C-section vs. VBAC -- it's all about the nursing

On Friday I returned to my OB for the first time since my post-partum Jack-pot appointments.  I am beginning to remember now that I got a lot of magazine reading done while pregnant the last time, due to waiting times in both the waiting room and then in the exam room.  There is no BusinessWeek or Time in the waiting room there, so I don't have to worry about doing serious reading.  I can read House Beautiful or Coastal Living with no guilt about how I should be working instead.

When my OB asked me whether I wanted to schedule a C-Section or try for a VBAC (vaginal birth after cesarean), I realized that all my thinking around this mostly has to do with breastfeeding and wanting it to be successful the next time around.  Exclusively Pumping was HARD. [Please check out this blog from an exclusive pumper who is doing it now with grace and little complaining. And she has a very cute baby too.]

It's not hard to do a pump session.  But when you are doing eight lengthy pump sessions every day, it becomes absolutely grueling!  Every time I gave up a pump session I was sad for about 10 minutes.  Then I would realize, OMG, I have more TIME!  I can sit down and rest for a few minutes!  I can do... whatever I want!

So there are some things that I want to change this time around about my hospital experience.  These things may or may not have contributed to our bad nursing experience.  But I need to give myself the best chance of success in terms of nursing the new baby.  I will Exclusively Pump again if I have to. But I DON'T WANT TO I DON'T WANT TO!  I want to have the baby fall asleep at the breast and be able to doze off myself and not have to put the baby down, grab the pump equipment and spend a half hour being milked when I could be cuddling my little boy.

Some things I think may have contributed to our problems:
1. I asked the nurse before my c-section: will you give me my baby to nurse after the procedure is over?  She said no.  And indeed, with the extra fluid that had not been squeezed out of Jack because he didn't travel down the birth canal, he spent a small amount of time in NICU having fluid sucked out of his respiratory system.  This delayed me getting him.

2. I asked the nurse to give him to me after we were in the hospital room.  They said no, his body temperature was too low. AND THEN THEY GAVE HIM A BATH INSTEAD!  This delayed me getting him again.

3. He was a sleepy baby -- always falling asleep before getting a full feeding -- and I am wondering if this is because of the drugs for the c-section and the narcotics for recovery that mom used.

4. Immediately after the c-section I wasn't able to get up to get him to nurse, so I was at the mercy of the nurses. Some of them were great and some of them were not.  I want more control next time.

 

And these things make me wonder if I should try for a VBAC.  I don't really want to personally. My c-section last time was easy, without complications, and healed very quickly. But if it would mean the difference in terms of successful nursing, a VBAC would be totally worth it.

Comments

[Plain Jane Mom]

I'm no expert, I just have my own experience. My 2 c-section births ended with me nursing my kids for 1 year each.

For different reasons, they each were also in the NICU for several days after birth, so breastfeeding was even more difficult.

I guess I'd say that in my experience, breastfeeding success was not related to c-section. But that's just me ;)

Good luck with your decision!

[Eva]

Thanks for the shout-out! (Wow, that is a very dorky thing to type).

I had a c-section too (breech presentation, preeclampsia, 37w5d).

If I am lucky enough to give birth to another baby (though sometimes I struggle with the idea that, having had a c-section, I did in fact "give birth" in the first place), I think I would want to try for a VBAC strictly for breastfeeding reasons as well.

My LC says that c-sections, in her experience, are often a complicating factor in troubled breastfeeding relationships for the following reasons:

--the IV fluids engorge your breasts;
--the epidural affects the baby in some way I can't recall;
--you don't get the baby right away and by the time you do, baby is usually past the alert-I'd-like-to-suckle phase and into the dead-tired newborn phase;
--the mother has trouble moving around and is often on serious drugs;
--the hormones of labor (for planned c-sections) aren't in place that stimulate a) the baby to be ready to be born and b) the milk to get a move on;
--hospitals monitor c-section mommies more and their babies more and are more likely to jump in with formula at any sign of trouble, thus leading to nipple/flow preference;
--planned c-sections are usually done at 39 week or even earlier, and given the lack of precision of dating a pregnancy, and the fact that (according to my godlike LC) babies born before 40 weeks are full term for everything EXCEPT nursing, you are more likely to have a baby who has trouble learning to nurse;
--you typically are in the hospital longer, which can make it hard to relax and get into the groove of a good nursing relationship.

So, I'd really like a VBAC, in theory, to avoid those things. (Before I had my baby I was all into having a fantastic birth experience, but now I am tremendously more focused on the breastfeeding relationship--I mean, which lasts longer, anyway?)

But in reality, I bet I will never have a vaginal birth. The statistics are against me, and the preeclampsia I had before is against me, and there's this other thing: I am already going to be totally crazed with anxiety about getting breastfeeding "right". I'm not sure I also want to be fretting about getting birth "right"--fighting with the hospital, the OB, the nurses. I might just want to let that battle go and go through something I have done before and will therefore feel more in control about so I can conserve my energy for nursing.

Again, though, it took 2.5 years for me to get pregnant the first time. I should count myself lucky to have to worry about this decision in the future.

[Mel]

Is there research that discusses the trends with breastfeeding and a vaginal or c-section birth? Mine were vaginal, but since I don't produce Prolactin, breastfeeding didn't really work. I wonder if the ease of breastfeeding is tied more to the ease that would be there regardless of circumstance with a smaller number of cases tied to not having immediate access to the baby/recovery. Is there a doctor you can ask for statistics?

[Aurelia]

Interesting idea...there is another option, and that is to switch to a hospital that will ensure you are able to nurse after a c-section. (You're moving anyway...this could be a criteria?) My hospital is so committed to helping moms that they put the baby to the breast immediately after birth, right while you are being sewn up after the section. Yes, the nurse has to hold him, no big deal...that hospital is committed to making sure all women get to breastfeed, c-sections, preemies, etc.
For example, lots of women have epidurals, I had one up to my shoulders done with morphine at the end of my first pregnancy with my oldest. He latched on just fine. A really good place to look for research on this might be Dr. Jack Newman's book/website. He's a breastfeeding expert and I'm sure a good place to get some ideas.

[maureen]

I didn't have any trouble breastfeeding after my c/s with my first son because the lc at the hospital immediately brought in a pump after my c/s and put me on a pumping schedule to help get my milk flowing. When my son was ready to feed in the NICU my milk was all ready and I was able to get my colostrum to him by bottle for his first feeding. It did not interfere with his later latching. Good luck either way you choose. I am making that decision now for my second son.

[Zara]

wow, how depressing. I live in the UK and here it's standard practice to have a nurse assigned to you immediately after the cesarean specifically to encourage the baby to the breast (basically she's there to help position you both!) Formula is NEVER given unless the baby hasn't eaten anything for upwards of 48 hours. But nobody expects women to be producing actual breastmilk either - I was told repeatedly with both my children that my milk wouldn't 'come in' for a few days and that my baby should be suckled to encourage it to come in, and that he would be fine etc etc.

I've had two scheduled c-sections and no problems with breastfeeding either time. I did refuse any painkillers stronger than codeine though - no NSAIDS as I am allergic and no opiates. So maybe that made a difference, though I was very uncomfortable!

The whole breast pump is weird to me too - hospitals always have them available but feel they cause more harm than good in the few days after birth.

[Tanya]

VBAC can mean so much more than successful breastfeeding. The recovery difference is nothing short of amazing. Being able to care for your infant at birth instead of relying on others is no comparison. I don't even remember the first couple days of my son's life because of the general anesthesia and pain relief after the surgery. I remember every vivid detail of my daughter's births (one hospital VBAC and one homebirth VBAC). Sadly, they are memories that I don't have of my son's birth. I have nursed all three of my children (still nursing #3 at six months). I highly recommend getting in contact with La Leche League while you are pregnant. Get your support system in place before the baby is born.

And no matter what method of birth you decide on, the hospital is employed by you. Policies are not set in stone, as much as they would like them to be. Get a birth plan and have your pediatrician and OB sign it. Be kind, but firm with your wishes in the hospital. In the event of a c/s, a doula can be there with you while your husband goes with the baby to make certain your wishes are followed. Good luck!

[Morgan Humble]

My first son was delivered using normal delivery. It was okay, I didn't regret the experience. The second one was tricky. Apparently, I had problems with my womb and I couldn't do a normal delivery again, so I opted for the C-Section. It was also okay and I have to thank my doctors for being so gentle with it. I don't know if I'll be pregnant again. But I think another C-Section is the way to go on my third child.