Why your milk might be delayed.
We have looked at how the physiological transition from colostrum to mature breastmilk occurs in the first week after birth. When everything is going according to nature's plan, mothers can expect to see indicators their milk is changing around Day 3-5.
But sometimes the process is delayed and mother and baby need additional support during this time. This is referred to as Delayed Onset of Lactation (DOL).
So, what are the reasons the second stage of breastmilk production might be delayed. You might be surprised by some of these!
The birth itself
Lactation can be impacted by how and when your baby is born. Today the rate of surgical delivery (commonly referred to as caesarean section) continues to rise. (All three of my own children were born this way).
There are two ways a caesarean can occur: unplanned (or emergency) and planned (or elective). Unplanned caesareans generally follow an induced or spontaneous labour, where progress is not happening in the optimal time frame or complications have occurred. Planned caesareans are generally due to existing or new conditions which make vaginal childbirth unviable or high risk. Rarely is it performed by request or for non-medical reasons. Major abdominal surgery is not undertaken lightly.
Research has shown that mothers who have planned caesareans without naturally going into labour are more likely to have a delay in their milk production compared to those who have an unplanned caesarean after going into labour. All caesarean births are more likely to have delayed onset of lactation than a vaginal delivery.
Research has shown that mothers who received labor pain medications were 2-3 times more likely to report delayed onset of lactation compared to mothers who did not use labor pain medications and delivered vaginally.
Mothers are entitled to make fully informed decisions based on current evidence. When interventions in childbirth have a known history of delaying onset of lactation, women need to be told and a management plan put in place, right from the start. Too many women are left feeling they have failed or there is something wrong with them and cease breastfeeding prematurely. They are then less likely to initiate breastfeeding with a subsequent child.
Retained placenta
Regardless of how a baby is born, the placenta is carefully assessed once it leaves the womb. Midwives will check to see that it is intact. However, if undetected fragments remain in the uterus, hormones of pregnancy might still be active, delaying the onset of lactation in the typical manner. It can be days or weeks before this is diagnosed by medical practitioners and may need removal under anaesthetic if it doesn't resolve naturally.
Post-parturition haemorrhage
When excessive blood loss occurs after childbirth, it can be a life-threatening situation. A significant loss will be treated as an emergency and is traumatic for all involved. The physical and psychological effects can delay the onset of lactation and - in extreme cases - cause damage to the pituitary gland, preventing milk production altogether. However, in most cases there might be a temporary delay without ongoing effects.
Maternal factors
There are recognised medical conditions such as diabetes and thyroid disorders which typically delay the onset of lactation. Mothers should be made aware of this during pregnancy and will benefit from consulting an IBCLC lactation consultant to develop a plan for the early days of breastfeeding.
Women with Insufficient Glandular Tissue or those who have experienced breast surgery or injury should progress through the transition typically but may not produce sufficient breastmilk to fully meet their baby’s needs. However the supply achieved can be maintained to continue partial breastfeeding, supplemented with donor breastmilk or infant formula. Frequent removal of milk in the first few weeks will maximise production.
Maternal obesity and overweight are associated with a higher risk of lactation being delayed. The exact reason is yet to be determined, as there are practical and psychological factors around body size in addition to any physical cause. Mothers with larger breast size can experience similar issues and all will benefit from consulting an IBCLC during pregnancy to discuss potential challenges. Postnatal support will also help to ensure positioning and attachment options are fully explored.
What to do while you wait
The most important thing to remember is that delayed onset does not mean you cannot make breastmilk or will not be able to breastfeed. Sometimes the process can take 7-14 days to work. Your priorities are to feed your baby and protect and support your lactation. Any maternal breastmilk your baby receives is important, even if supplemented by donor breastmilk or infant formula.
If your baby is latching on the breast, offer it at every sign of feeding cues. Avoid delaying feeds or using dummies. If your baby is being given feeds from a cup or bottle, offer the breast after the feed for comfort and settling. Offer the breast after a pumping session.
Pumping milk will probably be a big part of your plan. Hands-on pumping combines breast compression with using a breast pump. Aim to pump at least 8 times in 24 hours over the first 14 days - including overnight.
Skin-to-skin contact with your baby stimulates milk production. Take advantage of this by spending as much time as you can this way. You can hold your sleeping baby against you while you pump, increasing your oxytocin levels and maximising milk removal.
