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It's postpartum day number three. Where's my milk?

Early feeding frequency may determine how soon this baby get mature milk.
Early feeding frequency may determine how soon this baby get mature milk.
Photo courtesy of N. Giannoukos

Lactogenesis II is a fancy name for the onset of the mature milk after a baby is born. Usually, this process should occur by the third day postpartum, but sometimes, the milk is delayed, and the only thing that can be expressed is colostrum, making it difficult to satisfy a baby’s needs. There are few things more frustrating than holding a hungry baby and realizing the milk that should be there to feed her somehow forgot to show up. You’d think that all things related to breastfeeding should simply happen naturally, since our bodies are so perfectly designed to do this whole maternity thing. And while some medical complications can delay milk production, in most countries, only a very small fraction of women experience any delays in their milk coming in. But the truth is, a recent study showed that in the United States, as many as 44% of women will not have their mature milk by the third day. Sometimes, it takes longer than a week!

Why the difference in America? Researchers are looking closely at birth practices to identify what types of barriers may be in the way of normal milk development in Western women. The findings are very interesting. It seems that the more “medicalized” birth has become, the harder it has become for Lactogenesis II to occur in many mothers. Simple things such as whisking the baby away for a quick bath and assessment or wrapping the baby in several blankets while feeding can actually interfere with nature’s perfect plan. Early and frequent skin-to-skin contact appears to be necessary for timely milk production. Additionally, while our western hospitals almost unanimously vote for “rooming in,” they never allow “bedding in" due to concerns about risks related to cosleeping. That means, in American cities like Fresno, a baby will be at mother’s bedside in a rolling cart while they are in the hospital, but cannot be held in mom’s bed while they sleep. In other countries where the milk onset occurs sooner, it has been observed that there are no rolling carts. The mothers hold the babies almost continuously, and nurse them very, very often because of it. Frequent and inefficient milk removal by the baby almost guarantees that milk will develop as it should, so even if co-sleeping is not achievable, the focus needs to be on feeding frequency in the early postpartum period.

The more we understand about birth, breastfeeding, and babies, the more emphasis there is on keeping things simple. Generally, if we leave nature alone, she does a pretty good job at getting the job done. It’s when we become too “technically savvy” that things tend to fall apart, and our bodies don’t function the way they should. The good news in all of this is that even if there is a delay in Lactogenesis II, most women can eventually succeed in making milk for their babies. When in doubt, a Lactation Consultant can certainly help a mom persevere until the road becomes a bit smoother.