felt very ill. She was grateful to have support from...

Age at interview: 19
Sex: Female
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Did your partner have to help you? 

Yeah, quite a lot.

And was he good at doing that?

Yeah, he was okay, but not' I found my' I was living, I'm living with my grandparents after when I' and they helped, they helped brilliantly, especially my nan. She was, it's like your washing and things you didn't realise, like, how difficult that would be if you were on your own doing.

And did you' how did you feed your baby?

I bottle-fed.

And had you planned to breastfeed? 

I would have liked to have tried, but I just' after, I just didn't, I didn't have that, because as soon as he was born he was, he was taken because like he had to go to the special care as well. I didn't feel like I bonded very well with him and I, I felt so ill I just didn't want to' at the time.

And did you have any problems going to the loo or resuming sex again after you'd had the section?

'No, not really. It was just getting about really, it was getting up to get sort of around, yeah, because they try and get you up as soon as possible, which is' but you're so, it just feels' it's a feeling you don't ever feel so you don't really understand, and you've got all the other problems of having, after having a baby as well, plus that, it's like a bit-, takes you back.

And did you feel anything about yourself?

I, I think it got me down a little bit. I got to admit, I think I would have preferred to have' I think because I was so out of it and didn't get that time with him, I think, like after, it should be happy. Because I, I just wanted to go to sleep and they end up giving you an injection' I think I had a morphine injection so I was just out of it anyway, so like, all through the night after he was born, the first twenty-four hours after he was born, my partner looked after him, basically. I never, I couldn't' you can't get out of bed to go and get a bottle. You've got to call for someone to get it, and then they've got to get the baby and pass the baby to you, it's like everybody's doing things for you, you can't do anything for yourself. 

So, how long did you feel down for, do you think? 

Not long, it sort of picked up. It was only the first, when I was in hospital, because of the lack of sleep, because it's not just you, there's the other babies crying, and I think that was' once I came out of hospital and got back into my sort of own, I felt okay then.
 

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. 

 

She felt very let down by the lack of support she experienced on the hospital ward. It was hard...

She felt very let down by the lack of support she experienced on the hospital ward. It was hard...

Age at interview: 31
Sex: Female
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You said about the aftercare. Do you want to tell me what happened afterwards that concerned you, or what happened?

Right' Well, I mean everything was fine during the birth and that and the women down there were, were brilliant, but up, up in the ward, I just' the only way I can describe it - and I can remember saying it to mum and dad - was I felt like a burden on them. And I mean, having a section, I mean, it's major surgery, you're kind of limited, I mean, I was in bed with a catheter and a drip, got newborn baby beside me, never held a newborn baby in my life, wanting to breastfeed, and I just felt' I felt like I was a burden because I needed people to help me get the baby and I didn't feel like they were very forthcoming in helping. It was like there were no allowances for' you know, it's like, 'It's your baby, get on with it'. And it doesn't matter that you're hooked onto a drip, catheter, you know, you've had a great big wound in you and you're trying to reach over and' so I did feel really, like' I mean a lot of it could have been made worse' the fact that you've just had a baby and your emotions are all over the place. But I didn't feel like the aftercare was very good at all. And it's the one thing I'm not looking forward to this time. Because I've got a section booked for Monday, so I will be having another caesarean and I just want to get in and out of hospital as quickly as possible basically. 

And how long were you in for, after the first birth?

I had my daughter in the early hours of the Monday morning, and I was out on the Wednesday. So, it was just two nights.

And that was long enough?

Yeah, I just wanted to get out.

And, and it didn't improve at all as you felt better?

I don't think I was in for long enough, basically to really see. There was one girl that was brilliant; she was a young girl and she was fantastic. But the rest of them I didn't rate, and I mean, I had women opposite me, one woman that didn't, did not want to go home and they were basically like, 'Go!', you know, 'We need your bed space, just get out and get on with it. ' So there's just no allowances at all. I mean, as I felt, once, once I'd got rid of the catheter and the drip and I was up and about, you do feel better. But it's the fact that you were bed-ridden, and you're just like, you are relying on these people to give you a hand and, you know, and you just didn't feel like they were very willing to do so.

 

She felt reluctant to ask staff for help, but was glad they convinced her to stay in hospital for...

She felt reluctant to ask staff for help, but was glad they convinced her to stay in hospital for...

Age at interview: 40
Sex: Female
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And how did you feed your baby?

Breastfed.

And that wasn't complicated at all? 

Tiring, because I was obviously tired after the operation. Not as mobile as I would have been, if I have had him naturally' and so I was really pretty exhausted but I persevered. And I had a lot of help so that did' that was good.

And was that at the hospital you had the help?

Not necessarily at the hospital, when I came home, the first sort of four days because I was in hospital about four or five days I was fortunate I had my own room, that was fantastic. But the midwives just popped in as they would go and see the other people on the ward and they expected you to ring the bell if you needed help and I'm one of those people that don't ring the bell. I can do this, you know, it was my first child as well so I don't need to support, so I was pretty tired because I just persevered with it and upon reflection I probably would've asked for a little bit more help.

So do you think more should have been offered?

Yeah I would've liked that, not knowing what they should've done, but I would've liked that.

And do you think that that's part of an expectation that you should know what you're doing?

Yeah absolutely and I think they want you to think that you know what you're doing so that you can cope when you get home. You know you have had a major operation but you've still got to breastfeed, you've still got to get up in the night or your partner has got to get the baby for you or whatever and you've still got to do that every' if you're breastfeeding it was quite regular for me you know every two hours so it was quite exhausting. And so I was thinking they were just preparing you for when you got home. Whether that was the case I don't know, whether they were just so busy and they forgot I was in the room I don't know, but' [slight laugh].

And did you feel confident when you came home? 

Yes. I actually wanted to come home earlier though and they really persuaded me to stay and I'm so glad they did. I think I had a bit of... they call it the baby blues and a bit of the postnatal oh what's all this about and I just wanted my home comforts. But I know if I had gone home when I wanted to which was three days after, I wouldn't have been capable of- I think looking after the baby as efficiently as I did when I waited another two days.

Do you think you would've been overwhelmed?

I would have thought so yeah. I mean it showed me just a few more things like bathing the baby, and I had more opportunity to change the nappy with the midwife being there and just checking on the breastfeeding and little things that I think I would have missed out on.
 

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.

 

She felt like she had failed as a mother. Breastfeeding was a struggle and when she gave up, it...

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She felt like she had failed as a mother. Breastfeeding was a struggle and when she gave up, it...

Age at interview: 31
Sex: Female
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And how did you feed your son after?

I breastfed [Son] for about six weeks and then I stopped just because I was recovering from the section and I'd just had got like quite bad baby blues with [Son], just through the whole experience of having a section and not achieving vaginal birth and then, having, being a new mum is not as what' I'm not saying that it's, it's really bad, being a new mum but it's, there is parts to it that you, you do' nothing can prepare you for, you know? 'Your hormones are all over the place, so I just put him onto the' I found it very tying and I put him onto the formula, so'

Okay, that's great. And you, you'd said that it, you had this kind of sense of disappointment. Could you explain that a bit more? 

Well, just, I just felt less of a mum. I, I can't explain it, I just felt that I hadn't achieved a birth. I don't feel like, I feel like I'd been cheated out of it. That's what I felt.

Okay, thanks.

And when I look back now I regret not pursuing with my breastfeeding' because I felt even less'When I gave that up, I felt even more like disappointed.

And how long did you say, would you say that you had the baby blues for and when did you start to feel okay, that's it, I'm gonna'?

I think I, I had him for-, I mean, I had it for quite a while, and I think with chopping and changing [Son] off the breast onto the bottle and then I felt guilty so I put him back onto the breast again. And then he got a virus because he was born in December and he just got a cold and that so he was in and out of [Hospital] just being monitored, and that made me even worse, feeling that I wasn't' being a good mum at all. So it was a lot of nonsense, just all in my head [slight laugh].

No, it's hard isn't it?

Yeah, you just, because you worry for them so much, your overwhelming feeling of responsibility for this wee, wee baby, you know, so, yeah, so it was probably two or three months anyway.
 
 

She experienced postnatal depression for several months after the birth. Her husband's support...

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She experienced postnatal depression for several months after the birth. Her husband's support...

Age at interview: 31
Sex: Female
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I was never actually diagnosed with post-natal depression but I do think I had it, and I think that was maybe a combination of the pregnancy, the labour and the failure with the breastfeeding.

Why do you, what makes you think that you, you did have depression? Could you explain why you think that was?

I was just' I couldn't sleep at all, I was absolutely terrified the whole time. I would wake up in the middle of the night, pulling at the bed sheets, thinking [son's name] was falling out of bed and I just didn't feel I was coping at all. I felt like I was a bad mother and I just hadn't managed anything right. I hadn't managed the pregnancy, I hadn't managed the labour, I hadn't managed the feeding. 

And how long did you feel like that for?

It would be about six months.

And what, what changed to make you feel better?

My husband finally sat me down and he was like, 'Well, this is ridiculous, you know. You are a good mum and these were things that you couldn't have done anything about, so', that was basically it.

And did that help?

It did, yeah. Just the fact that he was being so supportive.

And is that a worry this time for you?

It is actually. I'm quite concerned I'm going to get post-natal depression.

Have you, have you talked about that with anyone?

No.
 


* Hobbs AJ, Mannion CA, McDonald SW, Brockway M, Tough SC. The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum. BMC Pregnancy and Childbirth. 2016;16:90. doi:10.1186/s12884-016-0876-1.

Last reviewed August 2018.
Last updated August 2018.

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