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 why milk production can be delayed and what you can do about it.
- Vitamin C is important for both mom and baby, helping with wound healing, promoting healthy skin, and protecting against infections.
- Breastfeeding moms should consume 120 milligrams of vitamin C daily, which can be obtained through a balanced diet rich in fruits and vegetables.
- Taking excessive vitamin C supplements can cause side effects, but the body regulates the amount passed into breast milk, so it doesn’t affect the baby after delivery.
- Vitamin C levels in expressed milk decrease over time, so use refrigerated milk within 24 hours and frozen milk within one month for maximum benefits.
What Stimulates Production of Breast Milk?
Throughout your pregnancy, hormones have been running rampant through your body. These include prolactin, cortisol, oxytocin, and insulin, all of which are involved in breast milk production. 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.
- Prolactin: While present in all women, pregnant or not, the levels increase significantly during pregnancy. It stimulates mammary tissue to grow and prepare for producing milk. When a baby suckles, prolactin levels in the blood increase and the alveoli produce milk (1).
- Cortisol and insulin: These hormones contribute to your breast milk supply.
- Oxytocin: This hormone causes the milk to flow, either before or during a feeding session. Sometimes called let down, it responds to suckling, a 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 milk production.
- Estrogen: This hormone regulates and inhibits prolactin during pregnancy. Once your baby is born and estrogen levels drop, prolactin can do its job (2).
It takes about 30 to 40 hours after birth and the separation of the placenta for progesterone and estrogen levels 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, your breasts will produce a creamy, rich first milk called colostrum.
This baby superfood supplies your 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 bacteria they now have contact with outside the womb.
Think of colostrum in teaspoonfuls, 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 milk helps your baby’s stomach prepare to take in more milk as it grows.
It can take about seven to ten days for your milk to come in fully. 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 in short supply, to begin with.
Many reasons 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 show up at all. It might just take a bit longer.
Causes of No Breast Milk After Delivery
There are several reasons you may not produce milk or it might be delayed. Let’s look at some of these.
1. Hormonal Imbalances
There are a few reasons the hormones in your body may be imbalanced.
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 that only occurs in pregnancy, called gestational diabetes.
As insulin plays a part in breast milk production, 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 your milk supply (3).
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), the milk supply might be late or non-existent.
Many things can affect the function of this vital gland. These include tumors, strokes, and blood loss during childbirth (Sheehan’s syndrome) (4).
The thyroid is a small butterfly-shaped gland in the throat. It’s responsible for producing two hormones: thyroxine (T4) and triiodothyronine (T3). These hormones are essential for regular functions and growth within the body and also for breastfeeding.
If this gland is underactive or overactive, it can interfere with your milk supply. It can cause overproduction, underproduction, or fluctuation in milk production. The good news is that this can be controlled with medication, even while breastfeeding (5).
Some medications can affect when and how much breast milk you produce. One 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.
Some herbs can also interfere with milk supply, especially parsley, mint, sage, and spearmint. So be aware of any herbal medicines you take.
3. Gestational Ovarian Cysts
These cysts can form during pregnancy and produce a high level of testosterone. This can suppress breast milk production, meaning you have insufficient breast milk after birth.
These cysts usually resolve themselves within three to four weeks, allowing a regular milk supply. It’s best to pump throughout this time to encourage your milk to come in (6).
Being overweight can have a negative impact on prolactin’s response in the body when your baby suckles. This could delay the onset of milk production (7).
Obesity can also contribute to diabetes or hyperthyroidism.
5. Polycystic Ovary Syndrome (PCOS)
PCOS affects hormone levels in about 15% 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 these can potentially interfere with the breast tissue and areola. This can mean they also interfere with breast milk production (8).
Birth Considerations for Delayed Lactation
Giving birth can be traumatic for any mom. However, it may be more so for some than others.
These are some of the factors surrounding the birth of your little one that can lead to insufficient breast milk.
- 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 (9).
- IV fluids during childbirth: Large amounts of fluid given intravenously during delivery can cause breasts to swell and become painful. It can make it hard for your baby to latch on and feed and be uncomfortable for the mom. It can reduce the amount of breast milk available immediately after delivery and might put mom off breastfeeding (10).
- 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. This is rare in developed countries (11).
- Retained placenta: In rare cases, 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 (12).
- Pain relief during labor: Pain medications administered during labor can delay your milk coming in and make your baby sleepy during the early days when suckling is essential to building the milk supply (13).
- 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 your milk let-down.
- Premature birth: Throughout your pregnancy, your breasts have been preparing mammary glands to get ready to feed your baby. If your 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.
- Heavy babies: First-time moms who have babies with an above-average birth weight might experience a delay in milk production (14).
- Age: Moms 35 years or over may have delayed breast milk production by a few days or weeks.
Solutions To No Breast Milk After Delivery
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. Your baby will likely be fussy and irritable, 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. These are some things you can do to help increase your milk supply:
- 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.
- Ensure 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 milk let-down.
- Ensure you offer your baby both breasts at each feeding. Using only one breast can cause a lack of milk production in the unused one.
- Ensure 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.