Breastfeeding is an enriching experience that mothers embrace. Mothers try to feed their little ones from the moment they are born. But, sometimes, things don’t go as planned, and the mother may have no milk supply. No milk after delivery may happen for several reasons, such as complications during childbirth or delayed onset of lactation.
For a new mother, the situation can get overwhelming. But, don’t worry, most mothers start producing milk within three to five days after birth (1). Even then, if the breast milk supply isn’t sufficient or there’s almost no milk supply at all, you can discuss baby formula use with your doctor until you establish the milk supply.
Read on to know possible causes why there’s no milk after delivery and what you can do to overcome the situation.
What Triggers Production And Supply Of Breast Milk?
Breast milk production (colostrum) starts in the second trimester. Until delivery, this mechanism stays under check by progesterone hormone. But, as soon as the baby is born and the placenta is delivered, the progesterone levels rapidly drop, and prolactin levels rise, triggering milk production (2). When the baby suckles from the breast, it causes the release of oxytocin and a further surge in prolactin.
The oxytocin hormone works on the muscles around the alveoli to contract and release milk out from the milk ducts. This process is known as the let-down reflex (3). For the first three to five days after delivery, the baby consumes colostrum, after which they get a fresh milk supply. Colostrum is a thick, yellowish-white fluid rich in vital nutritional and immunological components (4).
Causes For Little Or No Milk After Delivery
1. Overweight or obesity: Carrying too much weight during pregnancy can delay lactation onset postpartum. Keeping the pre-pregnancy weight at healthy levels and maintaining a healthy weight during pregnancy can avert this risk.
2. Traumatic birthing: Slow dilation causing long labor, extended pushing period, and birthing tools, such as forceps and vacuum pumps, make the birthing process stressful and traumatic. Under stress, the body produces hormones that can cause delayed lactation onset (8).
3. C-section delivery: Emergency cesarean delivery can be stressful to mothers and babies. The same is true for planned C-sections, as well. In both cases, early delivery, lack of delivery hormones, use of analgesics or pain killers, such as epidural, and extended separation of the baby and the mother due to premature birth can dip breast milk production (9) (10) (11).
4. Excessive IV fluid use: Intravenous fluid (IV) use during birthing is done in certain circumstances (12). Large amounts of IV fluids given to a woman in labor can cause breast engorgement due to water retention (13). Until breast engorgement subsides, milk production remains affected.
5. Excess blood loss: Postpartum hemorrhage is the condition where a mother loses large amounts, i.e., more than 1000ml of blood postpartum. Excess blood loss can reduce milk production by altering breastfeeding hormone (prolactin) production. Besides, stress and fatigue due to blood loss can also delay lactogenesis (14).
6. Retained placental fragments: After delivery, the placenta is delivered, which causes progesterone levels in the body to drop. However, progesterone levels may stay high if placental fragments are present, causing a delayed lactation onset, affecting milk production and supply.
Below are some other reasons that can cause a low milk supply.
7. Certain health conditions: Health issues, such as diabetes, PCOS, gestational ovarian cysts, and thyroid conditions, can interfere in breast milk production. The hormonal imbalance that happens in these conditions is what alters breast milk production and supply.
Thus, it is good to maintain pre- and post-pregnancy weight and follow your medications for your health conditions diligently.
8. Medications and herbs: The use of certain medications, such as estrogen-based hormonal birth control pills, can slow milk production. Likewise, certain herbs, such as oregano, parsley, (15). If you are breastfeeding and intend to use any herb or are on any medication, consult a lactation consultant.
9. Formula supplementation: When mothers have little to no milk supply, they resort to baby formulas. Formula supplementation replaces breastfeeding. Since breast milk production is a demand and supply process, milk production declines when the baby breastfeeds less.
Besides these, poor latch, breast surgery, prolonged bed rest, and insufficient glandular tissue are some other reasons that can reduce breast milk production. Thus, knowing the precise cause or at least causes that may relate to your case can help you find a solution for no milk after delivery.
Tips To Maintain A Healthy Breast Supply
If you have no or low milk supply after delivery, don’t get stressed. Remember, breast milk production is a demand (milk removal) and supply mechanism. The more you breastfeed or empty your breast, the more milk your breasts produce. Here’s are some tips that could help make milk come in (1) (18) (19).
1. Milk expression and pumping: Whether hand expression or pumping, try to empty your breasts every couple of hours. No matter how low the milk supply, frequent expression and pumping of the milk can stimulate the breast to produce milk. For pumping, you can opt for a hospital-grade breast pump with enhanced suction. Alternatively, you can try power-pumping, where you pump for shorter individuals with smaller intervals.
2. Breast massage: Lactation massage is a technique of massaging breasts in a specific way that can help enhance milk flow. You can massage your breast five to ten minutes between feeds to stimulate the breast for increased milk production. Research demonstrates that breast massage with breast pumping can increase breast milk quantity (20) (21).
3. Frequent breastfeeding: Besides massaging and pumping, breastfeed your baby whatever low amount of milk you are secreting. Aim at breastfeeding eight to 12 times a day for around 15 to 20 minutes per session. During each feeding session, switch breasts and nurse your baby at least twice on each side. Additionally, have as much skin-to-skin contact as possible. Ensure the baby is latched to the nipple properly and sucking.
4. Hot shower and heat pads: Applying heat on breasts can trigger milk flow. Take a hot shower or apply heat pads or warm compresses on your breasts before feeding. You may also apply heat pads or warm compresses before pumping the milk.
5. Relaxation: Fatigue is one of the reasons for a low milk supply. Thus, relaxing and giving yourself rest to boost the milk supply is pertinent. Choosing a relaxation technique is a personal choice. You could consider listening to soothing music or imagine yourself feeding your baby to relax and boost breastfeeding hormones.
6. Sound sleep: Taking care of a baby often leaves a mother sleepless and stressed. Persistent stress and less sleep cause cortisol levels to rise, hampering milk production and supply. Thus, it is vital to rest adequately, sleep soundly, and stay stress-free as much as possible.
7. Healthy lifestyle: Eating nutritious food, drinking healthy fluids, and plenty of water may up your milk production and supply. Eat a well-balanced, healthy diet consisting of a wide variety of nutrient-rich foods. Additionally, indulge in some physical activity whenever your doctor allows you to do so after delivery. Exercising helps maintain a healthy weight and releases endorphins that keep you stress-free and happy, a prerequisite to a healthy milk supply.
8. Galactagogues: Galactagogues are substances, such as herbs, that can help breastfeeding mothers enhance their breast milk production. You can consult a certified lactation specialist and discuss using galactagogues to enhance your milk production. They can guide you on whether galactagogues will be useful in your situation and, if they will, what specific foods you should take and in what quantities.
Additionally, you may consult your pediatrician about formula or donor milk’s use for the baby until the breast supply improves. It will ensure your baby gets adequate nutrition for their growth and development.
Breast milk is the primary source of nourishment for babies. However, sometimes there’s insufficient milk supply or no breast milk supply after delivery due to the delayed onset of lactation. Remember, delayed milk doesn’t mean you will not have milk at all. Consult a lactation consultant and determine the cause.
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13. Sonya Kujawa-Myles et al.;Maternal intravenous fluids and postpartum breast changes: a pilot observational study; NCBI
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21. Hand Expression of Breastmilk;La Leche League GB