Sam, your analysis of the increasing C/sec rate in the US and defence of VBAC is well taken, and the increasing rate of unnecessary C/secs is to be abhorred. But I think it's easy to lose sight of the fact that it is not the increasing C/sec rate which is the major contributing factor to breastfeeding difficulties; it is the lack of support for breastfeeding. When hospital practices are "permitted" to interfere with normal initiation of breastfeeding, it is too easy to blame the type of birth. There is no earthly reason for mandatory nursery time for most healthy babies born by C/sec - newborns can be positioned and assisted by nursing staff to breastfeed in the recovery room, even when the mother is still coming round from a general anesthetic, and mothers and babies can and should room in, or bed in, in the normal way. I've seen mothers after a second (elective or planned) C/sec suffer less pain, become mobile and competent and able to care for their babies without help faster than those who have had stitches after a vaginal birth. To be sure, when babies are delivered "too early", then many of them, particularly if they are also below normal weight, breastfeed less effectively, but many of them breastfeed just fine, and some of them much more efficiently than smaller babies born vaginally. So it's all relative. The answer is make breastfeeding after any birth the top priority; to facilitate early mother-baby contact, early breastfeeding, or early breastmilk-feeding for every baby, including those who are sick/small enough to need to be cared for in the NICU, to teach all mothers (regardless of the method of delivery) how to know that their babies are breastfeeding effectively - or not - and how to express/pump and provide EBM top-ups for the time that it takes the baby to become competent. While pain medication during labour can, and does, interfere with newborn sucking reflexes, we can reassure the mother that this is not her fault, the effects will wear off, and meanwhile she can breastmilk-feed her baby while she waits for him to recover. It's too easy to blame a less-than-ideal birth for breastfeeding failure. What we need to do is to beef up our breastfeeding advocacy, and to initiate hospital protocols (eg borrow one or two from the BFHI) which can work around the early difficulties that C/secs and drug-filled labours seem to place in the way of "ideal" breastfeeding. These difficulties are not insurmountable. The fact is that in developing countries there are far fewer C/sections, far less medicated deliveries (and far higher maternal and neonatal mortality rates), but breastfeeding is seen to be so crucial that what happens at the birth is not permitted to interfere with breastfeeding afterwards. That being said, now that I live in a country where breastfeeding is clearly not seen to be very important, and almost anything is laid down as a perfectly valid reason why it's OK for babies to be bottle-fed, I share your frustrations. Pamela Morrison IBCLC Rustington, England (formerly Zimbabwe) ----------------------------- Sam wrote, "With the increase in cesarean section, there is the corresponding increase in breastfeeding "difficulties" due to routine (and in our local hospital) mandatory nursery time. With the "need" to deliver these babies before their mother might enter into a natural labor, these mothers are delivering earlier and earlier - thus compounding the very high infant mortality rate the US has (currently the highest infant mortality rate of all developed nations)." *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html Mail all commands to [log in to unmask] To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or [log in to unmask]) To unsubscribe: unsubscribe lactnet or ([log in to unmask]) To reach list owners: [log in to unmask]