How Your Birth Can Affect Breastfeeding (And What You Can Do About It)
When you're preparing to breastfeed, you probably hear a lot about what happens after your baby is born.
“Get a good latch.” “Feed on demand!” “Watch for hunger cues.” “Do skin-to-skin!”
But breastfeeding doesn't actually begin at birth.
The time leading up to your baby's arrival can influence what breastfeeding looks like during those first hours and days, too.
Many common birth choices, outcomes and interventions can impact the start of breastfeeding, sometimes in ways you might not expect.
None of this means that these things are "bad."
And it certainly doesn't mean that choosing an epidural, induction, cesarean, IV medication—or anything else—means you won't be able to breastfeed.
Birth is not a test, and there isn't one correct way to do it.
As a doula and childbirth educator, I'm much more interested in informed consent: understanding the benefits, risks, alternatives, and implications of your options so that you can decide what makes sense for your body, your baby, and your birth.
If breastfeeding is unexpectedly difficult during those first 24–72 hours, understanding what happened during birth can sometimes help us recognize that the problem isn't necessarily breastfeeding itself.
It may simply be something you and your baby need a little help navigating while your bodies recover from birth.
IV Fluids: When Your Breasts Are Swollen Before Your Milk Even Comes In
IV fluids are incredibly common during hospital births. You may receive them with an epidural, medications, induction, surgery, or for hydration or medical stabilization.
Those fluids don't disappear immediately after birth. Some of that additional fluid can temporarily collect in your tissues, including the breasts and areola.
When it comes to breastfeeding, your newborn needs to get a surprisingly large mouthful of breast tissue in order to latch deeply.
Imagine trying to bite into an overinflated beach ball! When the tissue surrounding the nipple is very swollen and firm, your baby may have trouble getting enough of it into their mouth. They may repeatedly latch and pop off, become frustrated, or latch shallowly, which can also make breastfeeding painful for you.
Research examining maternal IV fluids has found an association between larger volumes of intrapartum fluid and postpartum breast swelling, although this is an area where we still need larger studies.
What can help?
One of my favorite tools for this situation is reverse pressure softening.
Rather than trying to remove milk, you use gentle inward pressure around the base of the nipple for a short period before feeding. This temporarily moves some of the swelling away from the areola, making the tissue softer and easier for your baby to grasp.
The technique was developed specifically to address areolar edema and engorgement that interferes with latch.
You may need to work around this temporary swelling for a day or two while your body processes the extra fluid.
IV Pain Medication and Epidurals: What If Baby Is Sleepy?
Opioid medications used intravenously during labor cross the placenta, and depending on the medication, dose, and timing relative to birth, they can sometimes influence newborn breathing and alertness. For this reason, many hospitals will not give a dose of these medications if they have reason to believe you are within a few hours of birthing your baby.
Epidural research is more complicated.
Modern epidurals typically use relatively small amounts of local anesthetic combined with an opioid such as fentanyl. Research looking at epidurals and breastfeeding has produced conflicting results: some studies have found associations between fentanyl exposure and early breastfeeding difficulty or changes in newborn feeding behavior, while other well-designed studies have found no meaningful difference in breastfeeding outcomes.
In other words:
Having an epidural does not mean you're going to have breastfeeding problems.
But if your baby is particularly sleepy after birth, their birth and medication exposure are useful pieces of the puzzle.
A very sleepy newborn can sometimes get caught in a frustrating cycle:
Baby is sleepy → baby doesn't nurse effectively → baby doesn't take in much colostrum → baby has even less energy for the next feeding.
That doesn't necessarily mean your milk isn't there or that baby can’t breastfeed. Sometimes baby just needs a little help getting started.
One simple trick: put the reward right where baby can find it.
Hand express a few drops of colostrum onto your nipple before trying to latch.
Now when your baby roots, smells, licks, or begins sucking, there's immediately something there, which for some babies is enough to keep them going to get more.
If baby is simply too sleepy to nurse effectively, hand expression can also help you remove colostrum while continuing to offer opportunities to breastfeed. Expressed colostrum can be collected on a spoon or in a syringe and offered to baby with guidance from your baby's care team or lactation professional.
This is also one reason some families choose to learn about antenatal colostrum expression late in pregnancy. It isn't appropriate for every pregnancy, so it's something to discuss with your maternity provider before beginning.
Pitocin: The Oxytocin Question
Pitocin is synthetic oxytocin and is commonly used to induce or augment labor and to help prevent or treat postpartum hemorrhage.
Oxytocin also happens to play an important role in breastfeeding.
When your baby suckles, your body releases oxytocin, which causes the tiny muscle cells surrounding the milk-making structures in your breasts to contract. That's what helps move milk toward your nipple: the milk ejection reflex, or "letdown."
So researchers have understandably wondered: Does receiving synthetic oxytocin during labor affect the body's oxytocin system afterward?
Some observational research has found associations between intrapartum synthetic oxytocin and differences in early breastfeeding or newborn sucking behavior. Other studies have found no significant difference in breastfeeding initiation or duration.
What we can't currently say with confidence is that Pitocin "blocks" your natural oxytocin or that receiving Pitocin will cause breastfeeding problems.
There are simply too many variables involved in birth to make that conclusion.
What we can say is that if milk isn't flowing easily at first, supporting your body's natural oxytocin production may help.
Skin-to-skin contact, warmth and relaxation before feeding, gentle breast compression during feeding, and frequent opportunities for your baby to nurse can all support milk transfer.
And remember: your breastfeeding story is not determined by how the first feeding goes, or even how the first 30 feedings go! It takes time for you and baby to figure it out, and every latch gets you a little closer to when it will feel like second nature.
Forceps and Vacuum-Assisted Birth
After a difficult workout, you probably don't want pressure on the sorest part of your body, right?
Babies can have a similar experience after birth.
Vacuum-assisted birth can cause swelling or bruising of the scalp, including conditions such as cephalohematoma. Forceps can also leave temporary marks, swelling, or tenderness where pressure was applied.
That doesn't always directly affect breastfeeding, but imagine that every time your baby tries to nurse, the position places pressure directly against a tender area.
They may arch, pull away, cry, prefer one side…or latch beautifully in one position and become upset in another.
What looks like a "breastfeeding problem" may actually be a positioning problem.
Experiment with gravity.
Laid-back breastfeeding can be wonderful here.
Rather than holding baby's head firmly or positioning them horizontally across your body, recline comfortably and allow baby to lie more vertically against you.
Try different angles.
Pay attention where your hands are supporting baby's head.
And get curious about what your baby is trying to tell you.
Sometimes the solution isn't fixing the latch, it's finding a position that’s more comfortable for your baby (this can be true of babies who were born without forceps or vacuum, too. Birth is hard!)
Persistent feeding difficulty, unusual sleepiness, significant swelling, or apparent pain should also be evaluated by your baby's medical provider and an appropriately qualified lactation professional.
Cesarean Birth
Cesarean birth deserves its own conversation because several things can happen at once.
There may be:
more IV fluid
anesthesia and medications
postoperative pain
difficulty getting into comfortable feeding positions
delayed skin-to-skin contact or separation for medical care
less mobility during those first hours
and, for some mothers, a slightly later transition to copious milk production
Large reviews have found lower rates of early breastfeeding initiation following cesarean birth, particularly planned cesareans.
But among mothers who did initiate breastfeeding, one large meta-analysis found no significant difference in breastfeeding at six months based on mode of birth.
That's exactly why I don't want someone to hear:
"C-section = breastfeeding problems."
I want them to hear:
"If I'm having a cesarean, I might want a little more breastfeeding support at the beginning."
If you know you're planning a cesarean, you can talk with your care team ahead of time about skin-to-skin in the operating room or recovery area when medically appropriate, keeping baby with you when possible, getting help positioning baby without putting pressure on your incision, and accessing lactation support early.
Side-lying, football hold, and laid-back positions can all be worth experimenting with depending on what feels comfortable in your body.
Postpartum Hemorrhage: Your Body Has Bigger Priorities
A significant postpartum hemorrhage can sometimes make breastfeeding harder to establish.
Part of that may simply be logistical: if you need urgent medical treatment after birth, you and baby may not be able to have uninterrupted skin-to-skin or begin breastfeeding immediately.
But substantial blood loss can also affect the physiology involved in milk production, and significant hemorrhage has been associated with lower rates of early full breastfeeding.
Rarely, very severe blood loss can affect pituitary function and interfere substantially with lactation.
None of this means breastfeeding won't work after a hemorrhage.
It means you will likely need more support from a qualified lactation professional (all the love to the baby nurses, but ask them to get an IBCLC in to see you ASAP).
If you're recovering from significant blood loss and milk production seems slow to increase, tell the lactation professional helping you.
Frequent milk removal, breastfeeding when baby is able, hand expression and/or pumping when indicated, lots of skin-to-skin when you are medically stable, and careful monitoring of baby's intake can help protect breastfeeding while your body recovers.
One of the Most Powerful "Birth Choices" May Actually Happen After Birth
There's one more factor I don't want to leave out: what happens to you and your baby immediately after delivery.
Immediate and uninterrupted skin-to-skin contact has some of the strongest evidence of anything we've discussed in this article.
Skin-to-skin gives your newborn access to the environment their nervous system expects after birth: your warmth, smell, voice, movement, heartbeat…and your breast.
Research has found that early skin-to-skin supports breastfeeding initiation and increases the likelihood of exclusive breastfeeding.
This doesn't have to belong only to uncomplicated vaginal birth: early skin-to-skin can often be supported after cesarean birth as well.
So when you're making your birth preferences, you might ask:
"If my baby and I are both doing well, how does this hospital support uninterrupted skin-to-skin after birth, including after a cesarean?"
If this isn’t standard practice in your birthing location, this one is worth making some waves about. Advocate for what’s best for you and your baby - which in most cases is immediate, uninterrupted skin-to-skin time.
Your First Breastfeed Is Not a Test
A baby who doesn't latch beautifully during the golden hour isn't destined to struggle with breastfeeding.
A sleepy baby isn't necessarily a "bad nurser."
A swollen breast doesn't mean you have the wrong anatomy.
A delayed increase in milk production doesn't automatically mean your body can't make enough milk.
And needing an epidural, Pitocin, IV fluids, a vacuum, forceps, a cesarean, or emergency medical care does not mean you made the wrong birth choices.
Instead of immediately thinking "Breastfeeding isn't working," we can ask:
"What happened during birth, and what might my baby and my body need right now?"
This information is critically important, and yet most of us don’t receive any information at all on this topic, before or after baby arrives.
And that's why I believe breastfeeding education belongs before birth, not after.
Want to Feel More Prepared Before Baby Comes?
I'm currently developing my Prenatal Breastfeeding Class, where we'll go much deeper into how breastfeeding actually works, what normal newborn feeding looks like, how birth can influence the early breastfeeding experience, common challenges, hand expression, milk supply, pumping, bottles, and how to know when you need additional help.
If you'd rather have individualized support, you can also book a one-on-one Lactation Education Session with me. We'll talk through your goals, questions, birth plan, and practical strategies so you can head into feeding your baby with a much better understanding of what to expect.
My role as a lactation educator includes breastfeeding education and basic support; when you or your baby need clinical lactation assessment or treatment beyond my scope, I'll also help connect you with an IBCLC or appropriate healthcare professional.
The goal isn't to have the "perfect" birth or the "perfect" start to breastfeeding.
It's to understand what's happening well enough to know what you can do next.
Further Reading
Parent-Friendly Books About Breastfeeding
If you're preparing to breastfeed and want something a little more approachable than a stack of journal articles, these are a few resources worth exploring:
The Womanly Art of Breastfeeding, La Leche League International
A comprehensive breastfeeding reference covering preparation, normal newborn feeding behavior, common challenges, milk supply, pumping, returning to work, and breastfeeding through different stages.
Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers, Nancy Mohrbacher, IBCLC, FILCA & Kathleen Kendall-Tackett, PhD, IBCLC
One of my favorite choices for understanding the why behind breastfeeding. Rather than focusing only on rules and techniques, it explains the biological processes that make breastfeeding work and helps parents recognize normal feeding behavior.
Making More Milk: The Breastfeeding Guide to Increasing Your Milk Production, Lisa Marasco, MA, IBCLC & Diana West, BA, IBCLC
An especially useful resource if milk production becomes a concern. It explores the many different reasons supply can be affected rather than treating low milk supply as a single problem with a single solution.
Latch: A Handbook for Breastfeeding with Confidence at Every Stage, Robin Kaplan, M.Ed., IBCLC
A practical, accessible guide that walks parents through breastfeeding from the early days through later transitions, with plenty of troubleshooting guidance along the way.
Breastfeeding Answers: A Guide for Helping Families, Nancy Mohrbacher, IBCLC, FILCA
This one is technically written for lactation professionals rather than parents, but if you're someone who loves understanding the details and wants a very comprehensive breastfeeding reference, it's an excellent resource.
Dive into the Research
If you'd like to explore some of the research behind this article, these are a few of the studies and reviews I found particularly helpful:
Cotterman, K. J. (2004). Reverse pressure softening: A simple tool to prepare areola for easier latching during engorgement. Journal of Human Lactation, 20(2), 227–237. https://doi.org/10.1177/0890334404264224
Erickson, E. N., & Emeis, C. L. (2017). Breastfeeding outcomes after oxytocin use during childbirth: An integrative review. Journal of Midwifery & Women's Health, 62(4), 397–417. https://doi.org/10.1111/jmwh.12601
Forster, D. A., Moorhead, A. M., Jacobs, S. E., et al. (2017). Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME]): A multicentre, unblinded, randomised controlled trial. The Lancet, 389(10085), 2204–2213. https://doi.org/10.1016/S0140-6736(17)31373-9
French, C. A., Cong, X., & Chung, K. S. (2016). Labor epidural analgesia and breastfeeding: A systematic review. Journal of Human Lactation, 32(3), 507–520. https://doi.org/10.1177/0890334415623779
Gomes, M., Trocado, V., Carlos-Alves, M., Arteiro, D., & Pinheiro, P. (2018). Intrapartum synthetic oxytocin and breastfeeding: A retrospective cohort study. Journal of Obstetrics and Gynaecology, 38(6), 745–749. https://doi.org/10.1080/01443615.2017.1405924
Kujawa-Myles, S., Noel-Weiss, J., Dunn, S., Peterson, W. E., & Cotterman, K. J. (2015). Maternal intravenous fluids and postpartum breast changes: A pilot observational study. International Breastfeeding Journal, 10, 18.
Lee, A. I., McCarthy, R. J., Toledo, P., Jones, M. J., White, N., & Wong, C. A. (2017). Epidural labor analgesia—Fentanyl dose and breastfeeding success: A randomized clinical trial. Anesthesiology, 127(4), 614–624. https://doi.org/10.1097/ALN.0000000000001793
Moore, E. R., Brimdyr, K., Blair, A., et al. (2025). Immediate or early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews, 10, CD003519. https://doi.org/10.1002/14651858.CD003519.pub5
Prior, E., Santhakumaran, S., Gale, C., Philipps, L. H., Modi, N., & Hyde, M. J. (2012). Breastfeeding after cesarean delivery: A systematic review and meta-analysis of world literature. The American Journal of Clinical Nutrition, 95(5), 1113–1135. https://doi.org/10.3945/ajcn.111.030254
Thompson, J. F., Heal, L. J., Roberts, C. L., & Ellwood, D. A. (2010). Women's breastfeeding experiences following a significant primary postpartum haemorrhage: A multicentre cohort study. International Breastfeeding Journal, 5, 5. https://doi.org/10.1186/1746-4358-5-5
