The Birth-Breastfeeding Continuum

Birth professionals have long been aware that there is a connection between birth and breastfeeding, but in recent years experts are making this link more explicit and the inextricable nature of the two experiences is becoming clearer. Birth and breastfeeding exist on a continuum. They are not discreet events. As speaker and author Dia Michels says, “we need a new word—birthandbreastfeeding.” Human women are mammals and the same things that disrupt bonding and breastfeeding for other mammals also apply to women. Darkness, quiet, no disruptions/interruptions, safe, upright, mobile, easy access to food and drink as they choose….these things support healthy births for female mammals! In brief, a normal, healthy, undisturbed birth leads naturally into a normal, healthy, undisturbed breastfeeding relationship. Disturbed birth contributes to disrupted breastfeeding.

New mothers, and those who help them, are often left wondering, “Where did breastfeeding go wrong?” All too often the answer is, “during labor and birth.” Interventions during the birthing process are an often overlooked answer to the mystery of how breastfeeding becomes derailed. An example is a mother who has an epidural, which leads to excess fluid retention in her breasts (a common side effect of the IV “bolus” of fluid administered in preparation for an epidural). After birth, the baby can’t latch well to the flattened nipple of the overfull breast, leading to frustration for both mother and baby. This frustration can quickly cascade into formula supplementation and before she knows it, the mother is left saying, “something was wrong with my nipples and the baby just couldn’t breastfeed. I tried really hard, but it just didn’t work out.” Nothing is truly wrong with her nipples or with her baby, breastfeeding got off track before her baby was even born!

Problems with breastfeeding often start before baby is born. According to Linda Smith, BSN, FACCE, IBCLC, co-author of the book Impact of Birthing Experiences on Breastfeeding (2004), birth practices that impact breastfeeding include:

  • Mechanical forces of labor (positioning of baby, positioning of mother, etc.)
  • Chemicals (drugs) used in labor
  • Injuries to mother or baby
  • Treatment of mother during labor
  • Treatment of mother after birth
  • Separation from mother after birth
  • Procedures that alter behavior

Linda Smith also notes that a mother’s confidence and trust in her body’s ability to give birth is related to her confidence in her body’s ability to breastfeeding. There are several birth related risk factors for breastfeeding problems (please note that not all babies with risk factors will actually have problems):

  • Induction of labor
  • Epidural and/or narcotic medications
  • Cesarean
  • Instrumental delivery (forceps or vacuum)
  • Post birth suctioning of baby’s airway

Additional procedures that affect baby’s ability to breastfeed if they are done before baby’s first breastfeeding include:

  • Separation of mother and baby for any reason.
  • Weighing and measuring
  • Vitamin K injection
  • Metabolic tests
  • Circumcision
  • Infant hypothermia

According to the Academy of Breastfeeding Medicine (, “unmedicated, spontaneous, vaginal birth with immediate skin-to-skin contact leads to the highest likelihood of baby-led breastfeeding initiation.” Immediate skin-to-skin contact restores the biologic continuum begun during conception.

When I was in graduate school, one of my professors used the following analogy to make a point and I now use it with my own students:

There is a river running through town. Daily, emergency workers are called upon to rescue people from the river who have fallen in and are floating downstream drowning. Day after day they pull the gasping people back to land until one of the workers suddenly realizes, “maybe we should go see what is happening upstream and try to stop these people from falling in to begin with?”

My professor then encouraged us to always remember to go “upstream” when working in the helping professions rather than only addressing the immediately presenting problem. Childbirth professionals are in an “upstream” position when it comes to protecting the birth-breastfeeding continuum!


For more about the value of keeping mothers and babies together following birth, check on Healthy Birth Practice Six: Keep Mother and Baby Together – It’s Best for Mother, Baby, and Breastfeeding from Lamaze.



If my mom were a platypus: what we can learn by studying mammal lactation, presentation by Dia L. Michels, La Leche League of Missouri Conference, November 2007.

Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum. Mary Kroeger and Linda J. Smith, Jones and Bartlett Publishers, Inc.; 1 edition (February 2004). ISBN-13 978-0763724818.

Mother-Baby Togetherness, presentation by Dr. Nils Bergman, La Leche League International Conference, July 2007.

The Power of Touch, presentation by Diane Wiessinger, La Leche League of Missouri Conference, November 2007.

Winning at Birth, presentation by Linda J. Smith, La Leche League International Conference, July 2007.


This article is adapted from “Celebrating World Breastfeeding Week and the Birth-Breastfeeding Continuum” by Molly Remer, MSW, ICCE, published in the International Journal of Childbirth Education, June 2008.

27 thoughts on “The Birth-Breastfeeding Continuum

  1. Pingback: More on the Birth and Breastfeeding Relationship « Birth True Childbirth Education Blog

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  3. Not to quibble with this article because I do believe there is a definite cause and effect here but….

    I had three c-sections and three very positive breastfeeding experiences. So one does not cancel the other out. I trusted my body even when it didn’t quite do the birthing correctly…it has nourished three very happy little people.

    • Oh, absolutely! I’m glad you had such good experiences–I’ve noticed both situations: mothers who have had cesareans who are DEVOTED to making breastfeeding work (because it IS something their bodies can do and they can trust in that/take comfort in that) or mothers who have had cesareans who feel their bodies have “failed” them and that they probably can’t do breastfeeding “right” either. The point of the article is just that people often overlook the possible relationship when breastfeeding goes “wrong” and then turn to self-blame, rather than system-blame…

  4. Great Article!! I had a HORRIBLE birthing experience with my 3.5 yr old daughter. First started with induction (38 weeks) and eventually led to c/s. Had loads of breastfeeding problems but I found the right lactation consultant & finally MADE it work! I don’t “blame” my body but I feel VERY strongly that the induction that led to the c/s (because I listened to my OB even though I knew that I wasn’t ready) was caused by my OB. I still feel bitter about it, it was like I had NO control over what was happening to me. Needless to say, we are still breastfeeding today & I’m 10 weeks preggo! I am positive I found the right midwife group & that I will have a positive birth experience this time!

  5. I had two very different births and two very different outcomes with breastfeeding. With my daughter I had a 51hr labor that resulted in a vaginal delivery with the assistance of pit and an epidural after 39hrs of un-medicated labor. My daughter was unable to latch and we had to teach her how to do that and we finger fed her for 12wks before she was able to take a bottle – she never did breastfeed – though she got breast milk through my dedication of pumping for her for 14 months. I worked with an amazing LC for the entire 14mths with my daughter trying different thing to get her to nurse. With my son – I ended up transferring to the hospital and had an emergency C-Section – my son latched on immediately after we were transferred to recovery and nursed for 45min each breast… two completely different deliveries, two completely different kids…

    • Gretchen, when you say with your son you xfered to hospital, were you originally plannning an out-of-hospital birth? if so, how long after xfer was the c-sec? your daughter got MANY hours of in-utero epidural exposure, which likely contributed to (if not being the primary cause of) your breastfeeding struggles with her, it can take weeks for a baby to get the epidural narcotics out of their system and by then the feeding problems on baby’s end have been pretty set & hard to fix. if you wound up getting the c-section pretty quick after arrival at hospital, and particularly if you didn’t have anesthetic until shortly before the surgery, his cross-placenta exposure was likely much lower (or nil, if the meds were administered & surgery started as soon as they took efffect for you) which could be why you had less struggles with him even tho it was a surgical instead of vaginal birth, and kinda proves the point of this article vaginal birth.

      fwiw, i had 3 totally unmedicated/non-interventive births (not so much as a saline IV line) after long, slow labors. all three latched on in the first 10min with no problems. i have breastfed for more than 5 years and counting at this point between the 3 of them (3rd is 6wks old today and i’m 1-handed typing while nursing him, hence lack of capital letters). never have had even the slightest breast infection or serious plugged duct. just helped a friend homebirth her 3rd baby 2 days ago, older 2 were hospital births with pit (1st induced/augmented at 37wks after spontaneous water rupture without contractions starting, 2nd induced on due date because of concern over possible heart defect concerns from ultrasound – misdiagnosis, baby fine.) she’s shocked at how much easier breastfeeding is going this time as the interventions with the earlier 2 left her so full of fluids her nipples flattened out. new baby, zero latch problems. also confirms this artcle’s statements.

  6. Regarding a mother’s confidence and ability to trust her body: this was so important for me!

    I had a wonderful natural birth, which was painful but easy to get through because of great support and the ability to just ride the labour rather than fight it. My initial breastfeeding experience however was anything but easy. I said repeatedly in the first 2 weeks that it was more painful and more difficult than my drug-free birth. But by the same token, the fact that I had made it through “childbirth” (in quotes because I’m referring to the “childbirth” that the media and most women have vilified into a horrible traumatic event) without drugs really empowered me, and my mantra during breastfeeding difficulties became “I gave birth to this baby without drugs, surely I can get through this.”

    • did you have baby checked for tongue-tie or other issues that may have made it more difficult? sometimes it takes a bit to get your groove going, but comparing the discomfort to birth is concerning. my mantra with breastfeeding advice is if it hurts, seek help, try different positions, make sure everything is where it should be, and if everything looks otherwise normal & healthy try to relax and enjoy what you can of the present knowing it will be different tomorrow

  7. I think this is a fine piece but honestly I am pretty sick of all the rhetoric out there about how C-sections are so terrible and have such far-reaching repercussions. I think it unfairly punishes mothers out there who, for whatever reason, couldn’t have the births they wanted and over-valorizes those lucky ones who could. Enough already.

    So, for what it’s worth and to encourage those women out there who couldn’t have the ideal nonmedicated vaginal birth you mention, I had a C-section with some complications and couldn’t see my son for about an hour after his birth, and I have had no problems whatsoever with breastfeeding. He is now 6 months, doing great, and I have breastfed him exclusively this entire time. We are just now thinking about solid foods for him. Sure, birth is very very important, but if you can’t have the one you want, don’t be devastated. I really think, for me at least, the most important thing for nursing was support from partner, family and friends and enough time off from work to get to know my baby and establish my milk supply.

    • Thanks for commenting! I’ve observed–and if I was re-writing this piece would include–what a very healing impact the breastfeeding relationship can have for mothers and babies who perhaps had a rough start with the birth. It is wonderful! This article is actually not focused on c-sections really, but more about birth interventions in general–IV fluids, epidurals, etc.

  8. Dina:
    no one is pointing the finger at women who had a C/S. It is useful though to diagnose problems and to hopefully prevent future ones. This info is crucial for birth workers to think about -all interventions have consequences and we need to try and minimize interventions, use them only when necessary.

  9. Judith,

    Intellectually, I *know* that no one is pointing fingers. But traveling in the circles that I do (the ones where I read these blogs, go to yoga classes, participate in pro-woman and pro-parent healthcare and politics) I do get sick of the constant intimations. It *feels* like people are pointing plenty of fingers, all the time.

    All I was trying to say, and I was having a bit of a day so I said it a bit crankily yesterday, is that women who had c-sections- for whatever reason, and the reason is really none of anyone’s business- deserve a little support and encouragement, and folks in the gentle birth world would do well to remember to be gentle with us too. In addition to being the kind thing to do, it will increase your audience and impact substantially.


  10. Hi Dina:
    i hear clearly what you are saying and i agree. In one way though, this info is very helpful in my experience. we are saying that some things contribute to a rocky start and with that knowledge in mind, we can support women to be successful with breastfeeding. some things are always important and even more so for moms who had a C/S, e.g. lots of skin to skin, keeping mom and baby together and teaching mom how to hand express colostrum. it is so powerful to see that yes, actually I am producing milk! hope this helps

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