Milk hasn't come in yet after birth? It doesn't mean you have none, and what helps in week one

It’s a day or two after birth. You express and express, and get only a few drops, while your baby cries beside you and someone asks every hour, “Has your milk come in yet?” Your heart sinks. The feeling that “my body has nothing for my baby” comes very easily at this stage.

Let us say this first: a small amount of milk in the first days is exactly how nature intended it. We’ll walk through when milk comes in, what makes it late, what really helps, and when you should ask for help.

Why do you only get a few drops in the first days?

Quick Answer: Because in the early days your breasts make colostrum, which is small in amount but very concentrated, and enough for a newborn whose stomach is still tiny.

Colostrum is the first milk, which your body starts making from the middle of pregnancy. It’s thick and yellow, full of protein, vitamins, minerals and antibodies, so much so that Cleveland Clinic calls it “liquid gold.”

Newborns don’t need a lot of milk, so getting only drops when you express doesn’t mean your baby is starving. And expressing by hand or pumping usually gets less than what baby actually gets by feeding anyway.

When will your milk “come in,” and what counts as late?

Quick Answer: For most moms, milk increases around day 3 to 5 after birth. If you’re past this point and still don’t notice any change, it’s considered late, and you should get help early.

When your milk starts to come in, you’ll feel your breasts get heavy, warm and fuller, the milk changes from thick yellow to a more milky white, and you’ll hear baby swallowing more often.

Nationwide Children’s Hospital says some moms may not have a large amount of milk until day 7 to 14 after birth, and in most cases it can still be fixed if you get help early.

What can make milk come in late?

Quick Answer: Common factors are a C-section, heavy blood loss after birth, being overweight, diabetes or thyroid disease, fever or infection, severe stress, and long periods of bed rest during pregnancy.

• C-section: wound pain and holding your baby later may have an effect, but the AAP says that for most moms, milk comes in almost the same as after a vaginal birth. Pain interferes with oxytocin, the hormone that helps milk flow, so managing pain well is important
• Heavy blood loss after birth
• Being overweight, diabetes or thyroid disease
• Fever or infection
• Severe stress
• Baby feeding too little, for example being separated for a long time, or feeding on a schedule instead of when baby is hungry

Please don’t blame yourself after reading this. None of these are mom’s fault. They’re just conditions where the body needs a bit more help.

What really helps milk come in during the first week

Quick Answer: Let baby feed often with a deep latch, do skin-to-skin, and hand express regularly, because your body makes milk according to how much is removed.

1. Let baby feed often, about 8 to 12 times a day, or every 2 to 3 hours, whenever baby is hungry. The more baby feeds, the more your breasts get the signal to make milk
2. Check for a deep latch. Baby needs to take in the areola, not just the nipple. Try 5 breastfeeding positions that help baby latch deeper
3. Skin-to-skin contact: let baby lie on your chest, skin against skin. It makes baby want to feed and helps mom relax
4. Hand express before and during feeds. You can feed the drops you collect to baby with a spoon or syringe. If baby can’t feed yet, or you’re separated from baby, express or pump every few hours instead
5. Manage pain. After a C-section, if your wound hurts a lot, tell the nurse. Most pain relievers that doctors give can be used while breastfeeding. Always ask your doctor or pharmacist first
6. Rest and eat enough. Eat a balanced diet, drink enough water, and let people at home help with other things

If you’re still pregnant, have a look at what to pack in your hospital bag, in case you want to bring a nursing cover or a support pillow.

Do ginger drinks, kaeng liang soup or milk-boosting supplements help?

Quick Answer: You can eat traditional Thai postpartum foods if you like them, but there’s still no clear evidence that any food or supplement speeds up milk, and the Thai FDA (อย.) has never allowed food supplements to claim they increase milk.

Kaeng liang (a peppery Thai vegetable soup) or ginger drinks that older relatives lovingly make for you are warm, comforting things for a mom after birth. Go ahead and enjoy them. Just don’t expect them to replace frequent feeding.

As for supplements advertised as “increasing milk,” the Food and Drug Administration has warned that it has never allowed that claim, and what mom takes can also pass through to baby. Before using any product or medicine, talk to your doctor first.

If you need to supplement with formula, does that mean you failed?

Quick Answer: Not at all. Sometimes supplementing temporarily is what keeps baby safe, and you can keep breastfeeding alongside it.

If baby has lost a lot of weight, is jaundiced or has fewer diapers than expected, the doctor may recommend supplementing. In the meantime, keep letting baby feed at the breast, then express or pump after feeds. That tells your body it still needs to make milk. For how to check whether baby is getting enough milk, see Diaper signs that baby is getting enough milk

In the end, whether baby gets only breast milk, a mix of breast milk and formula, or only formula, a mom who works to keep her baby full and safe is already a very good mom.

Call your doctor or go to the hospital if…

Quick Answer: If you’re past day 5 and your milk hasn’t changed, baby has unusual symptoms, or mom has a fever, contact the hospital or a breastfeeding clinic right away.

Take baby to the hospital right away if

• Baby is drowsy, hard to wake, or won’t feed
• Very few wet diapers, or no pee for many hours
• Jaundice (yellow skin) keeps getting worse

Mom should call the doctor if

• You’re past day 5 after birth and still don’t feel your milk increasing
• You have a fever, or a breast that’s red, hot and painful in one spot
• Your nipples hurt so much that you can’t keep feeding
• You feel so stressed or sad that you can’t look after yourself

Don’t wait until you’re exhausted. The sooner you get help, the easier it is to fix. Mom’s body is learning right alongside baby. Give yourself a little time, and take it step by step together.