When milk comes in later - delayed lactation
Milk coming in after childbirth
When a baby is born, you already have colostrum in your breasts; sometimes you are not even aware of it, because milk does not leak. The amount of milk normally increases 30-40 hours after birth. The timing of milk production onset is different for each mother; 2-3 days after birth, milk production is usually established, but in as many as 25% of mothers, this happens after the third day. The key prerequisite is breast stimulation, i.e. early initiation of breastfeeding. During the first day after birth, 10-50 ml of milk is produced; in the following days, the amount increases and colostrum changes to mature milk.
The two key hormones for breastfeeding are prolactin and oxytocin.
Baby's suckling is the driving force for the secretion of hormones, through sensory impulses from the nipple.
Prolactin is secreted during breastfeeding to provide milk for the next breastfeed. More prolactin is secreted at night, so night-time breastfeeds are especially important in the beginning. Oxytocin acts before and during a breastfeed to allow milk to flow out of the breast (milk ejection reflex). It causes uterine contractions and thus reduces the risk of bleeding and infection after childbirth. These contractions - afterpains - can be very painful during breastfeeding, especially in multiparous women.
The supply and demand principle
After the initial hormonal phase of milk production, further regulation mainly takes place locally, based on the supply and demand principle. The baby's efficient suckling and breast emptying are key. Without efficient suckling and removal of milk, milk production is reduced. Thanks to this principle, women who have very small breasts (low glandular tissue) can provide their baby with enough milk by breastfeeding often; the same goes for twins.
How to recognize that milk is coming in?
Fullness of the breasts, feeling of heaviness, heat, tingling, milk leakage tell you that the milk has "come in". You may need a few days to recognize the signs of milk coming in. You may be afraid of the sudden change that is happening to you. If you empty your breasts, you will notice a gradual change in color, from thick and yellow colostrum, to thinner and whiter mature milk.
When milk comes in later - delayed lactation
The most common causes of "delays" in milk coming in:
- In primiparous women, milk comes in on average one day later than in multiparous women
- Prolonged childbirth, stress and pain, unplanned caesarean section
- Higher blood loss during childbirth or retained placental tissue
- Late initiation of breastfeeding
- Premature birth
- Maternal diseases - obesity, insulin resistance, diabetes, elevated blood pressure
- Bad habits - smoking, alcohol consumption
- Breast surgeries
- Nipple problems: flat or inverted nipples, piercing
What to do if there is no milk for 4 days:
- Breasts should be emptied regularly and completely. Skin-to-skin contact can help increase milk production.
- The newborn's weight should be monitored daily to assess whether the baby is getting enough milk.
- On discharge from the maternity hospital, you will receive recommendations on any supplemental feeding and further monitoring of the child's thriving.
- Weighing the child on a daily basis is not particularly beneficial, especially not in improvised conditions at home. It can only confuse you, and sometimes it's not even safe! It is not advisable to weigh the baby before and after a breastfeed, to estimate the amount of milk suckled. Breastfeeds differ in duration, especially in the beginning; sometimes the child suckles from only one breast, sometimes from both, so one breastfeed does not provide a realistic insight into the efficiency of suckling.
If your baby needs supplementation, provide it in a way and in an amount that will not interfere with breastfeeding progress. If the beginning is difficult, remember that many mothers managed to gradually increase milk production to the full amount needed by the child within a week or two, and some even after several weeks.
