What are reasons for milk not coming in?

[Crapbankerswife]

Just reflecting on comments on another bf thread, and my difficulties bfing dd. My milk didn't seem to come in, no tingling, fullness,hardness etc tho milk was coming out. Dd lost too much weight in first week and midwife said I had to express every 3 hours for 48 hrs day and night to increase supply. It was all so stressful that i ended up topping up with ff and eventually did mostly bfing with one dream feed at night.

I can't reemember when feeding finally improved, it was very gradual and I had no confidence in my supply because it had been so difficult at the beginning.

Was the advice to express so often to increase supply incorrect?

In retrospect I feel the reason i had problems was that dd was small and had a poor sucking action - feeds took at least 45 min- and I didn't wake her often enough in first few days to feed - I distinctly remember her sleeping at least 3 hrs in first week and waiting for her to wake to feed. I would feed every 2 hrs regardless if I could do things all over again.

Any thoughts? I did bf up to 10 months in the end, after spending the first 6 months hating bfing and planning to stop all the time!

I think there is a lot more stuff about skin to skin contact and about getting rest than there was when I had my two. Everyone at the hospital seemed to think my milk wouldn't come in as it hadn't after five days which was a bit weird.

My children both started off in special care so I was breast feeding and they were being tube fed formula, they did tell me to express lots as your breasts make more milk the more they are used , i found it very hard to express with a pump and only ever got an ounce at the most . My first baby was a very successful feeder after a troublsome start, but my daughter and me just never clicked and I had a terrible milk supply.

I was told having a c-section delayed milk coming in but no idea if that is true or not. I did have a lot of problems bf'ing both times (had 2 sections) - but in particular with dd2, she lost lots of weight but slept right through the first night so perhaps I should have fed her more at the start? I wish there was more help and advice when we are still in hospital.

I had an EMCS - I hear that this can cause problems with milk, but I'm not sure why, does anyone have any thoughts?

My DD wouldn't latch, so I was also instructed to express every 3 hours. I never felt my milk come in at all, I wouldn't have noticed had it not been for me expressing (absolute pitiful amounts, especially at the start - I'm talking dribbles) and seeing the colostrum/milk change colour. When DD eventually did latch, we didn't get a tongue tie diagnosed until 5 weeks, and not snipped until nearly 8 weeks. During this time we had to BF, top up with EBM and formula then express - we were supposed to do this every 3 hours, although I couldn't always manage this (Bfing and expressing) for various reasons.

So, her not being put to the breast enough, together with getting formula top ups (which also made her not go to the breast enough, IMO) and me being crap at expressing, the EMCS and not latching for the first couple of weeks, then not being able to milk me efficiently because of the TT (thus not telling my body to make enough milk) meant my milk supply was cr*p. I think, anyway!

That all said, I did manage to mix feed and give her some BM until she was just over 7 months.

Not every feels engorged or tingly when their milk comes in.

Instead of advising expressing, I think the midwife could have suggested feeding the baby more often - every 2 hours at least and offering 2 or more sides per feed.

And 45 minutes per feed sounds pretty normal for a newborn to me! My ds was badly jaundiced at first and didn't wake for feeds, so I was waking him every two hours and each feed took an hour or more.

theborrower- I've just finished The Breastfeeding mother's guide to making more milk.

It's a really good read and explains the process of making milk as well as the causes of low milk supply.

Here's a quote about c-sections:
"Urgent caesarian births have been associated with delayed milk production, possibly related to the stress involved. However, lots of skin-to-skin contact and frequent nursing as soon as is practical will go a long way to minimizing potential problems. It may be reassuring to know that mothers who have had cesarian births have good milk supplies."

Sounds like you had a whole lot of problems that would have contributed to a poor milk supply. Such a shame that the TT was diagnosed so late.

In my case:

1. pre-eclampsia
2. 38 degree heat making skin-2-skin impossible without both of us blistering
3. Magnesium sulphate
4. Beta blockers
5. emcs at 36 weeks following failed induction
6. SCBU

Take your pick.

crikeybadger thanks for posting that info about C sections, and the link to that website. I had been referred to Dianne West (same lady)'s Low Milk Supply website at the time, but sometimes there's only so much you can do and in my case there were other circumstances (like frequent hospital appointments for DD's hips) that also got in the way of sitting at home relaxing and trying and pumping. So yes, it all went a bit tits up (pun partly intended)! I'm trying hard to be, and nearly over it now, but should there ever be a DC2, I'll have lots more info under my belt and I'll try again.

alpinepony :(

That's fine theborrower. You're right about accepting that you did the best you could in the circumstances.

I know waaay more than I do know about breastfeeding now since I had DS1 6 years ago. Shame I only discovered mumsnet and sites like kellymom after DS3 was termed 'faillure to thrive.'

I had an EMCS after an exhausting failed induction for PE and OC and then DD went to SCBU and my milk came in fine on day 3. I did then have to wake DD for feeds and pump for top-ups when she came out of SCBU.

Pumping is very useful if you need it, but it's no where near as efficient as a properly latched on baby. So although it can really help as a temporary boost, I think most women shouldn't have to get to that stage. Earlier help with latching and education on the importance of 2-3hourly feeds could avoid it.

I had a VD but my milk didn't come in until day 5. My DS was in the NNU for meconium aspiration, on a sugar drip which made him sleepy, and had an undiagnosed tongue-tie which made it difficult for him to latch.

I agree that expressing is nowhere near as good as feeding more (best advice I had in the first 3 weeks was to ditch top ups and feed more) but I also think expressing in hospital helped stimulate my milk supply when the baby wasn't. I also found expressing for the freezer quite reassuring, even though he never drank any of it!

interesting to read so many different experiences. I am remembering how stressful it was when my DD looked so hungry, combined with my mother trying to get me to give formula - i don't think DD was latching on that well, she was feeding, but as I said maybe her suction just wasn't that strong and when you add the fact that it is tiring for newborns to feed and she wasn't doing it that effectively... I don't think ~I could have avoided topping up at the beginning. I do wish I could have avoided all the pressure to produce milk via expressing. I never managed more than 4 oz total from both boobs and it doesn't matter how many articles you read, it still feels like oh well my boobs are crap because they aren't producing pints...

I hope to get daily support re: bfing this time round at the beginning, I don't care what it costs I want somebody I can trust to help me understand what's going on and what's best and help keep my FF obsessed mother at bay!

I should have added that I was pretty low on iron initially and was borderline for a transfusion - I refused it because I just wanted to get out of hospital... am sure that this contributed to my body refusing to play ball...

Anaemia. (Although I was severly anaemic with ds2, it still came but with less 'oomph' that with ds1)

Just read your last comment. I was offered a transfusion, but was also expecting it to have an impact, which helped me cope.

Alpine pony. Snap! Me too but 34 wks.
Lots and lots of skin to skin seemed to work for us.

Two sections and both times milk seemed to have come in late - around day 4 according to midwife as I didn't have a clue even though I tried to BF twice . Can't be sure if it was due to poor latch and infrequent feeding as well. Kept being told to top-up with formula and therefore baby would sleep for hours on end.

With DS2, I remember desperately wanting to wake him up to feed but told off by MIL that I shouldn't so first three days he would sometimes sleep for 6 hours, followed by 4+ hours sleep the following few days. I listened as she EBF all her children and thought she should know best. Big mistake. The first few days I also felt awful expressing because MIL gave me the most disgusted look when I expressed, along with other family members disapproving looks/comments when they saw the bottle practically empty after expressing. I felt like such a failure. So wonder if it's a combinatiton of c-section, fatigue, infrequent feeding, embarassment, stress.. all delays milk coming in?