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 Comments | Last revised on 06/19/2013

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