High Risk Pregnancy & Breastfeeding Challenges: How to Prepare

Breastfeeding is natural—but not always easy. When a pregnancy is high risk, it can increase the likelihood of lactation challenges and infant feeding complications after birth. Whether due to maternal health conditions, early delivery, or infant complications, families often need extra support to initiate and sustain breastfeeding.

What Is a High-Risk Pregnancy?

A pregnancy is considered high risk when there are medical concerns that could affect the health of the birthing parent, baby, or both. These conditions often require additional monitoring, interventions, or early delivery—each of which can interfere with milk supply and breastfeeding.

High-Risk Pregnancy Factors That May Impact Breastfeeding

1. Gestational Diabetes

Parents with gestational diabetes may experience a delayed onset of milk production. Babies may also experience blood sugar instability, leading to a shot NICU stay, and often donor milk or formula supplementation, which can interfere with establishing exclusive breastfeeding.

2. Preeclampsia or Chronic Hypertension

These conditions can result in preterm delivery, separation of baby and parent, and increased medical interventions. Preeclampsia can also disrupt the hormonal cascade needed for milk production.

3. Preterm or Late Term Birth

Premature babies, and even those born at 37-38 weeks, often have underdeveloped oral motor skills and may not be able to latch or suck effectively. Pumping and expressed milk become essential to protect and establish milk supply. And these babies benefit from hands-on feeding therapy to stimulate feeding reflexes, support muscle tone, and oral motor skills.

4. Multiple Births (Twins, Triplets, etc.)

Carrying multiples increases the risk of preterm labor and cesarean birth, and may lead to challenges with milk supply. Given that twins share an already tight womb, they are also at an increased risk for torticollis, or tension that interferes with feeding skills.

5. Thyroid Disorders

Both hyperthyroidism and hypothyroidism can affect milk supply and hormonal balance. These conditions may reduce the effectiveness of breastfeeding hormones like prolactin and oxytocin.

6. PCOS (Polycystic Ovary Syndrome)

Parents with PCOS may have underdeveloped glandular tissue in the breasts and struggle with low milk supply despite frequent feeding or pumping.

7. Cesarean Section

C-sections can delay skin-to-skin contact and the first feeding. Postoperative pain and medications may also make positioning or latching more difficult in the early days. Babies born via c-section also lose out on the opportunity to activate primitive reflexes that occur during a vaginal delivery. For this reason, they may struggle to coordinate oral motor skills for feeding.

8. Placenta Complications (Previas, Abruption, etc.)

These can result in early delivery, emergency birth, or significant blood loss—factors that can cause delayed lactation or supply issues.

9. NICU Stay or Infant Birth Trauma

Infants who require NICU care or experience birth trauma may have difficulty latching or maintaining stamina for feeds. These babies often need alternative feeding methods, and parents need support to maintain milk supply while separated.

10. Perinatal Mood and Anxiety Disorders

Anxiety, depression, or birth trauma can impact oxytocin release, milk ejection, and overall breastfeeding confidence. Supportive care and therapy are essential in these cases.

How to Support Breastfeeding After a High-Risk Pregnancy

• 💡 Schedule a prenatal lactation consultation if you’re at risk.

• 🧑‍⚕️ Build a team that includes your lactation consultant (IBCLC), infant feeding therapist (SLP, OT), bodyworker (CST, pediatric chiropractor), and mental health support if needed.

• 🍼 Start pumping early if baby can’t feed directly.

• 🤱 Prioritize skin-to-skin and bonding when possible—even in the NICU.

• 🧘 Be kind to yourself. Your story may look different, and that’s okay.

You’re Not Alone

A high-risk pregnancy doesn’t mean breastfeeding is impossible—but it may require extra effort. With early education, proactive planning, and compassionate support, many parents are able to achieve their feeding goals. If you're navigating a complex pregnancy and want support preparing for feeding, schedule a phone consult. Early guidance makes all the difference.