Booby Traps Series: Could something about your birth have made your milk come in late?

This is the tenth in a series of posts on Booby Traps™, made possible by the generous support of Motherlove Herbal Company.

We’ve wrapped up our series on Booby Traps in pregnancy, and are launching into a series of posts of Booby Traps in birth today!

Do you remember when your mature milk came in?  It’s a pretty momentous and memorable event for many of us.

But if your mature milk was late in arriving (defined as no breast fullness at ≥ 72 hours after your baby’s birth), you probably remember this as a stressful time.  You may have worried that your baby was getting dehydrated or suffering from inadequate intake.  Your pediatrician may have told you that your that your baby needed to be supplemented with formula.

Having a delay in your milk coming in can set off a chain of events than can -but thankfully don’t always – lead to weaning before you want to.  For some of us, breastfeeding is over just as it should be beginning.

How?  When your milk is delayed in coming in you’re more likely – often of necessity – to be told to supplement with formula.  Supplementation, when done in a manner not friendly to breastfeeding, can cause milk supply problems and sometimes nipple confusion.  Milk supply problems can lead to weaning before we meet our breastfeeding goals.  Of course, sometimes supplementation is truly necessary (Rule One:  feed the baby), but when done without trying to protect your milk supply, it can be devastating.

Poor intake can also make your baby sleepy, which can make him or her a poor feeder – one who falls asleep at the breast early in the feeding.  And that in turn can make babies take in too little milk, which makes them even more sleepy.  It also puts babies at higher risk of jaundice, which in turn creates makes even sleepier.  See the vicious cycle you have to turn around to make breastfeeding work?

What many of us don’t know is that there are things about your birth experience which can make it more likely that your mature milk will take longer to come in.  And that’s where the Booby Traps come in.

First, there are a number of factors associated with late mature milk which are beyond our control (or very difficult to control) when we deliver.  They include diabetes, obesity, thyroid problems, hypertension, polycystic ovary syndrome (PCOS), preterm birth, and even our age at time of delivery.

But there are some factors related to birth which we can influence (though admittedly not control):  having a cesarean section, receiving a lot of IV fluids, having a prolonged second stage of labor (pushing longer than one hour), and having a lot of stress.  In short, the cascade of interventions that happens for so many of us may in fact result in a delay in our milk coming in.

How can we influence (though not always control) these factors and beat this Booby Trap?

Have a doula or other trained labor support person present.

Numerous studies show that having a doula present at your birth reduces your risk of a c-section, results in shorter labors with fewer complications, and reduces the use of pitocin, and reduces mothers’ requests for pain medications (these last two are often accompanied by IV fluids).  In short, having a doula or someone who can serve like one may prevent the cascade of interventions which can lead to a delay in your milk coming in.

Know your provider and your hospital’s stats.

Want to avoid a c-section?  Then, as Linda Smith, author of The Impact of Birthing Practices on Breastfeeding, said in an interview with me, “Don’t go where they do 90% of them!”   Check out your provider (OB/midwife) and your hospital’s rates of c-sections, inductions, and epidurals, and choose carefully.  Your support team will have a lot to do with your early start to breastfeeding.

Learn non-drug pain relief techniques.

You may or may not end up using pain medication, but the cascade of interventions often there.  So the less you can use of them the better.  Non-drug means of pain relief are the kinds of things you might learn in a childbirth class, but you may want to supplement what you learn there with extra reading or instruction.  Be sure that you and your partner know lots of laboring positions, massage techniques, acupressure points, visualization and breathing techniques, and about the use of water in a birthing tub or bathtub, for example.  And make sure that your providers are supportive of these things.

Remember:  If you do experience a delay in your milk coming in, all is not lost.  Be sure to ask for help from a lactation consultant (IBCLC) who should be able to help you navigate the road ahead.

Did any of you have a delay in your milk coming in?  What were the factors that could have contributed to the delay?



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20 Responses to Booby Traps Series: Could something about your birth have made your milk come in late?

  1. Nicole B. says:

    Completely agree!

  2. Brandy Dewar says:

    I ended up having a c-section 24hrs after my water broke… they said I wasnt dialating and that it could take another 10 hours… not even 10 hours after my water broke they put me on petocin… I specifically told my doctor months before I didnt want induced or a c section I wanted to go all natural. Never again am I going to Evanston Regional Hospital. .. what a joke! over 90% of the women get a c-section there. I am going to Utah next babe and getting a VBAC! For having a c-section my milk came 5 days later… i pumped like crazzzy because I wasnt going to give up on breastfeeding… now he’s going to be 3 months on the 10th and still nursing exclusivly! Thanks for sharing this article with us!

  3. Shilpa says:

    I was a victim of this boobytrap. I was induced with pitocin without any pain medication. My labor lasted 5 hours & not difficult at all. I don’t have PCOS, thyroid issues.My milk came in late due to the pitocin and there was hardly enough even when it came in. I supplemented my daughter since she was 5 days old (due to dehydration & milk jaundice) and I could never stop since I hardly made more than a 2 oz at a time. However, I kept nursing her(with help of herbs and meds) and she still nurses at 19 months old. I sufferred from PPD due to this and would like to know what I can do different next time around.
    Boobytrap: if you could write an article on how low supply moms like me can do things right the next time.

  4. Melissa Cline says:

    Great information! The more I learn about lactation the more I wonder if I should just focus on birth activism, as so many breastfeeding issues that mamas have come right back around to birth interventions.

    I am one of the lucky ones who birthed (my first and only) at home and had a midwife coming every day after the birth to check on me and reassure me that baby’s frequent nursing requests were totally normal.

  5. EF says:

    Great post! I had a delay of milk with my firstborn and in retrospect, I place blame squarely on the hospital’s booby-trapping policies.

    I had an unmedicated labor with a midwife and 1/2 hr of pushing. BUT — baby wasn’t given to me for skin to skin afterwards, and I had an inverted nipple and didn’t have immediate latch. I was transfered to Postpartum 10 minutes after delivery and therefore robbed of my ‘magical hour.’ I learned afterwards that the midwives weren’t supposed to let moms do skin-to-skin because the hospital wanted to turn over the L&D room for the next mom as quickly as possible.

    The PP nurses conned me into thinking that I should send baby to the nursery overnight so “I could get my rest.” (There was no rest– I was so worried about her down the hall that I didn’t sleep at all!) Baby was born on a Saturday AM and the ‘lactation specialist’ wasn’t around until Monday, and by then, I was soooo sore! Plus, when she was 8 hours old, they took her away from me for a 4 hour hearing test during which they reported took so long because she was screaming so much. She came back sleepy because (I have no proof of this) I suspect she was given a bottle despite my instructions not to.

    Not surprisingly, we weren’t nursing enough and my milk was slow to come in. Plus, no one was able to help me with my inverted nipple. Baby became jaundiced and spent the first 2 weeks of her life on a light blanket getting heel prick blood tests every day to check her bilirubins. I fought and fought and fought to keep BFing her and finally got help from an IBCLC. I went on to nurse her for 3 years.

    I know better now (I’m actually a peer counselor) and hindsight being 20/20 I can see every step of the way where the system failed me as a new mother. I am still angry that my introduction to motherhood was so traumatic — and it didn’t have to be that way.

  6. Stephanie says:

    You can always look for mother to mother support from La Leche League as well. After many moms in our group were on to their second & third children they asked friends they made through LLL to bsue at their births along with a doula. The presence of strong like minded women during our experiences can help get through the toughest parts. LLL is support for breastfeeding concerns but also a gathering of mama wisdom that is too good to miss :)

  7. Tamieka says:

    My first birth was a section- milk came in 7 days. My second was a hbac transfer to hospital- milk came in on 5th day. The difference in days wasn’t much, it seems, for me.

  8. Melissa H. says:

    My milk came in on day 5 with my first baby. I tried to do everything “right.” I had a doula. I was not supposed to have an IV. An unexplainable fever, however, had me accepting antibiotics, hence an IV. I was only at the hospital for 2 hours before my son was born. My fever went down before he was even born, but they kept pushing the antibiotics through, as well as the IV. I had no other medication during labor other than the third stage pitocin shot. At one point pp, my IV was dripping wrong, and I was literally flooded with fluids. I also had a horrible cold with really racking coughs that made my after pains hurt a LOT. So I was given a cough syrup with codeine.

    I was fortunate that these booby traps didn’t hang us up for long. My baby lost more than 10% of his body weight, but our family doc did not freak out, and she gave us some options and we decided to continue skin-to-skin and frequent feedings and monitor everything. My milk came in on day 5, and my son began gaining quickly soon after.

    I’ve later learned that your body has to unload the excess fluids from the IV before it can make milk. And some cough medicine can affect your milk supply. If I’d only known…

    • Melissa says:

      Also, that drop in birth weight can come because the baby’s actual weight is inflated from the mom receiving IV fluids, then when the poor kid pees out the excess, it’s Oh no! Baby’s dropped SO much weight!

  9. Shannon says:

    I was induced with Pitocin and also had IV antibiotics since my white blood cells were (slightly) elevated. I had so much fluid pumped into me that my calves and feet ballooned like crazy a couple of days after my daughter’s birth (something that I had not experienced at all while pregnant). My milk didn’t come in for 5 days, and in the meantime my daughter’s pediatrician advised me to supplement with formula. Luckily I saw an amazing LC on day 6 who gave me all of the information, encouragement and tools I needed to get us back on track. DD is still nursing 27 months later! :D But for the record, I’m having a HOMEBIRTH next time and can’t wait!

  10. Julie says:

    My milk didn’t come in until day 5 – but I never worried. I was making plenty of colostrom, which I was sure of since my son’s diaper output was good, he once spit up a tablespoon or more after a feed, and he quickly regained his birth weight. Unless there’s something I don’t know, I think it’s the formula companies who try to scare us in to supplementing so then you hit all those traps (nipple confusion and the like) and end up on formula permanently. I don’t know which if any factors in my birth caused late milk: I went into labor on my own, labored for 24hrs with a midwife but was stuck @ 5cm so went to the hospital, received a sedative to “rest”, the midwife broke my water, then labor slowed and I was given some pitocin. Shortly after that I started pushing, which lasted about 30min. I had skin time and nursed him right after birth.

  11. Lane says:

    I had a spontaneous labor, unmedicated birth which was mostly uneventful. I was not interested in immediate skin to skin but was given my baby back soon after birth. (I wasn’t even given pitocin after the birth.) I was just so in awe that I spent most of the day sitting and staring at my new baby instead of keeping him close to me or trying to nurse. Milk was late (birth on Fri, milk on Tue/Wed). No one forced me to do anything. However, I was not as well informed as I believed I was. Baby #r was a sceduled breech C-section. Milk came in super-fast. It’s hard to teach all of the body awareness. First time moms are especially vulnerable. It’s not always the fault of the intervention, but the response to it.

  12. Kendra says:

    My milk took a full 5 days to come in. Lucky for me, I had been educated that 3-5 days was normal (birthing class, the hospital, pediatrician). Even luckier (or really how I made my provider choices), not one person suggested supplementing. The pediatrician was concerned about baby’s 10% weight drop after delivery and referred us to an LC. The LC asked right away if I had been on an IV (I had for pit after no labor 15 hours after my water broke) and then asked if anyone had told me that my baby’s birth weight was likely inflated because of my IV (no one had.) I felt so mug better! And baby gained back the weight a bit faster than the norm.
    I remember not stressing about it; my husband tells a different story. : )

  13. Aimee says:

    I like how this is discussed as “milk coming in late” rather than “milk not coming in.” I wonder how many women are too quickly diagnosed with the latter when they really could use support for the former. When women choose birth interventions they should be made aware of these potential risks, and hospitals should know to support the potential for milk coming in late in a way that preserves the possibility to breastfeed.

  14. Karen says:

    As a Lactation Consultant I think the best ways to avoid these booby traps are to take independent (not hospital based) breastfeeding and childbirth classes before you have you baby. I find so many moms who think they don’t need to do classes, that they know what they need to know or that their health care providers will tell them (ha ha). When I teach breastfeeding prenatally I spend a lot of time talking about avoiding these type of booby traps but also avoiding supplementation. Asking for “non-separation” where the baby never needs to go tot the nursery except for emergencies, sending your support person with the baby if they need to be out of your site, asking the right questions of the right persons if supplementation is suggested, etc., etc. Just one other comment, milk doesn’t “come in” it increases, Skin to Skin whenever mom is awake will help it increase more quickly even if the booby traps have already interfered.

  15. Courtney says:

    I didn’t do anything classes, watched no T.V. I DID however, read books, (as I feel anything graphic would scare me…lol) I completely trusted my body and that it would know what to do. I had a hospital birth free of meds. I do wish I had known more about late milk, as I wouldn’t have been so quick to supplement after leaving the hospital and being visited by the public health nurse to see about weight gain.

  16. Elizabeth says:

    My milk came in on day 5. I was severely anemic from blood loss after a drug-free normal vaginal, but looong, birth. Very frustrating that all nurses and doctors pushed supplementing rather than fixing the problem- get baby to latch! Finally the LC was able to come and help-oh boy I loved that woman from then on. We left the hospital AMA because I hated all the nurses telling me what to do regarding breastfeeding that was contrary to what the person with all the training had said to do.

    I think that I would recommend a breastfeeding class before birth for every new mom just to avoid all the “helpful” nurses with lots of opinions and experience but no actual lactation training.

  17. Kelly says:

    Thank you for all your commenting! I read every one of them! I am due with my second child in March 2012 and I really want to breastfeed with this baby. I wasn’t able to with my son because I was put on medication for my heart 6 days after he was born. But this time I want to do research and find out what meds are safe, if I need to be put on them again. I will need to do more research so I know what to do after I deliver. I will be delivering at the same hospital and last time they weren’t very pro-boob, so I need to be able to know all my research and be clear with my choices, so they don’t try to tell me other things.

  18. Aimee says:

    What a great article! I am a natural-minded mama who took charge and was really empowered to have as much say in my birth experience as possible, and still wound up with a completely unavoidable cesarean delivery 36 hours after my water broke. I was so drugged after my son’s arrival, I couldn’t even focus my eyes on him, let alone nurse him. I missed my magic window, and he had a difficult time really sucking well when the time came- he was probably too tired with low blood sugar! My milk didn’t come in until day 5- and I burst into tears, I was so relieved! We had no issues with nursing after that, and my supply was great! So a rough start can be overcome! Also, I made sure to revise my birth wishes with my second son. I had a “in the event of a cesarean” section. I requested- and discussed with the doctor, anesthesiologist and nurses that I would not be given any meds that might possibly make me sleepy at all. And it worked! I once again, despite my best efforts, delivered by unavoidable cesarean. But I was alert and insisted on holding my son as soon as I possibly could. I got him very quickly, and he nursed like a champ right away! We were together for quite awhile before they did the bathing, etc. The lesson here is- BE PREPARED! Learn as MUCH as you can, be vocal, make your wishes known to everyone, hire a doula, and have your partner be a voice for you as well. Speak up! This is your baby and your birth experience!

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