Some mothers experience a retained placenta after the birth of their baby.
Aside from being a traumatic experience for some, mothers can be surprised to find that it can affect their milk coming in.
This may cause even more stress and pressure when you're doing your best to get breastfeeding working well.
Rest assured that your breasts are just fine – it's not your breasts fault.
However, there are several things you should be aware.
Here are the answers to 7 common questions about retained placenta and breastfeeding:
#1: What Is Retained Placenta?
During pregnancy, the levels of various hormones are high, including prolactin (the milk-making hormone). So why is it then that you don’t make a lot of breastmilk during pregnancy? This is because your milk-making ability is supressed due to the high levels of other hormones, including progesterone.
After your baby is born, there is an important third stage of labour to birth your placenta. Most of the time, little, if any, intervention is needed for this to occur. Skin-to-skin contact with your baby and starting breastfeeding increase the level of the hormone oxytocin. Oxytocin helps your uterus to contract which encourages the natural release of your placenta.
On rare occasions, a piece of placental tissue may break off and stay attached to the wall of your uterus. This is referred to as retained placenta. This is more likely to occur when the placenta is slow, or tension is applied to help it, to come out. It can occur with a c-section too.
#2: How Might Retained Placenta Affect Breastfeeding?
Birth of the placenta is an important step to kick-start the process of your milk coming in. This is because when your placenta is removed, your progesterone levels plummet. This then allows prolactin to start taking effect on the milk-making tissue in your breast.
If not all of your placenta is removed, this can mean that progesterone levels don’t fall as much and this can interfere with the process of your milk coming in. Hence, there can be a delay in your milk coming in.
#3: What Are The Signs And Symptoms Of Retained Placenta?
There are various signs and symptoms you may experience if you have retained placenta. Possible signs and symptoms include:
- Examination of your placenta shows tears or missing pieces
- Postpartum haemorrhage
- Foul smelling vaginal discharge
- Painful cramping of your uterus
- Delay in your milk coming in
Please note that there can be various other causes for the above signs and symptoms. For example, a delay in your milk coming in could also be linked with other things such as diabetes, emergency c-section, obesity.
If you are worried you may have retained placenta, see your doctor immediately.
#4: What Does ‘A Delay In Milk Coming In’ Mean?
Many new mothers worry about whether they will have enough milk for their baby. For most, breastfeeding when your baby needs to be fed is all that is needed to ensure your baby gets enough.
In the case of retained placenta, there is a clear delay in your milk coming in, regardless of ruling out other possible reasons.
When your milk comes in, you may:
- Have a fuller feeling in your breasts
- If expressing at all, you may notice your milk gradually changing from a thick yellow coloured colostrum to a paler milkier colour
- Notice your baby’s poos changing to a lighter colour
- Be more aware of your let-down reflex. Some mothers don’t feel their let-down reflex. They only way they may recognise their let-down is when their baby’s sucking changes from a quick shallow suck at the very start of the feed to a deeper more rhythmical suck when the let-down occurs. They may also notice milk leaking from the breast their baby is not feeding from. Other mothers who feel their let-down, may feel:
- A tingling sensation in their breasts
- A sudden feel of breast fullness
- A slight pain in their breasts
According to the Academy of Breastfeeding Medicine, a delay in a mother’s milk coming is defined as if her milk comes in ‘day 3–5 or later [72–120 hours] and inadequate intake by the infant’.
#5: What Needs To Be Done If I Have Retained Placenta?
If retained placenta is suspected, a pelvic ultrasound might be done. Manual removal or a D&C (Dilation & Curettage) with a local or general anaesthetic may follow if it is confirmed.
#6: Will My Baby Need To Be Supplemented With Formula Until My Milk Comes In?
With prompt evaluation and treatment, many mothers with retained placenta can exclusively breastfeed. There are few medical reasons when supplementation with formula is necessary. The Academy of Breastfeeding Medicine Supplementation protocol provides helpful and evidence-based information about when supplementation may be necessary.
#7: Will My Milk Come In After All My Placenta Is Removed?
Yes, once your placenta is fully removed, you can go on to make a fully milk supply. Speaking with an Australian Breastfeeding Association counsellor or seeing a lactation consultant can help provide you with support and information to help get breastfeeding working well for you and your baby.