Infertility and Breastfeeding

By Jacque Ordner
Jun 27, 2024

IN THIS ARTICLE:

Tips for Breastfeeding: Cesarean Section, Preterm Delivery & Birth of Multiples

Infertility in the US

With 1 in 5 married couples in the U.S. struggling to conceive, it’s no surprise that infertility treatments are becoming more common. These treatments fall under the umbrella of Assistive Reproductive Technology (ART) which includes in vitro fertilization (IVF), intrauterine insemination (IUI), and frozen embryo transfer (FET) as well as other treatments or methods that manipulate gametes, eggs, sperm, or embryos to increase the chance of pregnancy. The CDC reports that approximately 2.3% of all babies born in the U.S. every year are conceived using some form of ART. ¹ ²

Breastfeeding After ART

There are common misconceptions surrounding breastfeeding after infertility treatment. One of the most frequently circulated myths is that IVF (or other forms of ART) always results in breastfeeding difficulty. In reality, it’s often the underlying cause of infertility that can negatively impact breastfeeding.

For example, conditions that affect ovarian function may also lead to low milk supply. One of the best ways you can prepare for breastfeeding success is to connect with an experienced IBCLC (International Board Certified Lactation Consultant) even before your baby is born. An IBCLC can review your medical history and help identify any possible risk factors for breastfeeding problems. Knowing these risk factors before labor means you and your IBCLC can create a feeding plan that supports your breastfeeding goals. ^{1, 3, 4, 5}

Conditions that may impact fertility and breastfeeding include:

PCOS (polycystic ovarian syndrome)
DOR (diminished ovarian reserve)
FHA (functional hypothalamic amenorrhea) or any impairment of the hypothalamus or pituitary gland
POI (primary ovarian insufficiency)

Tips for Breastfeeding: Cesarean Section, Preterm Delivery & Birth of Multiples

Certain ART therapies are also associated with an increased risk of cesarean section, preterm delivery, and birth of multiples. These circumstances can make breastfeeding more difficult as well. The key to success is to make an informed breastfeeding plan before your baby is born.

Tips for Breastfeeding After C-section

Opt for a gentle c-section if possible - A gentle c-section focuses on keeping parents involved in the birth process and on getting baby skin-to-skin with mom as soon as possible, even while surgery is wrapping up.
Take advantage of the longer hospital stay - Request a consult with the hospital IBCLC for specialized breastfeeding support. Focus on recovery and breastfeeding while the hospital staff cares for you and your baby.
Focus on early breastfeeding - Getting your baby to the breast as soon as possible has been shown to impact long-term breastfeeding success rates positively. If the baby is skin-to-skin with you right after birth, breastfeeding can even take place in the operating room.
Try different breastfeeding positions - Experiment with different breastfeeding positions to find those that are the most comfortable and keep the baby’s weight off of your incision.

Use a stepwise approach to postpartum pain medications - ACOG (The American College of Obstetricians and Gynecologists) recommends treating postpartum pain with nonopioid therapies first, such as acetaminophen and ibuprofen, before moving on to opioid treatments. This is because opioid pain medications enter breast milk and increase the risks of sedation and depressed respiratory function in infants. Babies who are sleepy from exposure to certain opioid pain medications are not likely to breastfeed well. The safest approach is to opt for nonopioid treatments first, then advance to mild opioids if breakthrough pain occurs.

Tips for breastfeeding a preterm infant:

Consult with an IBCLC - An IBCLC, along with your baby’s care team, can provide guidance on how to build and maintain your milk supply. An IBCLC can also advise on using tools such as a nipple shield or SNS (supplemental nursing system) to help support your baby’s nursing skills.
Focus on skin-to-skin - As soon as the baby is stable and can tolerate it, begin skin-to-skin or kangaroo care. This boosts oxytocin and helps get the baby prepped for breastfeeding.
Offer the breast after pumping at first - Starting with an “empty” breast can help a preterm baby practice suckling without being overwhelmed by the milk flow.
Go slowly - Practice latching once or twice per day at first. As your baby grows stronger, they’ll be able to tolerate more breastfeeding sessions.
Coordinate breastfeeding with tube feeding - This will help the baby associate breastfeeding with fullness.

Tips for breastfeeding multiples:

Streamline feedings - It’s ok to encourage twins to feed at the same time in order to make feedings more efficient. It is not uncommon for one baby to “request” to eat first, so follow that baby’s cues and encourage the other twin to feed at the same time.
Rotate who is first at the breast - Whether you have twins or higher-order multiples, rotating will help ensure each baby gets an equal opportunity to nurse when your breasts are full.

Consider a twin-specific nursing pillow - Traditional nursing pillows may work while your babies are tiny, but a twin-specific pillow will be more supportive as your babies grow. These pillows are great even if you have higher-order multiples!
Alternate breasts - It’s not unusual to have one breast that produces more milk. For this reason, each baby must have equal time at each breast.

General Tips for Breastfeeding Success

As you prepare to breastfeed after ART, there are some general tips to keep in mind to maximize your success. Know that breastfeeding is something that you and your baby may need time to learn.^6,7

Take breastfeeding classes - Knowing how breastmilk is made, how supply and demand work, which positions to use, and the characteristics of a deep latch will better prepare you to overcome potential breastfeeding struggles
Skin-to-skin is magical - It helps regulate a baby’s temperature, heart rate, respiration, and more! It also helps support breastfeeding by boosting oxytocin levels.
Focus on frequent feedings - Newborns need to eat at least 8-12 times in 24 hours. These frequent feedings send signals to your body to make more milk, driving your milk supply.
Hand express and pump if your baby isn’t nursing well - If the baby isn’t latching and nursing well, it’s important to begin pumping and hand expressing immediately. Hand expression is the most effective way to remove colostrum in the first few days postpartum. Pumping also provides breast stimulation which is important for telling your body to make more milk for your baby. Work with an IBCLC for help with latching and advice on how to build and maintain an abundant milk supply.
Avoid the “all or nothing” approach - Every drop of breastmilk is valuable for your baby! Don’t assume that breastfeeding isn’t worth it unless you’re making 100% of the milk your baby needs. Many mothers use their own breast milk in combination with donor breast milk or formula to meet their baby’s needs.