Some mothers experience a retained placenta after the birth of their baby.

As well having this traumatic experience, some mothers are surprised to find retained placental fragments can affect their breast milk production after they give birth.

This can cause even more stress and pressure, especially when they are doing their best to get breastfeeding working well.

However, there are several things you should be aware of.

7 common questions on breastfeeding after retained placenta:

Question #1. What is a retained placenta?

During pregnancy, there are high levels of various hormones, including prolactin (the milk-making hormone). Why is it, then, that you don’t make a lot of breast milk supply during pregnancy?

It is because your milk-making ability is suppressed, 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 after the birth of your baby.

For more information, read our article 7 Huge Benefits Of An Undisturbed First Hour After Birth.

On rare occasions, pieces of placental tissue might break off and stay attached to the wall of the uterus. These are referred to as retained placental fragments or, more simply, retained placenta.

It is more likely to occur when there is active management of the third stage of labour. This involves taking steps to remove the placenta after birth.

It can also occur with a c-section.

To find out more about this, read Retained Placenta | 7 Symptoms, Signs And Treatment.

Question #2. How might a retained placenta affect breastfeeding?

The birth of the placenta is an important step to kick-start your body into producing breast milk. This is because, when the placenta is removed, your progesterone levels fall abruptly, which allows prolactin to start taking effect on the milk-making tissue in your breast.

If the whole placenta is not removed, it can mean that progesterone levels don’t fall so low and this can interfere with the process of your milk coming in. This means you might experience low milk production.

Question #3. What are the signs and symptoms of retained placenta?

There are various signs and symptoms you might experience if you have a trapped placenta or retained placenta.

Possible signs and symptoms are:

Placenta accreta. This is when the placenta grows too deeply into the uterine wall. The condition might be picked up during pregnancy or birthFor more information, you can read BellyBelly’s article Placenta Accreta | Symptoms, Bleeding And Treatment.
Heavy bleeding or postpartum hemorrhage. This is defined as vaginal blood loss of more than 500 ml after birth
Foul smelling vaginal discharge
Fever
Painful cramping of your uterus
Examination of your placenta shows tears or missing pieces
Delay in your milk coming in.

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, or obesity.

If you are worried you might have retained placenta, seek advice from your doctor immediately.

Question #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 mothers, frequent breastfeeding, combined with postpartum hormones, is enough to kick milk production into gear.

According to the Academy of Breastfeeding Medicine, a delay in a mother’s milk coming means her milk comes in after day 3 or later than 72–120 hours after birth and that there is inadequate breast milk intake by the infant.

Signs of your milk ‘coming in’ can include the following:

A feeling of warmth or fullness in your breasts
A tingling sensation in the breasts
A change in colour of your baby’s bowel motions
If you are expressing, you might notice your breast milk gradually changing from being brighter in colour and lower in volume to being paler in colour and higher in volume
Awareness of your let-down reflex.

Some mothers don’t feel their let-down reflex. The only way they might 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 might also notice milk leaking from the breast their baby is not feeding from.

You can find out more about the let down reflex from the Australian Breastfeeding Association.

In the case of retained placenta, there is a clear delay in your breast milk coming in, or you have low milk supply, regardless of ruling out other possible reasons.

Question #5. What needs to be done if I have retained placenta?

If the placenta cannot be removed manually and a pelvic ultrasound has confirmed retained placenta, a procedure might be required.

A dilation and curettage (D&C) is done under a local or general anaesthetic and using a surgical instrument; it involves dilation of the cervix and removal of any placenta left in the uterus.

For more information, you can read BellyBelly’s article Dilation And Curettage | What To Expect.

Question #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 still exclusively breastfeed their babies.

There are few medical reasons why supplementation with formula might be necessary.

The Academy of Breastfeeding Medicine Supplementation protocol provides helpful and evidence-based information about when supplementation might be necessary.

Question #7. Will my breast milk come in after my placenta is removed?

Once your placenta is fully removed, you can go on to make a full milk supply.

If you continue to experience low milk supply and production after a procedure to remove your placenta – manually or surgically – you should seek help from an appropriate health care provider.

An International Board Certified Lactation Consultant (IBCLC) can help provide you with support and information to help get breastfeeding working well for you and your baby.