I sometimes hear stories about women who couldn’t breastfeed because their milk didn’t come in. This is one of those terrible misnomers. If the milk was delayed for a medical reason and the mum isn’t encouraged to continue initiating breastfeeding, she may believe she’s just one of those women who doesn’t have milk and give up. If she doesn’t pump or attempt to put the baby to the breast and baby goes straight on the bottle, it can even appear as if the milk never arrived at all. But it would have, given half a chance.
It’s virtually impossible for a mother’s milk to not eventually come in, as it’s a hormonal response to the placenta being removed from the body. The general time for this to happen is 48-72 hours after birth, but things like a large blood loss, retained placenta, conditions like diabetes, hypothyroidism, obesity, polycystic ovarian syndrome or past breast surgeries can interfere with the natural process, as can rare conditions like insufficient glandular tissue. Now that I look at it, this seems like a long list, but these are all reasons for a longer milky pause, not a complete failure, so the message is to keep at it and don’t panic. Your milk will come in.
If there is a delay, it’s a matter of looking at why and what can be done to feed your baby in the meantime. A few years ago, I interviewed author (and now UNICEF Australia’s Breastfeeding Patron) Tara Moss in my former job as a magazine editor, and her story was typical of a new mum who was gutted to be told her body wasn’t responding the way it should. On the second day after giving birth, a paediatrician decided her milk was slow to come in and her baby was prescribed formula. Day two! That’s 48 hours after birth. For a first-time mum, it is really normal for the milk to take the full four days to come in, sometimes even five or six. Many mums find their milk comes in much quicker with subsequent children (mine was in at 30 hours with No. 3 and that was after a highly medicalised caesar because of placenta previa).
The important thing is to keep putting the baby to the breast. Let your baby drink that colostrum! Her stomach is teeny tiny, only the size of a 5 ml marble, so it really doesn’t need the volume of mature milk yet. Yes, she will lose weight. Yes, she may even lose more than 10 per cent (take into account if you’ve been on a drip prior to the birth of your baby, as this can elevate your baby’s birth weight). This can be closely monitored but if your baby is breastfeeding well and has a good output, then there is usually little reason to pull out the formula tin.
If your milk still isn’t in by day 5 or 6 and your doctors are getting concerned, there are a number of options. If you aren’t keen on letting formula upset the good bacteria in your baby’s gut flora, you could ask for her to be put on IV fluids until the milk is in. Another option is to source donor milk (especially if you have a friend or relative who is breastfeeding) or if that’s not available, a small volume of formula used as a top-up in a cup or syringe after a feed at the breast. If none of these options appeal, you could ask to by monitored by a lactation consultant, wait another day, and just feed, feed, feed, every hour if you have to, and you may find that’s all you needed, voila, milk in!