Science You Can Use: Milk coming in late puts breastfeeding at risk, says new study. But is there anything you can do to make your milk come in on time?

Did your milk come in late? A new study says that a delay (defined as 72 hours or later postpartum) puts breastfeeding at risk.

Specifically, the study from Connecticut Children’s Medical Center, found that a delay in milk coming in is associated with the cessation of any breastfeeding, and exclusive breastfeeding at 4 weeks postpartum.

This conclusion was reached by reviewing data on nearly 2,500 mothers from the CDC’s Infant Feeding Practices II survey.  23% of the mothers surveyed experienced a delay in milk coming in, known as “lactogenesis II.”

Why might these two things be related?  The authors note that “care providers may advise mothers who report a delay in the onset of copious milk production to give infant formula supplements. This approach may ultimately shorten breastfeeding duration.”

The study focused on how to manage delayed lactogenesis II to protect breastfeeding, but I’d like to ask another question:  If a delay poses a risk to breastfeeding, is there anything you can do to prevent it?

The answer is yes and no.  We can’t exactly will our bodies to start producing mature milk (as hard as I tried with my second baby) but research is pretty clear that there are modifiable risk factors related to a delay.  Many of these are probably overlapping and interrelated, and the authors note that many of them are independent risk factors for poor breastfeeding outcomes.  I’ve combined a list of these factors from this study and another one into the list below.

To take the “no”s first, here are some things that are very hard or impossible to influence by the time you’re pregnant:

Now to the factors which you can more easily influence.  Again, these are things we can do to give ourselves better odds at they can be influenced.  There are no guarantees.

Let’s take them by group.  In the first group we have:

  • having prenatal care
  • infant birth weight
  • infant Apgar score <8
  • preterm birth

Some obvious behaviors related to these are having these risk factors for delayed lactogenesis II are having prenatal care, not smoking, and not using alcohol or illicit drugs.

The next group is related to birth:

  • delivery mode
  • prolonged second stage labor
  • labor pain medication
  • exogenous oxytocin (pitocin) use
  • stressful labor and delivery
  • psychosocial stress/pain

How could you influence these factors?  In a word:  doula.  Doulas have been shown to influence a number of the factors above, including shorter labors with fewer complications, less pitocin use, reduced risk of cesarean birth, and less use of pain medication.  Want to know more about how to reduce these factors?  Check out my post on birthing practices and breastfeeding.

And here are the neonatal factors associated with a delay in milk coming in:

  • supplementation within 48 hours postpartum
  • infant excess weight loss
  • nipple pain when breastfeeding
  • flat/inverted nipples (good support can help you with any problems that arise because of them)
  • prelacteal feeds (supplementation before mature milk comes in)
  • delayed first breastfeed episode
  • low perinatal breastfeeding frequency
  • hormonal contraceptive administration first week postpartum

And how can you reduce the odds of these factors?  If I had to choose one, it would have to be delivering at a Baby Friendly Hospital.  In Baby Friendly hospitals many of these practices don’t happen or do so far less frequently (supplementation before 48 hours, prelacteal feeds, delayed first breastfeeding, low feeding frequency).  But if delivery at a Baby Hospital is not practical (as it isn’t for most women in the U.S.), the next best thing would be to deliver at a hospital which follows as many of the Ten Steps to Successful Breastfeeding as possible.

If these recommendations sound familiar it’s because you’ve seen them before in posts I’ve written on ways of avoiding the breastfeeding Booby Traps.  For our best advice, see our checklists for pregnancy, birth, and during your hospital stay.

Did your milk come in late (defined as greater than 72 hours postpartum)?  How did it affect your breastfeeding experience?

 



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6 Comments | Last revised on 09/17/2012


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6 Responses to Science You Can Use: Milk coming in late puts breastfeeding at risk, says new study. But is there anything you can do to make your milk come in on time?

  1. Claire says:

    With my first baby, who was intubated in the NICU, I had delay in my milk coming in as a result of not having him at the breast those first couple of days (and he was very sleepy for a couple more, which didn’t help). That was pretty traumatic, because of course we knew to the mL how much I was expressing and ‘they’ said it wasn’t enough. It all worked out in the end, though, and we even avoided comping.
    The funny thing is, though, that I would really say, based on my second and 3rd children, that milk coming in within 72 hours would be early for me. My supply sort of builds up over 4-5 days of feeding to need, it’s not a sudden overnight increase. And IME that works fine if you don’t have people undermining your confidence by asking whether you’ve noticed a sudden increase. I wonder if the definition of ‘late’ is really appropriate if nearly a quarter of women experience this?

    • Tanya Lieberman, IBCLC says:

      I was thinking the same thing, Claire: doesn’t 25% make it normal? But then I remembered that 30% of births are by c-section in the U.S. now, and that is a risk factor for delayed LII. That could explain a lot of the 25%. If our rate was more in the 10-15% range, I wonder what the rate would look like?

  2. Nicole says:

    My milk didn’t fully come in until 5, yes FIVE, days after I delivered. I had severe complications and was seperated from my daughter for 3.5 days. I wasn’t allowed to pump bc it would put my body under further stress. I had to allow them to give her formula, I was devestated but DETERMINED to breastfed as soon as I could!! By the third day we were home she was formula free, after having it for her first 9 days of life! She’s now exclusively a booby baby! And my supply is plentiful as I have my fridge and freezer stockpiled!! It took a ton of hard work and my determination but we did it! I would nurse, supplement, and pump for an entire week straight… It seemed all I did was feed or pump… But it’s possible so don’t loose hope or faith and have a great support system!!

  3. Ruth says:

    I have never heard this 72hr ‘rule.’ I have read that milk coming in 4-7days pp is normal. My daughter was born just shy of 37 weeks so,’preterm’ and her first apgar was only a 4, second was 9. My milk came in around day 4-5. She even had jaundice but we never had to supplement. I guess by the study’s definition my milk came in ‘late’ but for my daughter and I it was right one time.

  4. beth says:

    With my first, I had copious amounts of pitocin (following 3 days worth of mag sulfate to stop the labor, my water then broke but my body wouldn’t labor). My milk also did not come in until day 5. I was released from the hospital on day 2 (a friday) without a lactation consult. By Monday, my baby was lethargic, my nipples were sore and finally I had my consult. The LC knew immediately the baby had high bilirubin and ordered a test. It was 19! From there we were admitted to a hospital NICU 30 miles away and the baby stayed for 5 days, peaking at 20 and narrowly escaping a double blood transfusion. Thankfully, the second hospital had great LC’s that helped me through nursing a NICU baby, or I would not have ever really gotten started. The first LC ended up being a wonderful support, and offered a weekly support group that I went to after we got released. I nursed him for 16 mos.

  5. Rachel says:

    My milk hadn’t fully “come in” by 72 hours, but at the hospital I gave birth in there was no mention of it being unusual. In fact, they said I had lots of colostrum, said I was doing a great job cluster feeding, and when my breasts doubled in size about 65 hours after birth (but still producing colostrum until the next day) they said my milk was coming in early, due to my son’s frequent feeding! My son regained his birth weight in one week and has never had formula.

    I had a short labour (8 hours in total from my first proper contractions), gas and pethidine pain relief, vaginal birth with no forceps, vacuum, or episiotomy. Bub was healthy and I had the standard syntocinon (pitocin) injection following delivery. I did find the labour very scary and traumatic, despite it being a very ‘good’ birth, and I did have a lot of pain breastfeeding. None of the other risk factors mentioned.

    I’m in Australia. The hospital is baby friendly accredited. There were definite issues with a lot of the advice on attachment, but there was no undermining of my ability to feed my baby.

    I have always been confused at the “need” to supplement a newborn baby with a stomach the size of a small marble! They just need frequent feeds of colostrum. Some people I’ve spoken to have felt the need (or been advised) to supplement their newborn when mum’s milk hasn’t come in, but I put it down to a lack of breastfeeding knowledge. Milk coming in on day 4 is normal. If it comes in before that, it’s early!!

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