Reasons for Delay in the Onset of Breast Milk Production

Mother holding newborn
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The first breast milk that your baby receives after birth is colostrum. Colostrum is concentrated and produced in small amounts, so it doesn't make your breasts feel full. The change from colostrum to the creamy transitional milk that fills your breasts takes a few days. This filling of the breasts usually starts at approximately the third day postpartum, but for some women, the process is delayed. There are lots of reasons for this delay, including these ten.

Why Your Milk Hasn't Come In

If any of these apply to you, you might notice that your milk doesn't come in by day three or four after birth. Keep putting your baby to the breast as often as possible. Babies benefit from colostrum, and the stimulation of nursing will help with milk production.

It's your first baby: It could take up to the fifth day postpartum for a first-time mother's breasts to fill with breast milk. With your next baby, your milk will most likely come in sooner.

You had a difficult delivery: A long stressful labor; a traumatic birth experience; or the use of anesthesia, Pitocin, or an abundance of IV fluids can slow down the production of breast milk.

You had a C-section: Surgery, stress, pain, and the emotional factors associated with having a cesarean section can make it take longer for your breast milk to come in. Start breastfeeding as soon as you can after your c-section and breastfeed very frequently.

Your baby was born premature: Although your body is capable of making breast milk by the end of your second trimester, the early end of pregnancy, the stress of premature delivery, and the inability to breastfeed your preemie immediately after birth can delay the production of your breast milk. Use a breast pump to try to stimulate your milk production and pump your breast milk for your baby.

Your baby is having trouble latching: Any problems with your baby's ability to latch on and breastfeed can interfere with the initiation of milk production. Newborns with a tongue-tie, a cleft lip/palate, or neurological issues may not be able to latch on well. Or, if your nipples are flat, inverted, or very large, it may be harder to get breastfeeding started. Ask for help from your nurse or a lactation professional.

You have diabetes: It may take longer for milk production to begin in mothers who have diabetes. This delay could be due to a combination of reasons including hormonal issues, the high rate of c-sections in diabetic mothers, premature delivery, and the separation of mom and baby at birth. Put your newborn to the breast very often and have them monitored to be sure they are getting enough breast milk. 

You have a hormonal issue: If you have symptoms of hypothyroidism or PCOS, it may take longer for you to make breast milk. Breastfeed your baby on demand at least every two to three hours around the clock and have your pediatrician monitor your baby's weight closely. 

You are overweight: Being overweight before conception, or gaining too much weight during pregnancy, can interfere with the onset of your breast milk production after the delivery of your baby. Keep putting your little one to the breast to stimulate the production of breast milk, and monitor the baby's growth and weight closely.

You have retained placental fragments: When part of the placenta stays behind in the uterus after childbirth, it can prevent the hormone changes needed in your body for breast milk production to begin. Once your doctor diagnoses and removes the retained placental fragments, the hormones will shift, and your body will begin to make breast milk. 

You have theca lutein cysts: These testosterone-producing ovarian cysts can delay the onset of milk production. They typically go away on their own within a few weeks after childbirth. Once they resolve, testosterone levels decrease, allowing full milk production to begin.

How Baby May React If Breast Milk Isn't Coming In

New mothers can typically feel a sense of fullness and even engorgement when milk comes in. But not everyone does, and it can be hard to tell if your baby is getting enough milk.

When your breast milk supply is low due to a delay in the onset of milk production, your baby can appear constantly hungry and frustrated. If it's only a slight delay, it isn't necessarily a problem. However, the longer it takes for your breast milk to come in, the more dangerous it is for your child.

If your baby shows signs of dehydration, jaundice, or excessive weight loss, call the doctor immediately. These symptoms are serious and need to be corrected as soon as possible. Other signs that baby is not getting enough milk include:

If you are concerned about your baby's intake, you can ask for a weight check at your pediatrician's office at any time. You might also wish to work with a lactation consultant, who can help you with techniques for positioning, proper latch, and improving supply.

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Article Sources

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Additional Reading

  • American Academy of Pediatrics. New Mother’s Guide To Breastfeeding. Bantam Books. New York. 2011.
  • Hartmann, P. and Cregan, M. Lactogenesis and the Effects of Insulin-Dependent Diabetes Mellitus and Prematurity. The Journal of Nutrition. 2001; 131(11): 3016S-3020S.
  • Hurst, N. M. Recognizing and Treating Delayed or Failed Lactogenesis II. Journal of Midwifery & Women’s Health. 2007; 52(6): 588-594.
  • Lawrence, Ruth A., MD, Lawrence, Robert M., MD. Breastfeeding A Guide For The Medical Profession Seventh Edition.  Mosby. 2015.
  • Riordan, J., Wambach, K. Breastfeeding and Human Lactation Fifth Edition. Jones and Bartlett Learning. 2014.