Why Didn't My Milk Come In?
Early milk, the colostrum, is already present in the second trimester of pregnancy and readily available to your newborn baby upon arrival. It is highly concentrated, and satisfies baby with only a spoonful amount the first days of life. Milk "coming in" refers to more mature milk, and is associated with the feeling of fullness or engorgement in the breasts. This typically occurs between days 3-7 after delivery. Sometimes mother's experience a delay in milk coming in, or will later recall that their milk just never came in, believing that their body cannot make enough milk. While there are a number of reasons for a delay in milk coming in, or low supply, the #1 reason is the lack of breastfeeding support. Having a lactation consultant before and after delivery can make all the difference.
Reasons For Delayed Milk Coming In or Low Supply in the Early Weeks
Postpartum hemorrhaging or retained placenta
Unable to breastfeed within 2 hours of delivery, maybe due to NICU stay
Medications (routine meds, or those administered during labor)
Medical condition: PCOS, thyroid, diabetes, high blood pressure
History of breast surgery (highly individualized)
Infant's inability to remove milk from the breast. This may be due to anatomical issues such as a tongue tie. Baby could be sleepy, such as as with jaundice.
Infrequency of breast stimulation. Perhaps baby isn't waking up on their own to feed often enough, or parent is following feeding schedule.
Supplementing with bottles
Lactation support before baby comes, and again in the early days of life are so important to breastfeeding success. In a prenatal visit, your provider will review your medical history, history of past pregnancies and breastfeeding experiences, provide education for what to expect immediately after delivery and in the first week. They will troubleshoot potential complications that could arise, and empower the breastfeeding parent to advocate for the feeding journey they want.
Lactation visits for when mom and baby come home provide peace of mind that you have support for all the unexpected moments and questions that come later. Often the need for breastfeeding support looks different in the first days vs first weeks, and months. Initially, you may be working with your lactation consultant on how to enhance supply, or how to get a sleepy baby to fill up. Later, there may be concerns for fussy at breast, nipple trauma, or clicking during feeds. Maybe there's a tongue tie. It changes. A return to work leave a mama wondering how to maintain her supply, or transition to full-time pumping. The CDC reported that in 2019, only 55.8% of mothers were exclusively breastfeeding (that includes pumped breastmilk). Most families do not breastfeed as long as they intended to. With a lactation consultant, you are better equipped to meet your feeding goals. No matter what they are. And you're aloud to change your mind. But know that support is available to help you meet your breastfeeding goals.
If you are an expectant parent, find our lactation packages under services. We offer 1:1 prenatal counseling, along with follow-up visits, which can be scheduled in office, online, or in the comfort of your home.