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 for some of us it can take much longer, up to one week! 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 if your baby is breastfeeding or not. However we do know that this change happens more quickly if your baby (or by pump or hand expression) is removing the milk frequently.

Breasts work on supply and demand but what does this mean? Basically 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 productions 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, over time the opposite will start 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 productions will start to decrease if we don’t drain our breasts frequently enough.

2. Your labor and birth.

It is well established in the literature about 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 breastfeed and the early hours after birth. Try to advocate for yourself (or even better have someone else advocate for you) and for your baby, to have the two of you 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 conditions, hormonal conditions, insufficient glandular tissue (where the milk is made and stored), diabetes, and more. If you feel as though 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, make sure to get some help in trying to figure out WHY this is happening. Did you notice breast growth during pregnancy? Do you have a history of any medical concerns? These are important questions that 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.

So 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! Just simply hang out with your baby as much as possible 24/7 in the early days, weeks, and months.
3. Ask for help! Ask for help from friends, family members, and hospital staff before you head home. The more time you can spend just lying in bed with your baby skin to skin, the more likely it will be that breastfeeding gets 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 very 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 was able to exclusively breastfeed throughout that first week (and beyond)! It is about making sure your baby is continuing to get 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 the lead of your baby.