Q & A: Preparing for Cesarean Delivery

Amber asks:

I am pregnant with twins and will be having a scheduled cesarean section.  I intend to exclusively breastfeed my babies. What can I do to prepare for the delivery and recovery so we get off to a good start with breastfeeding?

You’re off to a great start by planning ahead!  Many hospitals offer a prep class that will at least briefly address the “what to expect” questions regarding cesarean deliveries at that hospital, but I wanted to take a moment to address some factors that might be especially useful for an expectant mom of twins (or triplets, or more) who is anticipating a cesarean delivery and planning to breastfeed. A basic breastfeeding class, or a class focusing on multiples, would also be a good background.

Here are some thoughts about recovery and preparing for breastfeeding:

1. A cesarean delivery is major abdominal surgery. It’s easy to lose sight of this in the haze of “new baby + new baby” but it’s also important to take care of yourself so you’re able to take care of your new arrivals. Follow your practitioner recommendations for recovery – which are likely to include both to get up and moving as soon as you can AND to take it easy. “Up and moving” means to the bathroom and back in the early days, but the motion helps your body manage the fluids from surgery. Taking it easy means not doing much else.
2. Breastfeeding early and often is very helpful, not only for the babies but for stimulating uterine contractions which reduces postpartum hemhorrage. Ask for help positioning the babies. You may find that you prefer to feed the babies one at a time in the early days, or you may prefer tandem feeding with assistance. Hospital beds are not the most comfortable setup in the world, so try to be flexible about how you position babies in those early days. There will be plenty of time for a double nursing pillow, even if you find it doesn’t work well in the hospital.
3. Plan to have someone able to stay with you in the hospital at all times to help manage the babies, especially in the first couple of days after you deliver. This may reduce your need to ask the nurses to take the babies so you can rest – since early and frequent breastfeeding is good for all of you. If you have more than one support person available to you (your partner and your mom, for example) have them take shifts with you in the hospital – it’s incredibly helpful to have a well-rested (or at least semi-rested) support system.
4. Some moms find that a postpartum support belt helps to reduce the pain and pulling from coughing, sneezing, laughing, etc. You may find that simply holding a pillow to your abdomen will provide the necessary counterpressure to keep you comfortable as you cough, laugh, or sneeze.
5. You may have activity restrictions when you come home from the hospital. Often, moms recovering from surgery are limited to one trip up and down the stairs each day, so you’ll want to be prepared to “camp out” in one room for much of the time. Many moms like setting up a daytime “station” (maybe the living room) and a nighttime station (the bedroom) – each equipped with diapering supplies, spare clothes, burp cloths, and your breastfeeding supplies (pillows, water bottle, etc.). At a minimum, you will want each floor of your house to be equipped with your basic baby-care supplies so you don’t need to go back and forth for diaper changes.
6. Finally, if you do have to be separated from the babies due to any complications, ask for and initiate pumping as soon as you can! Early breast stimulation is important for bringing in a full milk supply, and even the smallest amounts of colostrum (early milk) are extremely beneficial for your babies.  You may find that hand expression works well for you in those early days. Studies have also shown that hand expression techniques can maximize milk removal when combined with the use of a breast pump – this is called hands-on pumping.

A quick note: Talking about the relative likelihood of a cesarean delivery in no way should be construed as a statement about the potential for vaginal delivery of your multiples. It is certainly possible to have a vaginal delivery of twins. Some providers are comfortable assisting in the delivery so long as Twin “A” (the baby closest to your cervix) is vertex (head down), some only if both babies are vertex. Check with your own provider about their experience with vaginal twin deliveries, and ask about their comfort with a breech presentation on the second twin. Some doctors (and many midwives) are trained and comfortable assisting with a breech extraction if the second baby does not turn vertex (or flips around after the first baby is birthed) and some practitioners are not. It’s a reasonable thing to ask about.