High-Risk Newborn

Delayed or Not Enough Milk Production

When milk production is delayed or not enough:

A delay in the time when milk "comes in" sometimes occurs after the birth of a high-risk baby. Also, it is not unusual to experience a drop in the amount being pumped after several weeks. A drop may be gradual or it may occur suddenly.

Do not wait to get help if milk production is ever a concern. The sooner you intervene, the better. Ask a certified lactation consultant (IBCLC - International Board of Certified Lactation Consultants), your baby's nurse, physician, or a breastfeeding support leader to help you figure out what might be affecting milk production if:

• you are not producing a daily total of at least 16 ounces (about 470 ml) of milk by seven to 10 days postpartum.
  
  
• you begin obtaining less and less milk each day for three or four consecutive days.
  
  
• the daily total dips below 12 or 13 ounces (350 to 400 ml) for more than two or three consecutive days.

Possible causes for delayed or low milk production:

Infrequent or insufficient breast pumping (milk removal) is the most common reason for a delay in the time when the milk "comes in," for insufficient milk production, or for any drop in milk production. A review of the number and length of pumping sessions should always be first thing you do if you are ever concerned about milk production.

It is easy to fall into the trap of letting more and more time pass between pumping sessions when recovering from birth and visiting the baby in the NICU. Also, a mother may initially obtain more milk quickly when several hours pass between pumping sessions. However, without frequent and effective milk removal, the breasts soon get the message to slow milk production. Within a day or two, a mother who pumps less and less often will start producing less milk.

Equipment checks:

If your breast pumping routine does not seem to be the problem, it may be the breast pump you are using. Be sure to use a hospital-grade, electric pump. For most women, manual (hand), battery-operated, or smaller electric breast pumps cannot establish and maintain milk production. Of course, even the best breast pump is still a machine, and machines can break down. Call the rental station if you suspect a problem and ask if they, or the manufacturer's representative, can check the suction with a special pressure gauge. If in doubt, ask to exchange the pump you are using for another one.

Maternal factors for delayed or not enough milk production:

• a delay when milk "comes in"
  Occasionally, a mother has a health condition that may temporarily delay the large increase in milk production usually seen between three to five days postpartum. Instead, some mothers do not begin to obtain large amounts of milk until seven to 14 days after giving birth. If this happens to you, do not feel discouraged. Keep pumping.
  
  It can be difficult to keep pumping at least eight times in 24 hours (for more than 100 total minutes) when getting only drops of milk with each session. However, it is extremely important to keep expressing milk frequently. This kind of delay does not mean a mother will have trouble producing enough milk once the milk does "come in." Usually, she has plenty of milk as long as she has been pumping (removing milk) often enough.
  
  Research has yet to discover whether the cause for a delay in increased milk production is due to a health-, pregnancy- or birth-related condition itself, certain medical treatments for such conditions, or to a delay in beginning frequent milk expression that often occurs with such conditions. Some conditions, or treatments, that experts think may possibly contribute to a delay for milk to "come in" include the following:
  
  
  • stress
  • cesarean (surgical) delivery
  • postpartum hemorrhage
  • retained placenta fragments
  • infection or illness with fever
  • diabetes (juvenile, adult-onset, or gestational)
  • thyroid conditions
  • strict or prolonged bed rest during pregnancy
    
    
• not enough milk
  Rarely, a delay in the time when milk "comes in" turns into an ongoing problem of low milk production. A mother begins obtaining more milk but it still is not enough; or a mother may have been producing lots of milk, but the daily total amount of milk obtained is slowly, or quite suddenly, decreasing. Some of the conditions associated with a delay may also have an ongoing effect on milk production, including increased stress, severe postpartum hemorrhage, retained placental fragments, and thyroid conditions. If a mother had a breast surgery that cut some of the nerves, milk-making tissue, or milk ducts, she may have difficulty producing enough milk to fully feed her baby.
  
  Other factors can also lead to insufficient or low milk production. These include the following:
  
  
  • maternal smoking
    
    
  • some medications and herbal preparations
    
    
  • hormonal forms of birth control, especially any containing estrogen. However, some mothers report a drop in milk production after taking a progestin-only contraceptive during the first four to eight weeks postpartum. Consult your physician or obstetrician for more information.
    
    

  If insufficient milk production seems to be a problem, yet you have been sticking with the recommended pumping routine and the pump is in good working order, consider the following:
  
  

  • Increase milk expression to nine to 12 pumping sessions, or to 120 to 160 total minutes of pumping in 24 hours, for several days.
    
    
  • Begin or increase the amount of skin-to-skin contact you have with your baby during visits to the NICU.
    
    
  • Ask your physician or a certified lactation consultant (IBCLC) to review your health history with you to learn if there may be a health condition, treatment, or medication interfering with your milk production.
    
    
  • Ask your obstetrician or a certified lactation consultant (IBCLC) about medications or herbal preparations found to have a positive effect on milk production.
    
    
  • Think positive. Although insufficient milk production usually can be reversed, any milk you produce, even drops, is valuable for your baby. Try to remember that the milk collection bottle is half full rather than feel discouraged that it is half empty.
    
    
• overproduction of milk
  Some mothers consistently obtain much more than 25 to 27 ounces (750 to 800 ml) in 24 hours. Their freezers are overflowing with containers of expressed breast milk. When mothers are making a lot more milk than even a full-term baby or twins could handle, some find they can drop one or two daily pumping sessions. However, most of these mothers still pump for at least 100 minutes in 24 hours; they just do it in five to seven sessions. If the daily amount pumped ever drops below 25 ounces (750 ml) for 24 hours, they add another pumping session.
  
  Making too much milk is usually not a problem, so there is no reason to interfere with a successful plan for milk expression unless it is hard to maintain. If you are "overproducing" and considering changing your pumping routine, wait. Do not drop any pumping sessions:
  
  
  • until you discuss your situation with a certified lactation consultant (IBCLC) or your baby's physicians and nurses.
    
    
  • when you are expressing milk for twins, triplets, quads, or more.
    
    
  • unless you have a clear plan that includes what you will do if milk production begins to decrease.
    

Most mothers would much rather make more than their baby needs than to discover they are no longer making enough.