When will my milk come in?

... it's THE question nearly every expectant parent wants to know.

And if you've recently delivered your baby, waiting for the day where your breasts are overflowing with milk may feel like a century.

Before I begin answering the most common questions parents ask regarding this much-anticipated phenomenon, I must make a disclaimer:

I hate the phrase "Milk coming in."

It perpetuates the idea that parents birth babies with no way to feed them in the days following birth, which, as discussed below, is not the case.

Professionals refer to "milk coming in" as Lactogenesis II, the onset of copious milk production, which is more accurate. However, for the sake of clarity- and because most people refer to this increase of milk volume as milk coming in- it's the phrase I use throughout this post.

On to the most asked questions!!

Can my milk "come in" before I give birth?

Yes. And No.

Milk production begins midway through pregnancy so, by the time you give birth, your milk ( Colostrum) is already present. Colostrum- which is absolutely, positively, undoubtedly milk- is food for newborns that has a unique ratio of components (ingredients) that makes it highly immune boosting.

The same ingredients found in transitional and mature milk (the milk that parents think of when "milk comes in") are present in colostrum, just the amounts of each ingredient may differ as lactation continues.

Generally, Colostrum production is lower than production is later on. Babies don't need 30 ounces a day on their first or second day and may not even take that much at two weeks!

So in the traditional sense of "copious milk production of white milk," no, your milk can't "come in" before birth.

Why?

The transition from Colostrum production to more mature milk is initiated (started) by the birth of the placenta; once the placenta leaves the body, progesterone, and estrogen levels in the blood decrease, which allows the cells that make milk to increase production.

It's this shift in cellular activity (from slow production to more rapid production) parents see, not the start of milk production.

How can I make my milk come in faster?

On average, parents see this increase in milk production by day 3 (within 72 hours post-birth), though it may be later depending on the labor, delivery, and medical history.

While the timing of "milk coming in" is based on factors outside of our control, there have been studies that have suggested that breastfeeding in the first hour decreases time to "milk coming in" in parents of very low birth weight infants. Additionally, many studies have shown an association between frequent milk removal and milk volume during the first week of lactation.

Luckily, milk removal frequency and effectiveness are totally within your control! Even if breastfeeding is not going well- let's say your baby refuses to latch or feeding is extremely painful- hand expression and/or pumping in the early days can provide the necessary stimulation to reap the benefits of frequent expression.

How long does it take for milk to come in after a C-section?

Cesarean deliveries, especially unplanned C-sections, are associated with a delay in "milk coming in," possibly due to or in conjunction with the fact that pain medication is associated with a delay.

Delayed Lactogenesis II is defined as the start of "milk coming in" after 72 hours, and it's not a rarity for parents to report it taking 3-5 days for milk to come in.

Ideally, your milk will come in within 72 hours post-delivery; however, it may be helpful to have a plan for if there is a delay in lactogenesis II and weight loss/ diaper output becomes a concern.

How long does it take for milk to come in after an induction?

As discussed above, ideally, your milk will "come in" within 72 hours post-delivery, however, because inductions increase the rate of pain medication use, pain medications are linked with a delay in lactogenesis II.

Often, a lot of fluids are given during inductions, which can increase swelling of the breast, reducing milk flow, causing the appearance of a delay.

It's, for this reason, that I suggest every parent get familiar with Reverse Pressure Softening and utilize this strategy as needed.

What are the signs of my milk coming in?

There are predictable breast changes that occur shortly before parents notice an increase in milk output. These changes are referred to as engorgement and are not necessarily caused by the increase in milk volume, but instead, breast swelling from interstitial fluid.

The changes you may notice in your breasts include increased

warmth
fullness
tenderness or discomfort

With frequent and effective breastfeeding, these changes resolve quickly and become nothing more a minor nuisance.

Abnormal (pathological) engorgement

Sometimes typical engorgement becomes abnormal engorgement. Parents may find their breast fullness and discomfort becomes unbearable, and they may notice a decrease in milk output.

This type of engorgement is not normal and often occurs if milk removal is not frequent enough or the breast isn't drained fully.

Typically the breast feels soft like a cheek. (Yes, please do feel your face for this!).

During typical engorgement, breasts may become firmer and feel similar to the tip of your nose.

Never should breasts become as firm as your forehead, and if they do, it's a good sign that you've got an abnormal amount of engorgement.

Why does engorgement it hurt?

The simple answer is swelling and inflammation.

Even an average amount of engorgement can cause discomfort. Swelling of any type puts pressure on the nerves, which stimulate them unnecessarily, but also chemicals are released during inflammation further aggravate the surrounding tissues adding to the discomfort.

Things you can do to ease discomfort

Cold Compresses between feeds to reduce swelling
Reverse pressure softening
Frequent feeding/milk removal
Warmth during feeds/expression to help milk removal
Anti-inflammatory use

Why might milk "coming in" be delayed?

Many factors might contribute to a delay in milk coming in. As mentioned above, a delay is considered the beginning of Lactogenesis II after 72 hours, so they delay may be slight (say 75 hours post-delivery) or extreme (92 hours post-delivery).

The good news is most of these possible causes only results in a slight delay- rarely do parents see extreme delays or complete lack of milk coming in.

Risk factors for delays include:

This is your first child
Stress or pain
Diabetes
High blood pressure
Stressful Labor/Delivery
Unplanned Cesarean
Delaying breastfeeding/ Infrequent breastfeeding
Replacement feeds/ Prelactal feeds during first few days post-delivery
Immediate Birth control administration

Can breast milk come in after two weeks?

A line of questioning I see often is can breast milk come in after X amount of time. In this case, I discuss two weeks, but I've seen many variations of this question.

The answer to this question is not very straightforward, as many things may need an assessment before determining if milk supply will increase with the proper care plan.

I have seen parents build full milk supplies after an extended delay. I have also seen parents who never transition from colostrum.

Some parents will inevitably experience "Lactation failure," which is NOT a failure on the part of the parent, though I imagine that many parents feel it's the case.

Insensitive medical terminology aside, the reality is that some parents may not make milk. Each pregnancy increases the chance of successful breastfeeding, so there is some encouragement in that.

Yay for continued breast development!

All hope is not lost if your milk hasn't come in by day 5, though it's certainly worth seeking the care of an IBCLC to help you navigate the situation. If you'd like to read more about low supply, which also overlaps with the delayed Lactogenesis II, Please check out Low Supply Overview.