Are you pregnant and intend to breastfeed your new baby? Are you concerned you might have no breast milk after delivery? While it’s not common, it can happen.
Having insufficient breast milk after birth to feed your new baby can be disheartening, especially when you’ve been looking forward to that special mom and baby bond of breastfeeding. Setting your expectations and realizing why your milk is not immediately on demand can put your mind at rest.
It can take a few days or even weeks for milk to be readily available on demand for your baby. Let’s look at some of the reasons why milk production can be delayed, and what you can do about it.
What Stimulates Production of Breast Milk?
All through your pregnancy, hormones have been running rampant through your body. These include prolactin, cortisol, oxytocin, and insulin, all of which are involved in the production of breast milk. Added to the mix are estrogen and progesterone, which help prevent milk from being produced until it’s needed.
Each of these hormones has an individual role. These are:
- Prolactin: While present in all women, pregnant or not, during pregnancy the levels increase greatly. It stimulates mammary tissue to grow, and get ready to produce milk. When a baby sucks, levels of prolactin in the blood increase and the alveoli produce milk (1).
- Cortisol and insulin: Both of these hormones contribute to the supply of breast milk.
- Oxytocin: This is the hormone that causes the milk to flow, either before or during a feeding session. Sometimes called let down, it responds to sucking, baby’s cry, or even thinking about your baby.
- Progesterone: Throughout pregnancy, progesterone prevents milk from being produced in the breasts. Following birth, the levels of this hormone drop quickly and trigger the production of milk.
- Estrogen: This hormone regulates and inhibits prolactin during pregnancy. Once baby is born and the high levels of this pregnancy hormone drop, then the prolactin can do its job (2).
It takes about 30 to 40 hours after birth and separation of the placenta for the levels of progesterone and estrogen to drop.
When Does Milk Production Start?
Within a couple of days of your little one being born, you might notice your breasts start to feel full. This is your milk coming in. It happens as a result of the hormonal changes we have mentioned—the drop in estrogen and progesterone and the increase in prolactin.
During the first few days after delivery, the breast produces a creamy, rich, first milk, called colostrum.
This baby superfood supplies the newborn with all the nutrition they need for the first few days of life. It also helps boost their immune system and protects them against bugs they now have contact with outside the womb (3).
Think of colostrum in teaspoon-fuls, not ounces. It’s thick, almost jelly-like when expressed. Your baby will only need little bits at a time, but will need it often.
Editor's Note:Michelle Roth, BA, IBCLC
About two to five days after birth, colostrum begins to mix with mature milk — this is called transitional milk. This helps your baby’s stomach get ready to take in more milk as their stomach grows. Generally, after anything between a few days and a week, your milk will come in.
It can take about seven to ten days before your milk fully comes in. The transitional milk may look whitish with some yellow mixed in, but will eventually look thin, white or even bluish.
Why Isn’t My Milk Coming In?
Breastfeeding is considered to be the best nutritional option for a newborn. When you have insufficient breast milk after birth, you might feel you’re lacking in giving your baby the start they need. Most women will produce colostrum and some milk, even if it’s in short supply, to begin with.
There are many reasons which can contribute to a delay in milk production. It’s worth noting that just because your milk is delayed doesn’t mean it won’t happen at all. It might just take a bit longer.
Medical Causes of No Milk
There are several reasons why no milk will be produced or it will be delayed. Let’s look at some of these.
1. Hormonal Imbalances
There are a few causes for the hormones in your body being out of whack. These include:
Diabetes or Gestational Diabetes
Diabetes happens when your body either doesn’t produce sufficient insulin (Type 1) or is unable to use insulin properly (Type 2). There is also a type of diabetes which only occurs in pregnancy, called gestational diabetes.
As insulin plays a part in the production of breast milk, changes in its availability can affect your milk supply. This won’t happen for all moms who have diabetes. Carefully controlling blood sugar and insulin levels should help regulate milk supply (4).
Conditions Associated with the Pituitary Gland
The pituitary gland is responsible for producing both oxytocin and prolactin. These are two of the main hormones needed for milk production. If this gland is underactive (hypopituitarism), then the milk supply might be late or non-existent.
Many things can affect the function of this important gland. These include tumors, strokes, and blood loss during childbirth (Sheehan’s syndrome) (5).
The thyroid is a small butterfly-shaped gland in the throat. It’s responsible for the production of two hormones, thyroxine (T4) and triiodothyronine (T3). These hormones are important for normal functions and growth within the body, and also for breastfeeding.
If this gland is under or overactive, it can interfere with milk supply. It can cause overproduction, underproduction, or fluctuation of the amount of milk produced. The good news is this can be controlled with medication, even when breastfeeding (6).
Some medications can affect when you produce breast milk and how much. One of these is birth control medication taken in the early weeks following delivery. It’s best to check with your medical provider about any medication you’re taking and the likelihood of them affecting your milk supply (7).
Some herbs can also interfere with milk supply, especially parsley, mint, sage, and spearmint. So be aware of any herbal medicines you take (8).
3. Gestational Ovarian Cysts
These are cysts that can form during pregnancy and they produce a high level of testosterone. This can suppress the production of breast milk, meaning you have insufficient breast milk after birth.
These cysts usually resolve themselves within three to four weeks, allowing a normal milk supply. It’s best to pump throughout this time to encourage your milk to come in (9).
Being overweight can have a negative impact on the response of prolactin in the body when your baby sucks. This could delay the onset of milk production (10).
Obesity can also contribute to diabetes or hyperthyroidism, which we have already mentioned.
5. Polycystic Ovary Syndrome (PCOS)
PCOS affects hormone levels in about 15 percent of women. It causes high levels of male hormones, irregular periods, and cysts on the ovaries. It also interferes with the production of all the hormones that help produce breast milk.
If PCOS could be the reason your milk supply is low, your doctor will address the underlying hormonal imbalances.
6. Previous Breast Surgery
Women can have breast surgery for many reasons. Maybe you’ve had implants for augmentation, a reduction in size, or a lumpectomy, mastectomy, or biopsy.
All of these have the potential to interfere with the breast tissue and areola. This can mean they also interfere with the production of breast milk (11).
Birth Considerations for Delayed Lactation
Giving birth can be traumatic for any mom. However, it may be more so for some than others.
Some factors surrounding the birth of your little one can lead to insufficient breast milk after birth. These include:
- Traumatic or stressful delivery: A long labor, difficulty pushing the baby out, or medical interventions like forceps, ventouse/vacuum, or a cesarean surgery, can increase stress hormones. These hormones can delay the onset of lactation, meaning your milk is delayed (12).
- IV fluids during childbirth: Large amounts of fluid given intravenously during the birth can cause breasts to swell and become painful. It can make it hard for baby to latch on and feed, as well as being uncomfortable for mom. It can reduce the amount of breast milk available immediately after delivery and might put mom off breastfeeding (13).
- Sheehan’s syndrome: A loss of more than one pint of blood can damage the pituitary gland. This prevents the hormones necessary for milk production from signaling the breasts to lactate. Fortunately, in the developed world, this condition is rare (14).
- Retained placenta: Although not a common problem, it’s possible that all the placenta is not delivered after birth. The placenta produces estrogen and progesterone during pregnancy to prevent you from producing milk before it’s needed. As a result, the drop in these hormones that signal the production of prolactin doesn’t happen, and you might have little or no breast milk (15).
- Pain relief during labor: Medications administered to take away some of the pain associated with labor can delay your milk coming in, and could also make baby sleepy during the early days when suckling is essential to building the milk supply (16).
- Nerve or spinal damage: Damage to the nerves that signal the release of breastfeeding hormones, or damage to the vertebrae in the spine can affect the let down of your milk (17).
- Premature birth: Throughout your pregnancy, your breasts have been preparing mammary glands to get ready to feed your baby. When a baby is born early, your breasts might not be ready to produce a full milk supply. The good news is that with management you will likely be able to produce milk for your baby by the time they are ready to suckle (18).
- Heavy babies: First-time moms who have babies with an above-average birth weight might experience a delay in their milk production (19).
- Age: Moms aged 35 years or over could find the production of their breast milk is delayed. This may be by a few days or a few weeks.
Solutions To No Breast Milk
You might feel upset or disappointed that your milk is not coming in, but it’s important not to let this get to you. This will only cause you stress and anxiety, which can delay your milk even more. Instead, get advice from your health professional or a lactation consultant as early as possible.
Despite your feelings about it, your baby must get the nourishment they need. Until your milk supply is in full flow, you might need to supplement with formula or donor milk.
Signs that your baby might not be getting enough milk are weight loss, jaundice, or dehydration. There might be no change in the dark meconium, and bowel movements might decrease. The chances are your baby will be fussy and irritable, will spend a lot of time at the breast, and still seem hungry after feeding.
The production of breast milk is a supply and demand situation. The more milk is demanded, the more supply there will be. To help increase your milk supply, you can (20):
- Hand-express breast milk regularly, even if you only get a few drops out at first. The more you express, the more likely your supply will increase.
- Make sure your baby is latched on the breast properly and is actually feeding. Your health care team will be able to advise you on this.
- Massage your breasts during feeding to stimulate the let down of milk.
- Make sure you offer your baby both breasts at each feeding. Using only one breast can cause a lack of milk production in the unused one.
- Make sure you have lots of skin-to-skin contact with your baby as this can stimulate milk production.
- Hold off on giving your baby a pacifier until your milk supply is well established.
Breastfeeding creates a special bond between a mom and her baby. When your breast milk does not come in as expected, it can cause you to worry.
The chance of having insufficient breast milk after birth or no breast milk at all is extremely rare and there are doctors and lactation specialists who can help. Make sure you consult someone as soon as possible if you have any concerns.
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