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Have you heard the stories of how breastmilk comes in following birth? Tales of engorged breasts and looking like you’ve had breast augmentation when your milk comes in? Of babies with milk sprayed all over their face as the let-down happens? While it’s true that some women have firehose breasts and extreme engorgement within a couple of days following birth, it can look quite different for many others. Some of us won’t feel any engorgement. Some will have concerns with their supply within hours after having their baby. For others, they will be confused about whether or not their milk has even come in at all! I will cover how this process happens and how you can encourage your milk to come in quickly and effectively.
When Will My Milk Come In?
Let’s start with the physiological process of how our bodies actually make milk. Here are the different stages of lactation:
Stages of Lactation
Mammogensis (from puberty until the end of the 3rd trimester):
This is when our breast tissue grows in size and weight, starting with puberty. When we become pregnant, we get more growth due to the production of estrogen and progesterone.
Lactogenesis, stage 1 (mid-pregnancy to day 2 postpartum):
This is when our glandular tissue (where the milk is made and stored) starts actually to make the milk! This is why many of us can start to squeeze colostrum (or “liquid gold”) out even before our baby is born. Once our baby is born, we continue to make colostrum until it turns into mature milk over time.
Lactogenesis stage 2 (day 3-day 8 postpartum):
This is when the colostrum changes into mature milk and when many people feel their milk “come in” with engorged, warm breasts. This is triggered by the rapid drop in progesterone levels which happens when your placenta detaches following birth. This is why women with retained placenta products in the womb will sometimes have supply issues as their progesterone levels are still high.
Galactopoiesis (day 9 until involution):
This is when the milk is established and controlled by the autocrine system (the supply and demand system). This will not continue unless the baby (or pump) is effectively draining the breast.
Involution (average 40 days after the last breastfeed):
When your child weans, your breasts go through this final process. You might find that you can squeeze out some milk for many months following weaning, though!
Pay Attention to Breast Growth and Changes
There are two questions I always ask people when taking a history. The first is, “Did you notice breast growth and changes during pregnancy?” Followed by, “Did you notice your milk come in after your baby was born?” I ask these questions because it gives a good indication of whether their body has prepared and gone through the expected physiological changes for lactation. Even if you don’t plan on breastfeeding your baby, your body will still go through these changes of breast growth and your milk coming in (unless you’re given medication to stop your milk).
If you do not have breast growth or changes during pregnancy or you do not feel your milk come in, it is a good idea to speak with an International Board Certified Lactation Consultant (IBCLC), so you can make sure you are prepared in the event you do not have enough milk to feed your baby. It is so important to note here that even if you suspect your breasts have not changed much or you didn’t feel your milk come in, it does not mean you are guaranteed to have to supplement with formula! Some women will not notice much breast growth or changes. And some never feel engorged but still have enough milk. These are just indicators we look out for that *might* indicate possible challenges with milk supply.
Ways to Help Bring Your Milk in Quickly
It’s not just about physiology, though. It’s also about how you are feeding your baby and whether or not your baby can effectively and efficiently drain your breasts. Here are the important factors to think about to help bring your milk in and establish your supply.
1. Cesarean Birth May Bring Challenges
Research shows that having a cesarean birth increases your likelihood of having breastfeeding challenges (Hobbs et al., 2016). However, if you have a cesarean birth, you can still do things to ensure your milk comes in as quickly as possible! The most important first step to this following birth is simply being skin-to-skin with your baby not only as quickly as possible following the birth but also for as long as possible. The more frequently you can be skin-to-skin, the more opportunity your baby has to breastfeed, which equals stimulation and milk removal! This, in turn, leads to more milk more quickly.
2. Skin-to-Skin is Essential
Skin-to-skin does not just apply to those who have had cesarean births! It is the single most important thing that everyone should do as much as possible, 24/7, after the baby is born. Just let them “hang out” with your breasts as much as possible. This ensures unrestricted access to the breast, encourages more frequent feeds, and allows you to pick up on the early feeding cues that they’d like to breastfeed!
3. Follow Your Baby, Not the Clock
We have all heard the term “supply and demand” when it comes to breastfeeding. But what does that actually mean in practical terms? The more you feed your baby, the more milk will be removed, then the more milk you will make. If you are trying to follow a set schedule that you found in a book or website or are trying to stretch out the time between feeds, then you risk decreasing your supply. As you stretch out the time, your breasts are filling up. As they fill up and stay full, your production slows down (so your breasts don’t explode!). This is why following your baby and feeding on demand is so important. If you’d like to breastfeed exclusively and avoid formula supplementation, feeding on the demand is the best way to help this happen.
4. Make Sure Baby Has a Good Latch
If you are concerned about your baby’s latch or their ability to drain your breast well, make sure to seek help ASAP! For your baby to encourage your milk to come in, increase in volume, and maintain your supply, they must have optimal milk transfer. In other words, you need to make sure they can effectively and efficiently drain your breast, so you make more throughout the 24-hour period. Even if someone tells you the latch “looks good,” it doesn’t matter. If it doesn’t feel right to you, or if you know something is not right, seek another opinion! How the latch looks to someone else means nothing.
5. Determine If Pumping Would Help
If your milk has not come in or you have a low supply, the important thing is to have frequent effective milk removal, whether this is from your baby or a breast pump. If your baby can drain the breast well, then do this with your baby. If your baby cannot remove the milk well (or easily), or you have to miss feeds with your baby (due to separation), then you’ll need to use a pump. Using a double electric hospital-grade pump usually leads to the most effective milk removal.
Remember, the best way to establish and maintain supply is by being skin-to-skin as much as possible in the early weeks and following your baby, not the clock. Seek help from a volunteer breastfeeding counselor or IBCLC quickly if you are concerned that your milk is not coming in as quickly as you’d like.
Reference:
Hobbs, A. J., Mannion, C. A., McDonald, S. W., Brockway, M., & Tough, S. C. (2016). The impact of cesarean section on breastfeeding initiation, duration, and difficulties in the first four months postpartum. BMC Pregnancy and Childbirth, 16(1). https://doi.org/10.1186/s12884-016-0876-1
Wambach, K., & Spencer, B. (2019b). Breastfeeding and Human Lactation (6th ed.). Jones & Bartlett Learning
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