Delayed Milk Coming In: Risk Factors and What Helps

Key takeaways: Most people notice their milk “coming in” within 72 hours. Delays are more common after a first birth, cesarean, long labor, diabetes, higher body weight, heavy blood loss, or retained placenta. Frequent milk removal and skin-to-skin help. Watch your baby’s diapers and weight closely and supplement if medically needed.

In the first days, your baby gets colostrum. Then, usually around 2 to 3 days after birth, milk volume increases significantly. When this takes longer, it’s called delayed onset of lactogenesis II.

How You’ll Know Milk Is Coming In

• Breasts feel fuller, heavier, or warmer.
• You hear more swallowing during feeds.
• Diapers increase: more wet diapers, and stools turning from dark to greenish to yellow.
• Your baby seems more satisfied after feeds.

Risk Factors for Delay

Research, including studies by Dewey and colleagues and by Nommsen-Rivers and colleagues, has linked delay to:

• First-time birth.
• Cesarean birth, especially unplanned.
• Long or stressful labor.
• Higher body mass index.
• Diabetes.
• Heavy blood loss after birth.
• Retained placental fragments, which keep progesterone levels high.
• Infrequent or ineffective feeding in the early days.
• Higher amounts of IV fluids in labor may make breasts swell but don’t necessarily delay milk.

What Helps

• Feed early and often, 8 to 12 times a day or more.
• Skin-to-skin as much as you can.
• Hand express after feeds; early hand expression can increase milk removal.
• Pump if your baby isn’t feeding well, ideally with a hospital-grade pump.
• Get latch help from an IBCLC.

Supplementing When Needed

If your baby has too much weight loss, low blood sugar, too few diapers, or other medical reasons, supplementing may be needed. Use your own expressed milk first, then donor milk or formula, as advised. Supplementing while protecting supply is a bridge, not failure.

When to Suspect Retained Placenta

Signs can include heavy or prolonged bleeding and milk that doesn’t come in. Tell your provider if you have these.

Call your baby’s doctor if your baby: has fewer wet diapers than expected, still has dark stools by day 4 or 5, seems very sleepy, is more yellow, or has lost more weight than expected. Call your provider if you have heavy bleeding, fever, or foul-smelling discharge.

The Bottom Line

Delayed milk is more common with certain risk factors. Frequent milk removal, skin-to-skin, close monitoring, and supplementing when needed keep your baby safe while your supply builds.

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Related Articles

• Low Milk Supply: Real vs. Perceived, and What Actually Helps
• Is My Baby Getting Enough Breast Milk? 7 Reliable Signs
• Breastfeeding After Heavy Bleeding at Birth

Sources

1. Dewey KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics. 2003;112(3 Pt 1):607-619.
2. Nommsen-Rivers LA, Chantry CJ, Peerson JM, Cohen RJ, Dewey KG. Delayed onset of lactogenesis among first-time mothers is related to maternal obesity and factors associated with ineffective breastfeeding. Am J Clin Nutr. 2010;92(3):574-584.
3. Kellams A, Harrel C, Omage S, et al. ABM Clinical Protocol #3: Supplementary feedings in the healthy term breastfed neonate, revised 2017. Breastfeed Med. 2017;12(4):188-198.
4. Lawrence RA, Lawrence RM. Breastfeeding: A Guide for the Medical Profession. 9th ed. Elsevier; 2022.

This article is for general education and is not a substitute for individualized medical advice. Always talk with your baby’s health care provider or your own provider about your specific situation. If you think your baby or you may have a medical emergency, call 911.