Emergency C-Section in Egypt

Premature twin in incubator

The twins spent their first few days in an incubator in the NICU in Egypt.

To say I was excited when I found out I was pregnant would be an understatement.  I had dreamed of being a twin when I grew up and always thought I would love to raise twins. Still, I’m not sure anyone can be totally prepared to hear they are having twins! This excitement quickly turned to fear though when I realized I would have to birth twins.

I really wanted to avoid a C-section and I planned and prepared all throughout my pregnancy.  We were living in Egypt and my doctor strongly encouraged me to have a planned C-Section.  When my boys were breech and not changing positions we made plans to return to the states where my doctor was still keen to let me try to birth them vaginally.

breastfeeding premature baby

First time to attempt breastfeeding my twins – 26 hours after birth.

Fast forward to January 24th. . . I was 32 weeks, 3 days pregnant without problem. I felt great, well, except for feeling like a blue whale, but don’t all pregnant women feel large at the end?!  I was packing and preparing for our return to the states just four days later.  That morning I woke up around 8:00 a.m. and felt mildly uncomfortable in my still half-asleep state. I tossed and turned a little and remember saying, “I think I’m having a contraction.” My lower abdomen was tightening, but I figured it was just Braxton-Hicks . . .

After getting up and taking a shower, these mild contractions suddenly turned into intense labor with contractions coming almost on top of each other.   We called my doctor (who had been quite relieved when he learned we were going back to the states) and we headed to the hospital in Egypt instead.

syringe feeding colostrum

Since they were losing weight at the breast I syringe-fed my colostrum to the boys.

We arrived at 9:45 a.m. and I was already dilated to 8 cm. Since they were breech the hospital doctor wanted to prep me for a c/s but I refused. I was taken upstairs to labor and delivery and I could feel the contractions change and I had the urge to push – I knew I was now fully dilated. But, I didn’t feel a peace to work with the contractions and push those babies out without my doctor there. (I look back now and have to laugh at this scene because here I am on a bed in the hallway because the medical staff at the hospital didn’t know what to do with this foreigner who was refusing a c/s – and they didn’t know how to help me birth breech twins! We were all just waiting for my doctor to arrive.)

My doctor did arrive and said on the way he’d been thinking about it and he had decided he would give me the opportunity to birth them naturally. I was so thankful. He went and washed up and I went to the delivery room. However, when my doctor checked me his entire demeanor changed and I could sense the intense worry in his eyes. He said he had talked with the neonatologist and both really recommended a c/s.  I just didn’t have a peace to do this naturally without his support – especially since just a few minutes earlier he was okay with me trying for a natural delivery.

Syringe feeding colostrum when my newborn preemie was unable to latch on.

Syringe feeding colostrum when my newborn preemie was unable to latch on.

At this point I didn’t even have an IV so they put me under with general anesthesia.  They put the mask on my face and I was out.  They were born within a couple minutes – which makes me thankful that James and Luke still didn’t get exposed to much anesthesia.

James was born first (3 lb, 15 oz.), and then Luke (3 lb, 13 oz). They received a surfactant lung treatment since there had not been time to give steroids to me to boost their lungs before their birth. They also had extra oxygen to breath for the first 24 hours (their heads were under an oxygen bubble) and the next day they were breathing fine on their own.

We were in the hospital for six days before bringing our twins home.  (I realize that they would have probably stayed much longer had we been in the states as they were just 3 ½ pounds when we brought them home!)  You can read about my journey breastfeeding these little guys here.

Premature baby's hand

My boys were both under 4 pounds (1.8 kg) at birth.

Though this birth was nothing like I’d planned or hoped, I am very thankful they were born healthy and safe.  It is okay, and important, to grieve a birth that doesn’t go as planned.  I took comfort in knowing that I had done everything I could to prepare for a natural delivery – even to the point of buying plane tickets to another country!  I wonder sometimes what would’ve happened if I’d just pushed them out.  I do wish it hadn’t ended in a C-section but, more importantly, I am thankful they are safe and healthy.  And even though there were many “strikes” against us making breastfeeding difficult (preemies, twins, emergency C-section, not breastfeeding for the first time until 26 hours after delivery, no skin-to-skin after birth, and more) we made it.  Determination can overcome these barriers and more!

Breastfeeding after C-Section

Breastfeeding after a C-Section

Whether you had a planned cesarean section or labor didn’t go as you’d hoped and you ended up having an unplanned one, breastfeeding following this type of delivery is still completely possible.  In fact, being able to nurse your baby will not only establish a strong bond together but can help overcome any guilt or regret some moms feel after an unplanned cesarean section.

How long must I wait following a Cesarean section to begin breastfeeding?

Physiologically, you do not need to wait to hold or breastfeed your baby, although you will need assistance.  But, each hospital has its own set of regulations regarding this.  If you have a planned C-section, you can discuss their policy and possibly negotiate this in advance.  Hospitals typically do not encourage rooming-in for the baby immediately following a cesarean but when a new mom has another person to help, keeping the baby in the room with her at the hospital is very doable.  This can further aid breastfeeding: mom is able to watch early feeding cues the baby gives and nurse regularly; there is less chance that baby will be given formula in an attempt to “allow the mother to rest;” and skin-to-skin time will be easier and more frequent as mom and baby are near one another without interruption.

What if my hospital is not supportive of nursing my baby during recovery?

If your hospital will not allow you to nurse your baby during recovery, you could plan to have your baby in skin-to-skin time with his father and then nurse/hold baby skin-to-skin immediately following recovery.  While some hospitals are beginning to change their policies regarding this and allowing moms to hold their babies during recovery, others still do not.  Having another adult to help support the mother following surgery is important.  Whether you are holding your baby during recovery or afterwards, your partner should not only help to hold or stabilize the baby immediately following the birth, during skin-to-skin time, and/or while you are breastfeeding, but he can also help with diaper changes and bringing baby to mom so she doesn’t have to move as much following surgery.

How do I begin breastfeeding after a Cesarean section?

The single most important factor to getting breastfeeding off to a good start is skin-to-skin contact immediately following birth.  While most women who have a C-section do not have immediate skin-to-skin contact, there are maternity units that are more and more supportive as they begin to understand its importance to breastfeeding.  If this is not the case with your birthing facility, having skin-to-skin contact as soon as possible after the birth, for as long as possible, is optimal.  This not only encourages bonding and maternal and baby health benefits, but it helps a mother’s milk production. In the first few days following birth, spending as much time cuddling your baby, especially skin-to-skin, and nursing as often as your baby wants are the most effective things you can do to get breastfeeding off to a strong start.1

Does having a cesarean birth delay my milk coming in?

No, a C-section in and of itself does not delay a mother’s milk.  Actually, hormones associated with the removal of the placenta trigger breast milk production and this occurs with a surgical as well as vaginal birth.  When the placenta is delivered, there is a sharp drop in progesterone, which is what holds milk production in check during pregnancy.  But while a C-section doesn’t delay milk, stress associated with the birth experience can.  The more stressful the birth experience is for a mother, the greater the chance of her milk coming in more slowly.2  Both an emergency C-section and instrumental vaginal delivery may be more stressful than a planned cesarean.  However, even the most stressful birth experience does not have to be detrimental to breastfeeding. (You can read about my emergency C-section in Egypt here.)

Are pain medication and/or anesthesia contraindicated with breastfeeding?

No.  All types of labor and delivery pain medications are compatible with breastfeeding.  Mothers do not need to wait a certain amount of time, or discard any of their precious colostrum because of a medicated C-section delivery.  However, babies born by cesarean are likely to feel the effects of the pain medications the mother had during labor.  Many times this leads to a sleepier baby who is harder to arouse to nurse, and/or a baby who has a harder time latching and suckling.  It is important to make sure to rouse a sleepy baby to nurse frequently – at least 8-12 times in a 24 hour period – as a mother’s body is getting the message to make plenty of milk for her new baby.

What breastfeeding positions are most comfortable following surgery?

Following a C-section the mother usually experiences quite a bit of pain, especially when moving around.  This can make nursing challenging.  There are many positions that support breastfeeding as well as protecting the mother’s incision.  Many moms find the “football” hold to be effective.  Propping up pillows around the mother so that she is comfortable, she can then sit up or recline while holding her baby’s body on her side while she nurses.  If it is more comfortable for the mother to lie down, she can nurse her baby on her side while her baby is lying on the bed tucked in next to her.  Nursing while reclining, with baby wrapped around mom’s chest and feet tucked in on her side, is another possible position.  There is no one right method, though.  The most important thing is that you are comfortable, baby isn’t putting undue pressure on your incision, and your baby is able to latch and remove milk effectively.

You may also be interested in reading about my unplanned, emergency C-Section in Egypt.