Booby Traps Series: Obstetrical practices are making late milk-coming-in the new normal.

Patient with dripA little while back, when I was writing this post about delayed onset of mature milk (“milk coming in”), I ran across this statistic:

Nearly one in four mothers experience their milk coming in late – defined as after 72 hours.  For first time mothers, CDC data suggest the rate is nearly one in three.

How could that be, I wondered?  If so many mothers have their milk come in after 72 hours, doesn’t it make that pretty normal?  Doesn’t this undermine the definition of late onset of mature milk (post 72 hours)?

But then I remembered that many obstetrical practices are associated with late onset of mature milk.  And I decided to compile the rates at which these practices occur, including data from the recently released Listening to Mothers III Survey.  Here are some factors known to cause a delay in milk coming in:

Cesarean birth.  The CDC reports that 33% of births in 2010 were by cesarean.

Labor induction and augmentation.  The Listening to Mothers III Survey found that 41% of mothers said that their providers tried to induce their labor, (63% of those inductions involved pitocin), and 31% had their labor augmented with pitocin.

IV fluids.  The Listening to Mothers III Survey found that 61% of women had received fluids by IV (55% of women who birthed vaginally and 77% of women who birthed by cesarean).

Labor pain medication83% of mothers in the Listening to Mothers Survey reported having had labor pain medication.

There are other, non-birth related factors which are on the rise, such as older maternal age and obesity.  But the birth-related factors alone could explain an awful lot of this “new normal,” couldn’t they?

While I couldn’t find any data about late onset of mature milk over time, one suggestion that rates could be much lower comes from a study of first-time Peruvian mothers, which found a rate of 17% (again, compared to 31% of first time mothers in the U.S.).  And this was among first-time mothers, and we know that first time mothers are more likely to have delayed lactogenesis II, so the overall rate could likely be significantly lower if non-first time moms were included.

Why is this important?  Because late onset of mature milk is associated with the cessation of any breastfeeding, and exclusive breastfeeding at 4 weeks postpartum.  Late onset of mature milk often leads to supplementation, and early supplementation is strongly associated with non-exclusive breastfeeding and shortened breastfeeding duration.

And this isn’t even considering the effects of some of the factors above on other breastfeeding problems, such as the effect that IV fluids have on newborn weight loss and breast edema.

This is a Booby Trap which remains hidden in plain sight from many mothers.  Moms who experience a late onset of their milk and have subsequent breastfeeding problems may be quicker to blame themselves than to look in the rear view mirror at the state of obstetrical practices in their hospital.

If you’re planning your birth and want to avoid as many of these practices as you can, check out our post on planning for a breastfeeding-friendly birth.

Did you experience your milk coming in late?  Do you think it was related to any of the above obstetrical practices?  How did your milk coming in late affect your breastfeeding experience?



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32 Responses to Booby Traps Series: Obstetrical practices are making late milk-coming-in the new normal.

  1. Michelle says:

    I was not induced, had no IV, and gave birth vaginally without augmentation or pain meds, and my milk still took 3-4 days to come in. However, I was given pitocin AFTER I gave birth to help my uterus go down, which makes me wonder if pitocin after labor can affect your milk coming in, too.

    • Tanya Lieberman, IBCLC says:

      I’m not sure about pitocin after birth, but there are other factors which are associated with late mature milk, including:

      age
      maternal obesity
      parity (which number birth this is)
      diabetes
      having prenatal care
      hypertension
      infant birth weight
      infant Apgar score <8
      preterm birth
      prolonged second stage labor
      stressful labor and delivery
      psychosocial stress/pain

      Maybe one of these other factors was an influence?

      • jennifer says:

        i am a midwife who attends out of hospital birth and PP hemorrhage and severe blood loss post birth is also a factor in delayed milk ‘coming in’.

      • Alma says:

        Thank you for posting this list, Tanya. I am a SAHM mom of 2 (my 2nd is now 14wks old) and I have been exclusively breastfeeding him from birth. and i have come across sites with women saying that they had “low” milk supply or their milk wouldn’t come in which leads me to believe that maybe something is going on here because i felt like it’s just so many women with this problem these days. now that you’ve posted this list it makes sense. and moms need so much support if this is an issue :). this is just a personal observation :). glad to see that 72hrs+ is also normal.

    • Brittney says:

      I have heard from the LC on the KNOX BREASTFRIENDS GROUP page that indeed it can. A blow by blow description of how was written to explain it to me but I forgot all that was said. I do know that it plays a role in slower milk production though!

  2. Tara says:

    Due to a horrible sequence of unnecessary events, I ended up with an emergency c-section and lost a lot of blood. (You can read my story at: ChampagneWishesDiaperReality.blogspot.com). I was in the hospital 6 days and not a single drop of milk came in until day 7 (I didn’t even have colostrum). I believe that the time frame alone would have had most women convinced that “my milk just wouldn’t come in and I couldn’t breastfeed”, but I luckily was determined to breastfeed, no matter what. I do believe that all the interventions and the surgery had a dramatic role in my supply and our breastfeeding relationship in the beginning. I can happily report that we are going strong 17 months later and have no plans to wean anytime soon.

    • Denise says:

      Thanks for this information Tara. My daughter-in-law has just experienced your same circumstances and I can relay your message to her, encouraging her not to give up. She is at day 7 now. Thanks so much.

  3. Celeste F says:

    With my second baby, my milk did not come in until more than 72 hours after the birth. I had an all natural drug-free vaginal birth without any complications. I did have the standard IV dose of Pitocin after the placenta was out. I also had an all-natural drug-free birth with my first child and my milk was much sooner to come in that first time. I also had the dose of Pit post birth. My birth experiences were nearly identical. Having my milk come in later the second time did cause plenty of stress for me but I was stubborn and did not supplement and my milk finally came in closer to the 96 hour mark. The dry diapers then changed to heavy ones and everything has been going great since then. I really don’t have an answer for why I think it was delayed the second time.

  4. Ashley says:

    My milk didn’t come in for 3 WEEKS. It was the “perfect storm,” if you will. Severely preeclamptic/hypertension which led to an induction at 39 weeks. After cervadil and cytotec both failed, I labored on pitocin for 12 hours–7 of which were hard labor–all without pain meds. After 36-hours I only dilated to 5cm. I ended up needing an emergency cesarean, a magnesium drip for 24 hours after; I was on an IV for the 1.5 days prior, as well as 4 additional days in the hospital. I was on blood pressure meds for six weeks after delivery. Baby is now 5 months, my milk supply is low and we’ve been supplementing since we figured out I had no milk (about day 4 after delivery). My natural, drug-free childbirth dreams definitely didn’t happen how we’d planned, but our case is one Im grateful for hospitals and surgeons so that my baby could be delivered.

    • ARC says:

      Ashley, I feel your pain with wanting a natural birth and getting all that intervention. It sounds an awful lot like my first birth. I can tell you that you can increase your milk supply. My mother completely lost her milk supply with my youngest sister and managed to get it back up to where it was supposed to be. She had a really great doctor at the time that told her how to do it. You start by first slowly decreasing how much formula you give your baby each day. The baby will still be hungry, but that will make your baby suckle longer for yoru breastmilk. The more demand there is for your breastmilk, the more milk you will make. You can also try eating some food that help you do better at producing milk. Oatmeal and flax seed are just a couple. I an nursing my 3rd baby (5 months old) and I eat oatmeal flax seed pancakes every morning. I hope you can get your milk supply up. Good luck.

  5. @Wolf_Mommy says:

    Interesting.

  6. Sarah says:

    My milk came in on day 4-5 as a G1P1. I didn’t know this was unusual. I was induced at 42 weeks with Cytotec only (didn’t put me in active labor) and then 48 hrs after that with Cytotec (did work). After 12 hours of hard labor I gave in to the epidural (because my labor was slowing and they said I needed Pit- and I was having horrible back labor I could barely stand). So I spent about 9 hours on Pit with an epidural. After 2 hours of pushing the baby had shoulder dystocia and I got a 3rd degree epis (glad I had the epidural then!). Her 1min Apgar was 2 and she required 45sec bag mask. But her 5 min was 9. After 3 weeks and several trips to the LC- feugreek, pumping, lots of breastfeeding, syringe supplementing and trying and SNS, I started bottle feeding after every breast feeding. I quit altogether at 6 months. I had wanted to EBF for a year at least, but it ended up being so much harder than I anticipated. Struggling with your infant at every feed is just exhausting. Mentally and emotionally.

  7. Jessica Rollins says:

    I experienced all of those main factors listed in the article, as well as gestational diabetes, and my milk still came in within twenty-four hours of my son’s birth. :)

  8. Rina says:

    My milk came in on day 5 with all four of my babies. The last 3 were homebirths with no interventions and a rapid labour (1 hour for my second and fourth babies. I had none of the risk factors mentioned above. I was aged between 25 and 34 when my children were born.

  9. Kinsey Christin says:

    I was 29 when my first was born and it was a very long and difficult birth. My body just wouldn’t budge and I was induced at 12 days post date (due to low amniotic fluid). While we avoided a C-section, it was not without having to employ every other medical intervention (pain meds, IV, epidural, etc.). I went into labor (thanks to Pitocin) Tuesday morning at 6am and my son was born at 3am on Wednesday. My milk came in at dinnertime on Friday evening (I remember b/c we were walking into the store to pick up dinner on the way home from the hospital all of the sudden I was soaked all down my front – while wearing white!), so it was between 48-72 hrs.

    With my second, I was 32 yrs old, had gestational diabetes, but had a very quick, easy and 100% natural birth, and my milk still came in during the same timeframe. I was in much better shape for this birth having drastically changed my eating and exercise habits to manage the diabetes w/o insulin.

  10. Renee Arbia says:

    My milk was over a week late coming in. I did not know this at the time but later I found out it was because I had to have a blood transfusion and that made it come in late. I had to supplement with formula during that week. However, I got an Ameda double electric breastpump and used that as well as baby attempting to nurse what he could every three hours until it finally came in and we never had to go back to formula. I breastfed him for over a year.

  11. Renee says:

    My milk came in on day 5. I had been induced at 39 weeks because my baby was getting too big. 8+ lbs. I had gestational diabetes. I had the epidural and iv fluids and pitocin after vaginal birth. We did have to supplement formula because baby had jaundice and I had no milk. It was exhausting but I stuck w/ it. Took 3 entire months before we really got the hang of it. But we’re still going at 13 months.

  12. AMitchell says:

    My milk “came in” at day 10 on one side and 12 on the other. (IV fluids, pitocin, epidural, induced at 39.4 weeks due to age and baby size…9.4lbs). My baby lost 17% of his body weight in the first 5 days, so the pediatrician told me I just wouldn’t be able to breast feed and sent me home with formula. My OB agreed. I started pumping anyway until my milk slowly started to come in on day 10. By week three I was finally breast feeding exclusively and we have a new pediatrician.

  13. Elly Egenberg says:

    I interpret this article to have a hidden agenda. Modern obstetrics saves the lives of mothers and babies by implementing safe birth practices. Iv’s are an “intervention” that keep a low risk labour from spiralling out of control should something go awry. IV’s can prevent dehydration and exhaustion by keeping a mother hydrated. Hospitals are the best place to give birth and hospitals are the best place to have an infant accessed after being born.

    • Jenny Hoffmann says:

      This article might help you understand the issues at play. And, actually, you’re just stating your opinion regarding hospitals being the “safest” place for babies or birth. The statistics don’t back that up either. http://evidencebasedbirth.com/are-iv-fluids-necessary-during-labor/

    • DB says:

      Yes, and how do hospitals manage to do this best? By providing care based on scientific evidence.

      If the scientific evidence shows that intervention X makes it more likely that Y will happen during breast-feeding, should that not be communicated to both doctors and women so they can tailor their care for the patients accordingly?

      Speaking of scientific evidence, can you please provide a reference to the study that shows that routine IVs have a protective effect against “a labor spiraling out of control”?

      • Jessica says:

        I too would be interested to read this ‘scientific based’ imformation that suggests all women need an “IV during birth to stop it spiraling out of control”.
        Yes medical intervention saves lives and has a place. But not every woman needs it! FEAR and CONTROL are the only things to suggest that women need IVs, amoung other interventions during birth. Labour is unpredictable yes, but that is why giving birth in a hospital is there, for emergencies. Not preventative methods that most of us do not need. What a completely ludicrous thing to suggest.
        It is really sad that there are so many with the mentality against women laboring how nature intended. As Ina may gaskin says “your body is not a lemon” more people need to adopt this saying.

    • Kimberly says:

      ^^ talk about a hidden agenda.

  14. Lucy d says:

    With my son, I was Induced, ended up with a csection, milk came in on day 4, I “had to supplement” because he was just too hungry, as they said… It was a long 3 weeks of crying and struggling after getting home from the hospital on getting him to latch and other issues… But I overcame them and breastfed till 22 months.

    With my daughter I had a VBAC, they did use a bit if pitocin to get things to speed up a little. My milk came in on day 3 or 4, the dr had me supplement with one bottle to see if she would gain weight, since she had list a significant amount… I wasn’t too happy about that. But had a few issues with cracked nipples, which made the initial latch almost inbearable( I literally had to bite something to keep myself from screaming in pain) I discovered lanolin and after about a week or less everything got better! Now she just turned a year and is still going strong :)

  15. PlekaKat says:

    I had four live birth experiences with varying degrees of intervention ranging from none to pitocin to an epidural. No c-sections. I had hypertension with the last birth and needed to be induced, and had two babies who were tongue thrusters and couldn’t latch properly. Regardless of the differences, my milk came in within 24 hours each time.

    Maybe it is genetics?

    • Annaleigh says:

      I was thinking something along those lines…same here 4 births, varying degrees of differences and my milk always comes in on the third day. I’ve never had to supplement though. Colostrum lasts until then.

  16. Anna says:

    I thought I was the only one that experienced this! With my first child I was given 3 bags of fluid with my epidural and was so swollen after the birth. I had a vaginal delivery but due to the swelling I had trouble producing. I pretty much had to supplement the entire time. I was able to produce some, but it was always a struggle. With my second, who is a month old, I went completely natural at a maternity center. No fluids, drugs etc. I was producing right away and have exclusively breastfeed or pumped.

  17. Annaleigh says:

    Interesting. I’ve had 4 births…my milk always comes in on the 3rd day. Like clockwork. First birth had pain meds, second nothing, third pitocin (no induction though), and the fourth was a home birth. Aside from the booby traps I wonder how much of that is diet or hidden stuff in foods (GMO, hormones, antibiotics, etc). Or just evolution. For me, milk on the third day is normal. I’ve never had to supplement either.

  18. Jennifer says:

    After having 4 children, I have the answer to this one! Let your significant other enjoy your breasts for the whole pregnancy. My milk has always come in early. There is absolutely no reason to stop enjoying your breasts because you are pregnant & apparently it helps the baby.

  19. Clarice says:

    I did have late mature milk onset with my second. With my first I was engorged by the second day. both babies were born with a midwife, no drugs, no induction, natural birth. With my second, it never seemed to come in fully, and the poor dear was losing too much weight, after more than 3 days. I chose to supplement her on doctor and midwife advice, while I did everything in my power to increase my supply. I took a presciption medication called Domperidone, which is a drug designed for digestive issues, and one of the side effects is that it can increase milk supply. With nursing as much as possible, pumping after each feeding, and taking the domperidone, I was able to increase my supply to the point that I could stop supplementing, fully meet my babies feeding needs, and had extra to pump and store. When my supply flourished,after 8 weeks post birth, I stopped taking the drug. And nursed my baby for over two years. Slow onset was scary for me, I felt like I was not doing the right thing by making my very hungry lethargic baby wait longer than 3 days. She wasn’t having enough wet or poopy diapers, and I could tell that she just needed to be fed. She lost more than 10% of her birth weight and at that point, I just had to do whatever it took to first make sure she was being fed and gaining back the weight, and then figuring out what could be done to improve my supply. I guess my story isn’t all together about late onset, it’s more about that plus a weird supply issue. So, my question is: if late onset (past 72 hours) is within normal range, what should moms do when their healthcare provider recommends supplementation? When your baby has lost too much weight, which most say is a loss of 10% or more, how do you not do something to remedy that? How long should a baby be made to wait? It’s true that supplementing in the early days and weeks of breastfeeding tends to lead to partial breastfeeding and usually a shortened duration, but it doesn’t have to always, as was our case. It’s got to be about educating the mother and her choice.

  20. Kianichi says:

    This is interesting. And sad at the same time. I have three children and now pregnant with my fourth. I Breast-feed all my kids up till they were 10 month. And never had any problems. Hope this time won’t be any different.

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