Having your milk come in late (defined as more than 72 hours after birth) can be frustrating and sometimes scary. And research shows that it can be a real barrier to meeting your breastfeeding goals.
Unfortunately it's also fairly common. The CDC reports that one in four mothers experience a delay in milk coming in - one in three for first time mothers. So if this happened to you know that you're not alone!
There are a number of factors, from how you birth to how your hospital cares for you and your baby, that are associated with a delay in your milk coming in. According to Breastfeeding Answers Made Simple, these include:
- first baby
- maternal overweight, obesity, or excessive weight gain pregnancy
- breast issues such as underdeveloped breasts, breast surgeries or injuries, or unusual breast or unusual breast or nipple anatomy
- PCOS (polycystic ovary syndrome)
- thyroid or pituitary issues
- luteal phase defect
- prolactin resistance
- theca lutein cysts
- baby issues such as unusual oral anatomy, birth injuries, breathing problems, health or neurological problems
- long labor or traumatic or stressful birth
- Cesarean section
- preterm birth
- retained placental fragments or other placental issues in pregnancy
- blood loss of more than 500 ml
- little or no breastfeeding or expression postpartum
- separation of mother and baby, little or no skin-to-skin contact
Fortunately there are things you can do to increase the odds that your milk will come in on time. Two key things you can do: have a doula(or other trained labor support person) at your birth, and birth at a Baby Friendly hospital.
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. If hiring a doula isn't in your budget, you may be able to find a doula in training to support you. You might ask a friend or family member to get some training in labor support and be present for your birth. Or ask a friend who has had a positive birth experience to be there.
Baby Friendly hospitals are hospitals where policies and practices are supportive of breastfeeding. Baby Friendly hospitals must train their staff in breastfeeding support, encourage breastfeeding on cue, not give pacifiers, and other practices shown to support breastfeeding. If delivery at a Baby Hospital is not practical due to distance or insurance, the next best thing would be to deliver at a hospital which follows as many of the Ten Steps to Successful Breastfeeding as possible.