Newborn feeding: Special circumstances

Breastfeeding after Cesarean birth

Giving birth by Cesarean will not prevent you from breastfeeding. The pain medicine(s) you receive are safe for your baby.

However, you may need a little help the first few days positioning and burping your baby.

Here are some suggestions to make breastfeeding easier:

• Use pillows to keep your baby off your incision and in a good breastfeeding position.
• Take pain medicine so that it is working when you begin nursing.
• Let others take care of things so that you can rest as much as you can.
• Eat well and drink plenty of fluids to help your body heal from the surgery.
• At home keep your baby in your room for easier access at night.
• Limit your activities and housekeeping so you have energy for your baby and breastfeeding.

Breastfeeding twins and more

You can breastfeed if you are a mother of multiples. It may be helpful to work with a lactation resource while you are in the hospital so that you can get information and support right away.

At first it will be easier to nurse each baby separately. That way you can make sure that each is in a good position and has a good latch.

As your babies get bigger and used to breastfeeding, you may be able to nurse twins at the same time. Your lactation resource can show you the best ways to position them for this.

Breastfeeding a premature baby

Breastmilk is the best food for a premature baby. It can help prevent infection, promote growth, and shorten your hospital stay.

Your nurse can help you master pumping and storing your milk so that it can be fed to your baby.

As your baby grows you will be able to breastfeed her directly. Skin-to-skin contact can provide closeness until your baby is strong enough to nurse on her own.

Returning to work or school

You can continue breastfeeding after you return to work or school. Continuing to breastfeed may help you and your baby reconnect at the end of the day.

You may wish to start pumping once breastfeeding is well-established, usually around four weeks. Pumping before you need to return to work or school will:

• help you become comfortable with the breast pump
• let your baby practice using a bottle
• establish a supply for the first couple of days after you return to work.

It can be helpful to talk to other mothers who are continuing to breastfeed. Talking about your feelings with your partner is important for both help and support.

• Spend the first three or four weeks with your baby establishing your milk supply with your baby at your breast.
• Start pumping when breastfeeding is well established at about four weeks.
• Pump for each missed feeding.
• Talk with your lactation resource to create a plan for you.
• Nurse often to boost your milk supply and reconnect with your baby.

Talk to your employer

Some companies have programs to support breastfeeding mothers. You have the right to pump breastmilk when you return to work.You may also have the option of extending your maternity leave, working part-time for a while, working from home some of the time, or job sharing.

Choose a supportive day care provider

Share information about how to store and thaw breast milk with your day care provider. Ask that your baby not be fed right before you are scheduled to return so your baby will be ready to nurse. If your baby is hungry during that time, the day care provider should give your baby one-half of an average feeding of breastmilk.

Introduce a bottle before you return to work

When your milk supply is well established and your baby is nursing well, introduce a bottle. Your baby may be more receptive if someone else does the feeding. Then, offer a bottle occasionally to remind your baby of this option.

When you put breastmilk in a bottle, consider the average feeding for a baby younger than 3 months is two to five ounces. But remember, every baby is different.

Rent or buy a high-quality, automatic breast pump

You will need something more than a hand-held pump to maintain your milk supply. Depending on your work situation and where you will be pumping, choose an electric or a battery-operated pump. Look for a pump that will cycle on its own rather than require you to release the pressure. A breast pump should never cause you pain.

Use a double-pumping kit

This will enable you to express milk from both breasts at the same time. Expressing from both breasts saves time and will help maintain your milk supply.

Give the pump a trial at home

Become familiar with the pump before using it at work. Knowing how it works will help you relax while you're using it.

Try not to start back to work on a Monday

If you can, return midweek so that you only have a few days until the weekend. This can make the transition easier.

Remember the law of supply and demand

The more your baby or a pump stimulates your breasts, the more milk you will produce. Don't skip a pumping session at work.

Work feedings into your schedule

Nurse just before you leave in the morning. If you can, meet your baby for lunch. Pump two or three times during your workday. Have each session last 10 to 15 minutes.

Be patient

You may feel anxious or nervous the first few times you try pumping at work. This can inhibit your milk let-down reflex. Massage both breasts for about 30 seconds before starting to pump. Be creative in finding ways to relax:

• Listen to music through headphones.
• Look at a picture of your baby.
• Imagine nursing your baby.

Refrigerate the milk

If you don't have a refrigerator at work, use a cooler case.