I was recently alerted to some Dutch research (March, 2023) that detailed the incredible function of breastmilk after a caesarean birth. Now I must stress that I am not expressing views around cesarean birth and I am instead trying to speak in facts.
The facts are that when a baby is born vaginally they encounter health benefits such as being squeezed through the birth canal which helps break up the fluid in a baby’s lungs. The bacteria that babies encounter if born vaginally begins the process of colonizing their gut to offer protection to their immature immune system.
The bacteria that babies encounter if born vaginally begins the process of colonizing their gut to offer protection to their immature immune system.
What if your baby isn’t born vaginally? Knowing that their baby will miss the introduction of key friendly bacteria combined with the fact that antibiotics may be prescribed which also interfere with gut flora, some parents opting for an elective c-section may prepare by ‘seeding’ their baby’s biome.
Essentially, this involves transferring a mother’s vaginal fluids to their baby’s mouth, face and skin by wiping the parent’s vaginal area with a sterile cloth then wiping the baby with it. This may sound out there but I once taught a couple a hypnobirthing course and when I explained the absence of vaginal flora and fauna transferring to the baby during a caesarean the dad-to-be said, “Well couldn’t you wipe the mum and then the baby after to transfer the bacteria?” Yes! It seemed an obvious solution to him.
“Microbiome transfer and development are so important that evolution has ensured that those microbes are transferred one or another way from mother to child. Breastfeeding becomes even more important for children born by cesarean section who do not receive gut and vaginal microbes from their mom.” – Professor Debby Bogaert, University of Edinburgh
A 2023 study conducted by Professor Debby Bogaert, Dr Wouter A.A. de Steenhuijsen Piters et al. aimed to understand how a baby’s microbiome develops during the first month of life. The researchers found and sampled 120 Dutch mothers and soon-to-be-born babies. They collected skin, nose, saliva, and gut microbiome samples from the babies two hours after they were born then again when they were one day old, one week old, two weeks old, and one month old.
From the mothers, the team also collected six different types of microbiome samples—skin, breastmilk, nose, throat, fecal, and vaginal—to determine which of these sources were responsible for “seeding” the babies’ various microbiomes. They then analysed these results against several factors that are thought to impact microbiome transfer, including mode of delivery, antibiotic use, and breastfeeding.
Dr de Steenhuijsen Piters, a physician and data scientist at the University Medical Center Utrecht, writes that, “We saw that many niches of the mother are important for the transmission of microbes, and if some of these pathways are blocked for one reason or another—in this case, we saw that happening with the cesarean section—then these microbes can still reach the infant through other paths,” says Dr de Steenhuijsen Piters.
Researchers found that regardless of the method of birth by which a baby is born that approximately 58.5% of a baby’s microbiome comes from their mother. Cesarean-born babies, however, received fewer microbes from their mother’s vaginal and fecal microbiomes, but— by comparison —acquired more microbes from breastmilk. Fascinating right?
This means that as well as your body tailoring milk production to the gender and needs of your baby it can also account for their method of birth. The after effects of the absence of bacteria being introduced during a baby’s birth have been established.
“For a long time, Cesarean section birth itself has been associated with certain outcomes—for example, obesity, Type-1 diabetes, and allergies,” explains de Steenhuijsen Piters. Additionally, substantial microbial differences in C-section babies have been shown to directly cause some of these health conditions.
Which barriers might mothers face when attempting to breastfeed after a caesarean?
Skin-to-skin is celebrated as a crucial part of bonding with your baby and establishing breastfeeding. However is you are going to have a surgical birth then the gown along with the pre and post op preparations may get in the way. You may decide to wear your hospital gown back to front so that your chest area is accessible for your baby and that any monitoring aids can be adhered to your back to leave the area free also.
Post-surgery discomfort may cause difficulty when trying to feed your baby for the first time. Feeding pillows* definitely have a place for relieving strain and ensuring comfortable feeds. However, pillows should be used once you have attached your baby at the breast and ensured a good position and latch. The steps for doing so require your baby to be close to you, their body inline and your nipple should be aimed at their nose – encouraging them to tip their head back (supporting their head at the base will allow this) and get a full mouthful of your breast tissue.
Feeding pillows definitely have a place for relieving strain and ensuring comfortable feeds.
The feeding position often used by mums recovering from c-sections is the rugby ball hold where the baby lies alongside their mother, their body under her arm pit and face looking up towards the mother’s breast.
Rest and recuperation and accepting offers of help from loved ones would be especially important for a mum wanting to establish breastfeeding after a caesarean.
With the right support and ensuring breastfeeding can be implemented comfortably would mean babies can then have access to the essential microbiome that they missed at birth but that the mother’s clever body is accounting for in equipping breastmilk with the friendly bacteria that can help their baby thrive.
Bogaert D, van Beveren GJ, de Koff EM, Lusarreta Parga P, Balcazar Lopez CE, Koppensteiner L, Clerc M, Hasrat R, Arp K, Chu MLJN, de Groot PCM, Sanders EAM, van Houten MA, de Steenhuijsen Piters WAA. Mother-to-infant microbiota transmission and infant microbiota development across multiple body sites. Cell Host Microbe. 2023 Mar 8;31(3):447-460.e6. doi: 10.1016/j.chom.2023.01.018. PMID: 36893737.
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