Tips from an LC: If Milk Isn't Coming In, What Should I Do?

Transcript: If My Breast Milk Isn't Coming In, What Should I Do?

In this video, I’m going to talk about what to do if your milk is not coming in on time. Please see the link to our other video, which talks about those women who may have a greater chance of experiencing a delay in their milk coming in. But, in this video, we are going to focus on timely tips to help increase your milk supply.

...But What Does "Milk Coming In" Even Mean?

The phrase "milk coming in" actually refers to a usually rapid increase in your milk volume.

Technically, you have been producing colostrum (the first milk) since you were around 20 weeks pregnant. But, the hormones of pregnancy stop your breasts from producing large volumes of milk until after birth. Once your baby and the placenta have been born, your body knows that you are now no longer pregnant and those pregnancy hormones rapidly decrease, allowing for the lactation hormones to take over.

When we describe your milk as "coming in", what is meant is the volume of milk has increased.

So, How Will You Know That Your Milk Has Come In?

For most women, this is very easy to recognize; your breasts will feel much fuller, heavier, and maybe even a little warmer and sometimes tender. It’s very clear to see for many women!

If you have had a physiological vaginal and fairly straightforward birth, your milk usually comes in anywhere between 24 to 72 hours after birth.

What should you do if you notice your milk hasn’t come in by 72 hours after birth?

For some moms, there may be a delay in when the milk comes in. This is usually down to the type of birth you and your baby have had, if you have diabetes, if your baby needed to go to the neonatal intensive care unit, or if your baby was not feeding frequently in the first few days because they were either too sleepy or maybe affected by the medications given during labor. There are several reasons a delay could occur.

Some research has shown that women who experience a delay of more than 72 hours for their milk to come in are at an increased risk of low milk supply at 4 weeks after birth - especially if they are not supported early to get milk production back on track.

What Should You Do if You Notice Breast Milk Isn't Coming in Around Day 3?

Be proactive! It is important to let your healthcare professional know if you notice or think your milk supply is delayed, so that they can give you some more advice and support specifically tailored to you and your breastfeeding experience. This then enables you to keep building a good milk supply in these early critical days, when your milk-making cells need to be activated the most. Things that your healthcare professional may advise or be looking for are:

How frequently your baby is breastfeeding. Babies should be feeding a minimum of 8 times in every 24 hours in the first four weeks after birth. This ensures that they get enough food, and you build an adequate milk supply. But it is not just the frequency of the feeds, it is how effectively or how well your baby is feeding. This is why it’s really important to get as much support from your midwife, nurse, or lactation specialist early on as possible to ensure that your baby is latching on effectively, correctly, and comfortably at the breast.

When a baby is well attached to the breast, they can transfer the milk out into their little tummies perfectly. If they are not well attached, then it makes the milk much more difficult to flow into your baby’s mouth. Always seek help and support if you feel like your baby is not latching on well enough.
How many wet and dirty diapers your baby is having every day. It is important for you to keep an eye on your baby’s output. This can tell you if your baby is starting to drink more milk. See our video on how to know if your baby is getting enough milk for more details!
They will likely weigh your baby. It is normal for babies to lose between 5 - 8% from their birth weight in the first 3 days, but after this point they should be gaining weight again (because your milk volume has increased!)
They will often ask you if you have noticed an increase in the size in your breasts. They'll ask if they feel fuller, heavier? Perhaps you noticed that they felt warmer or firmer. As your milk increases in volume, these are some of the changes you will likely feel in your breasts. You may also start hearing your baby gulping your milk too! If you are not noticing these signs by the third day, it is advisable to discuss this with your healthcare provider.
If your healthcare provider notices from any of these points we have just discussed that your milk supply seems to be slightly delayed, they may suggest that you start pumping as well as breastfeeding. This advice is given to help stimulate your milk-making cells. Your healthcare provider would likely recommend that you continue to pump until your baby is able to breastfeed effectively and once you have a sufficient milk supply. Once this has happened, they will likely advise you to stop pumping and just breastfeed - and, of course, get plenty of rest in between.

Know When to Seek Help

For most new moms, the milk will come in on time. However, for those moms who are at greater risk of a delay, it is good to know when to seek early and appropriate help. Never be afraid of asking for help or questioning what is happening! Feeling well-informed helps us to feel in control and confident, and that is one of the most important things when we are starting out in our breastfeeding journey.

If your baby is breastfeeding with no problems and your milk supply is on track, then your healthcare provider will not need to give you any extra feeding plans. Instead, they will just give you support and ongoing encouragement.

For extra help, download our printable feeding and pumping log to keep track of your little one's feedings and your pumping sessions through those early days and nights. You can also check out our other videos for more breastfeeding support and tips to help you during the first few days and weeks with your little one!