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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