When your breast milk is delayed after birth

Katie James, Lactation Consultant talks about what happens when your breast milk is delayed after birth, who is more at risk and what we can do about it. You can either watch the video, or read the article below.

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Reasons for delayed breast milk

On average mature milk comes in roughly around 60 hours after birth for most women. Some women will be much quicker, at around 24 hrs. There is a recent study showing that for some women it will their milk may be delayed by up to 80 or 82 hrs. There are a couple of common reasons that can delay your milk coming in, some of the risk factors include:

• Gestational diabetes
• PCOS
• C-section
• Above ideal weight
• Retained products of conception or if the placenta is incompletely expelled
• Undiagnosed low thyroid problems

These conditions mean a woman is more at risk, but doesn’t necessarily mean that you will have a delay if you have one of these conditions.

What happens if there is a delay in my breast milk coming in after birth?

It can be quite distressing when your milk is delayed. The general process in most hospitals nowadays is to weigh babies at 48 hrs of age. Most babies will lose around 7-8% at this point, and this is considered normal. Up to 10% is also considered ok. Anywhere over 10% is concerning that babies hasn’t taken in enough. 

[related link: what to expect in the first week after birth]

Women with delayed milk coming in may have a baby who will weigh ok at 48 hrs, and will often go home. However, they may then run into problems if the milk hasn’t come in as expected. At this point your baby is having small quantities of the wonderful colostrum. But from day 2 or 3 your baby is expecting larger volumes of milk, and can become very fussy or irritable and feed all day and all night, causing everyone to get quite stressed. [related link:  positioning and attachment] Often what happens then is when your baby is reweighed, she baby will have lost more weight again, perhaps more than the 10% cut off point, but yet there is still no signs of the milk coming in – the breasts still don’t feel heavy, there’s no lumpy areas of the milk starting to come in. They’re not feeling warm and you haven’t noticed the veins coming up on the breast. We can’t always predict when your milk will come in which can also be stressful.

When babies are losing weight this is when the formula supplementation may come into conversation which can be really distressing for mums who have planned for a natural birth and breastfeeding and its only day three and it feels like it’s all going out the window. Mum’s may also feel that they’ve failed already.

What do we do if there is a delay in the breast milk coming in?

At this point, please remember that breastfeeding isn’t black and white, there is so much grey area in the middle. Sometimes we just need to give babies more volumes, and sometimes all we have is formula. It is used for this medical purpose until your milk has come in. So don’t panic.

You can see it as a short course of antibiotics, we’re using it for a medical reason to fix a problem at the moment. We’re planning to use it for 2 to 3 maybe 5 days, possibly 7, and once your milk comes in, we’re going to help you remove any extra supplements. It’s just tiding you over until your milk comes in.

So what can you do to help your supply come in, particularly if you’re at risk.

The key thing is to remember that magic number 8. That is, ensure your baby is breastfeeding at least 8 times in 24 hrs or more, this equates to at least 3 hourly feeds. 4 hourly is just not enough to get your supply going.

What if you’ve had a caesarean, or perhaps you’ve had a really long labour, you’ve had pethidine, or an epidural and your baby just isn’t interested in feeding for the first 24 to 36 hours, and really isn’t feeding effectively at the breast. In this case, it’s a great idea to start hand expressing from within the first hour after birth. Previously advice was to start hand expressing within the first 6 hours, however a study in about 2012 showed that hand expressing in the first hour made a bigger difference on your milk supply in the future.

If your baby isn’t breastfeeding frequently, you must mimic breastfeeding by hand expressing at least 8 times every 24 hours to establish your supply. If your milk is delayed and you’re at 60 or 72 hours, and your baby has lost weight, your midwives will recommend that you breastfeed at least 8 times in every 24 hours. And after every feed, hand express or pump express for 10-20 mins on both sides. For maximum benefits, we recommend that you express for 3 to 7 minutes on one side and then switch to the other side, and then go back for a couple of minutes on each breasts, so you’re really overstimulating the brain and the hormones as much as possible to say “Hey, bring in this milk quickly because we really need it!”.

This is a huge process and it’s really difficult because you’re exhausted, but there’s a purpose and it’s hopefully a short term issue that we can remedy, within a day or two. Then the milk comes in and your breasts become full and there’s lots more milk for the baby and everyone’s happier. [related link:  a guide to engorgement] Then we can start to reduce the supplements so within a day or two you’re fully breastfeeding.

The biggest thing to note is that there are people that are more at risk of a delay in the milk coming in, but it isn’t permanent, it’s just a delay. You may need to use some formula if there isn’t enough milk and your baby has lost more than 10% of their weight, or there are other clinical signs that will medically recommend this. But, if you do need to use it, it’s only for a temporary period of time. Don’t panic too much, this isn’t a failure, and it’s only temporary. Stress impacts on our milk let down, it makes us feel awful, and prevents us from getting good sleep. It’s really important to rest while you’re coping with so much.

Coping with a delay in milk coming in

It is really important that you ask for help from people around you, and also make sure that you’re comfortable with your care provider and or lactation consultant, don’t be afraid to get a second opinion. If you’re not sure of anything being said to you or you’re uncomfortable with the advice being provided, you can always call the ABA, or you can also call another lactation consultant or ask for a change in consultant, because it is a very stressful time. Remember that article is based on averages, and your individual history, birth, and your baby will be different. When you work with a health care provider it will be on a one to one basis and will take into account your individual situation. Breastfeeding and milk supply issues change quite quickly so the plans may change every 24 hours and that’s ok.

If you’re unclear about anything, ask why, and make sure you have things written down so you know you’re on the same page and you can reference your plan. It’s amazing how much your memory suffers while you’re caring for a small child!

Did you experience a delay in your milk coming in after birth? Share your experience in the comments below.