Dear June,

You make a very interesting observation and points for discussion.  I have had personal experience working as a birth doula/lactation consultant.  I had a mother have a C-section for a breech baby.  The baby was between 7-8 lbs and otherwise very healthy.  The baby's reaction at birth was exactly how you describe.  He had a very difficult time to transition, had some respiratory distress (grunting) and did not latch well the first 24 hours.  Furthermore, the baby was removed from the mother after the first hour or two to be observed in the NICU for respiratory distress.  I do believe he had formula supplementation in this time.  When he stabilized, he was brought back to the mother hours later, and they resumed breastfeeding where they left off.  After this initial separation, he was able to latch.  The mother practiced skin-to-skin contact, and frequent nursing.  She was able to fully breastfeed with success.  
At the delivery and during this time of respiratory distress, the medical staff explained that the baby did not get "squeezed" through the birth canal, and that the fluids which are normally cleared in a normal vaginal delivery, are not cleared in a C-section causing breathing difficulty.  Furthermore, my client felt as if her baby was not "ready" to come out.  She was saying this in the time leading up to the planned C-section.  When he was born, he  appeared to be in shock and had difficulty with the transition, and the mother was therefore right in how she felt.  Is this difficulty with transitioning observed in scheduled C-sections (when there is no chance to labor), or is it mostly seen in Breech babies?  Another thought to consider is why a baby is breech?  Are they breech for a reason we do not know or understand, and does this affect how they respond when they are born?  

In terms of working as a LC with these mothers, there are obviously challenges, i.e.
- baby not ready to latch
- hospital separation of mother/baby
- formula supplementation in NICU
- lack of maintaining a supply

What made breastfeeding successful for my client, could be for many reasons, some of which I believe are:
- she had birth and breastfeeding support beyond the medical staff 
- she was well informed about breastfeeding
- she was encouraged
- she practiced skin-to-skin and began breastfeeding as soon as possible
- (she did not pump to maintain her supply, but if the separation continued, she would have done so)

June, I am also wondering if Breech babies are more at risk for (unsuccessful) breastfeeding.  Being aware of this risk would already bring them more attention by the medical and lactation staff, such as a premature baby gets.  Breech babies are often born at term and are "healthy" so it may be that their vulnerabilities are easily being overlooked.

I am interested in hearing more about this discussion.

Warmly,
Patricia Ried, PhD, RN, IBCLC


Date:    Wed, 25 Jan 2012 19:05:32 +1300
From:    J Nicholls <[log in to unmask]>
Subject: Breech babies

Hello Wiseones

I have been  thinking about the breech babies that are delivered where I work and I have noticed that these babies do not latch for at least 24 hrs could be longer, but there will be intervention
All breech  babies are born by caesarean section.
So I am wondering why  they seem to need an adjustment time, even with skin to skin they do not appear to show feeding cues and I am trying to find a logical answer.  Our workload increases as Lactation Consultants because we are suppose to be able to get these babies latched!
So my question is has anyone noticed this trend? 
I am hoping that Cathy Watson-Genna will read this post and hopefully have the time to post a reply that will enlighten me

Many thanks for reading my post

June Nicholls
IBCLC

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