Why Won’t My Milk Come In?

Your baby has arrived, so why hasn’t your milk?! Statistically speaking (at least 75% of us) will feel our milk come in around day 2-3. However, it can take up to one week for some of us! Here are some of the more common risk factors that research shows as to why this could be happening:

1. Breasts Are Not Being Drained Frequently Enough

Research shows that your milk comes in due to hormonal changes within your body, regardless of whether your baby is breastfeeding.¹ However, this change happens more quickly if your baby (or by pump or hand expression) removes the milk frequently.

Breasts work on supply and demand, but what does this mean? What happens is that your breasts go into full-speed milk-making production when they are well-drained. So the opposite is also true . . . as your breasts fill up, your milk production slows down. This can be a bit confusing for people as I’ve had women say to me, “I’ve been waiting a bit longer between breastfeeds because I then have more milk for my baby when he breastfeeds!” While this might be true in the short term, the opposite will begin to happen. This is because the longer you go between feeds, the more your breasts fill up and the slower your production gets. This is great because it means our breasts won’t explode! However, it also means that our production will start to decrease if we don’t drain our breasts frequently enough.

2. Your Labor and Birth

It is well established in literature how our labor and birth experience can affect breastfeeding and how our milk comes in. The following can delay this process, including cesarean birth, large amounts of IV fluid during labor, postpartum hemorrhage, and retained placenta. If you do experience some (or all) of these, make sure to seek help straight away from hospital staff so you can get breastfeeding off to the best start! Be with your baby skin-to-skin as often as you can.

3. Separation of Mother and Baby

Being separated from your baby can put you in a very challenging situation when trying to establish breastfeeding. Having your baby sent to NICU or even the separation of just an hour or two can affect the first breastfeeding and the early hours after birth. Try to advocate for yourself (or, even better, have someone else advocate for you) and your baby so you can be together as soon as possible. If your baby is in the NICU, then ask to be brought there as soon as you can so you can start skin-to-skin and, if possible, start breastfeeding. Even if you cannot breastfeed your baby, you might be able to be skin-to-skin, which is just as important in the early days and weeks!

4. Maternal Concerns

These include thyroid, hormonal conditions, insufficient glandular tissue (where the milk is made and stored), diabetes, and more. If you feel you have had great skin-to-skin the first few days, baby is feeding well, and everything seems OK, but your milk still hasn’t come in, get help to figure out WHY this is happening. Did you notice breast growth during pregnancy? Do you have a history of any medical concerns? These important questions must be worked through to help form a plan for you and your baby.

5. Baby Concerns

Do you have worries that your baby is not draining your breast well or cannot latch properly? There are different possibilities as to why this could be happening, including (but not limited to) tongue tie, low tone, and torticollis (“twisted neck”), where your baby is uncomfortable and finding it difficult to be in certain positions. This can affect how they breastfeed. It is imperative that your baby is examined by someone with experience diagnosing tongue ties and has an understanding of the different possibilities as to why your baby is having trouble breastfeeding. Do not let someone say, “Well, that latch looks fine!” and then go on to ignore the other signs that something is not right. Trust your instincts and seek help until you find the person who listens to you.

How Can You Put Yourself in the Best Position to Have Your Milk Come In Quickly?

1. Breastfeed early and often. Frequent milk removal is key. Aim for at least every 2 hours during the day and 3 overnight. Make sure baby is effectively and efficiently draining your breasts.
2. Skin to skin! In the early days, weeks, and months, hang out with your baby as much as possible 24/7.
3. Ask for help! Before you head home, ask for help from friends, family members, and hospital staff. The more time you can spend lying in bed with your baby skin-to-skin, the more likely breastfeeding will get off to a great start.
4. Ask for a pump if your baby is not breastfeeding efficiently and effectively. If your baby cannot remove your milk, then you will need a pump (or to master hand expression) straight away. Do not delay removing your milk regularly.

It is important to mention that while it might take a bit longer for your milk to come in, that does NOT mean you will have to supplement with formula. I just saw a woman the other day for a breastfeeding consultation who told me it took almost one week for her milk to come in. However, she had copious amounts of colostrum and never had to supplement with formula or her expressed milk. She could exclusively breastfeed throughout that first week (and beyond)! It is about ensuring your baby is getting enough of your milk, regardless of whether or not your milk has come in. Seek help from an International Board Certified Lactation Consultant if you have questions or concerns. And remember, always trust your instincts and follow your baby’s lead.