Your breastmilk coming in can be a momentous occasion, especially if there has been a delay in it coming in.
Different definitions exist as to what a ‘delay’ in milk coming in actually is.
Some say there is a delay if your milk is not in by day 3 (72 hours) and others by day 5 (120 hours) after giving birth.
The longer the delay in your milk coming in, the higher the risk your baby needs to receive supplementation (e.g. with donor milk or formula) for a medical reason.
There are various factors associated with a delay in your milk coming in, as this article will explain. It’s not known however whether the delay is due to:
- A maternal physiological response
- Subsequent suboptimal breastfeeding management
- A combination of the above
Regardless of the reason for a delay in your milk coming in, early, frequent and effective milk removal is the most important factor in establishing breastfeeding.
What Can Delay Milk Coming In?
Here are five things which may delay your milk coming in. It’s important to note that while these factors may delay some mother’s milk coming in, for other mothers, it wont be the case. Like most concerns or problems, this issue is something that doesn't tend to impact 100% of all people.
Read more in our article, Can Diabetes Impact Breastfeeding Success? (Includes gestational diabetes or type 2).
#2: A C-Section
It’s not clear if a C-section might delay your milk coming in due to:
- The stress of the surgery
- Drugs used for and after the surgery
- A delay in getting breastfeeding started
- Suboptimal breastfeeding management
- A combination of these things
There are many ways to get breastfeeding working well for you after a C-section – read our helpful tips here.
#3: Significant Blood Loss
This may be because:
- Significant blood loss may lead to injury to the pituitary gland. This gland is important for breastfeeding, because it makes the two main hormones involved with breastfeeding – oxytocin and prolactin. Mild to moderate damage to the pituitary gland is known as pituitary insult and may lead to reduced functioning of it. Severe damage is known as a pituitary infarction or Sheehan’s syndrome, and can result in a failure of a mother’s milk coming in
- It may be associated with various interventions (especially a medical induction of labour) and stress during the birth
- It may result in a delay in breastfeeding getting started due to mother/baby separation
- It may be associated with maternal exhaustion, which may result in early supplementation and subsequent difficulties in establishing breastfeeding
Maternal obesity is another factor associated with a delay in your milk coming in.
Various mechanisms have been suggested as to why obesity might cause a delay in milk coming in.
- Animal studies have shown maternal obesity can interfere with the normal development of the breast, which in turn can affect milk coming in
- A decreased prolactin response to a baby sucking at the breast has been observed in overweight and obese mothers
- Insulin resistance, which is associated with obesity, may be another possible mechanism linking obesity with a delay in milk coming in
#5: Retained Placental Fragments
Birth of the placenta is an important step to set in motion the process of your milk coming in. If all of your placenta is not removed, this can interfere with the process of your milk coming in. Read more about breastfeeding after retained placenta.
Once the placental fragments are removed however, your milk can come in.
If exclusive breastfeeding is important to you and/or you thought breastfeeding would just work perfectly from the outset, a delay in your milk coming in can be a particularly stressful time. It may be even more stressful if there is talk of your baby needing to be supplemented.
The good news is there are many things that can be done to optimise breastfeeding (depending on your individual circumstances), such as frequent breastfeeding, hand expressing and plenty of skin-to-skin contact. You can read more about how to get breastfeeding off to an optimal start here.
If supplementation is required, it’s usually only needed temporarily. Donor milk may be an option for you. The method of supplement delivery and volume of supplementation given can all be done in ways that are most compatible with breastfeeding.
Working with a lactation consultant (an IBCLC) can help you work out what would work best for you and your baby. In most cases, even if there is a delay in your breastmilk coming in, you will be able to go on to breastfeed your baby in the way you would like.