Not producing breast milk in the period immediately after birth is common in medicated deliveries.
The milk is designed to "come in" after about three days. Before that your baby drinks colostrum, a thin, yellowish first milk.
If you have had a caesarean, which is now the mode of delivery for one in four women, you may find that it delays your milk coming in or that you have a lower supply.
This is because the analgesia may cause the baby to be drowsy and affect his ability to root and suckle. Research has shown that even one injection of Demerol in a vaginal birth can have this effect.
As the initial infant reflexes are crucial to the successful establishment of breastfeeding, this is of concern to medical professionals, who are trying to develop pain relief options that don’t pass through the placenta.
Babies born to mothers who had an epidural have in one study been shown to have lower motor skills, including rooting behaviour, which persisted for eight hours after delivery.
Caesarean mothers may also produce less oxytocin and less prolactin. Prolactin is necessary for both the formation of milk and its ejection from the breast. This is why some C-section moms find that their milk supply is low, or they take longer to produce milk after childbirth.
This, coupled with post-operative pain can lead to a failure of breastfeeding. If you have had a caesarean or a medicated vaginal birth, you can do the following to try and increase your supply:
1. Use a breast pump in addition to trying to feed your baby directly, as this may stimulate your breasts to produce more milk.
2. Don’t top your baby up with formula, this will just compound the problem because the fuller he is, the less he will try to breastfeed and your supply will diminish even further.
3. If your baby wants to feed, feed him as much as he wants. Don’t schedule feedings.
4. Don’t give your baby a pacifier until he’s at least six weeks old, as babies who suck on pacifiers suck less at the breast. It might also give him "nipple confusion" and cause him to reject suckling at the breast if it is offered before your milk supply is established.
5. When you are breastfeeding, carry on for as long as the baby wants and don’t switch sides before he has finished one side. If you do, he may only get the foremilk (watery milk that is his drink). Babies have to feed for longer in order to get the hindmilk (the creamy milk that is his food).
If he consistently only gets foremilk, he may not gain enough weight. You can tell if he is getting milk because you will hear him swallowing it, faster at first while he’s hungry and then slower as his appetite is satisfied.
6. If you’ve had a caesarean and are afraid to breastfeed due to pain, try the "clutch" or "rugby ball" hold where you hold your baby at the side of you, in one arm, with his head to your breast. This means you don’t have to lie him across your scar and will prevent any extra pain.
7. If he is excessively sleepy and this is what is hindering the breastfeeding relationship, undress him completely and hold him against your skin. This is called skin to skin contact or "kangaroo care" and can wake up a sleepy baby and stimulate his senses so that he will want to breastfeed.
8. Let your baby suckle for comfort as well as for feeding and this should increase your supply.
9. Remember that not producing enough breast milk is actually a rare problem. It is however the most common reason cited for discontinuation of breastfeeding by mothers in industrialized countries where formula milk is readily available.
In very rare cases you may have an illness called postpartum hypopituitarism. This is decreased functioning of the pituitary gland in the brain, after childbirth.
It is caused by complications such as hemorrhage and shock, amniotic fluid embolism or HELLP syndrome and may cause you not to produce breast milk. If this happens, you will be given hormone replacement therapy for the rest of your life and this can stimulate milk production.
10. If your milk supply is consistently low, your baby may become dehydrated and fail to thrive. In this case you can ask for a drug called domperidone which should increase your supply. If you’d rather try something natural, fenugreek herbal tea has also been shown to increase milk supply.
Sources:
Effect of caesarean section on breast milk transfer to the normal term newborn over the first week of life, Archives of Disease in Childhood, Fetal and Neonatal Edition, volume 88, issue 5, 2003.
Full Text: http://fn.bmjjournals.com/content/88/5/F380.full
Analgesia after Caesarean Delivery, The Free Library. Web. 9 August 2012.
http://www.thefreelibrary.com/Analgesia+after+caesarean+delivery.-a0204614214
Low Milk Supply, BabyCentre. Web. 9 August 2012.
http://www.babycentre.co.uk/baby/breastfeeding/problemsandsolutions/lowsupply
Increasing your Milk Supply, Ask Doctor Sears. Web. 9 August 2012.
http://www.askdrsears.com/topics/breastfeeding/faqs/increasing-your-milk-supply
The effect of galactagogue herbal tea on breast milk production and short-term catch-up of birth weight in the first week of life. J Altern Complement Med. 2011 Feb;17(2):139-42. Abstract:
http://www.ncbi.nlm.nih.gov/pubmed/21261516
Sheehan Syndrome, University of Maryland Medical Center. Web. 9 August 2012.
http://www.umm.edu/ency/article/001175.htm
Reviewed August 8, 2012
by Michele Blacksberg RN
Edited by Jody Smith