Delayed breastfeeding or expression after delivery

Did not breastfeeding or expressing right after my baby’s birth affect my milk supply?

To establish a full milk supply, mothers need to remove milk effectively from their breasts within one hour of birth, either by breastfeeding or by expressing. Delay can result in a low milk supply or can cause the milk to come in late. Continued regular and effective breastfeeding is also needed to establish the milk supply. If a newborn cannot breastfeed regularly or effectively, mothers should express for a minimum of 7 times in 24 hours and supplement the baby. This should continue until the baby can breastfeed well.

A) Describing timely milk removal

Removing colostrum from the breast right after birth, along with C1passing the afterbirth, stimulates the breast to convert from making colostrum to making milk. Colostrum and milk removal can be done by breastfeeding or expressing; Breastfeeding is often more effective.  

Ideally, in order to establish a full milk supply, effective breastfeeding should occur within one hour after birth and continue regularly after that.

If breastfeeding is not possible, mothers need to express within an hour of birth and then regularly thereafter to establish a good milk supply. Expressing should be for a minimum of 7 times in 24 hours. This is either after the baby has tried to breastfeed or instead of breastfeeding. Mothers should supplement their baby with milk and continue to express until the baby can breastfeed effectively. 

B) The effects of delaying milk removal

1) Delayed breastfeeding  

A delay in the first breastfeeding session can result in a low milk supply (Dewey et al. 2003; Kent et al. 2016). The longer the delay, the more likely it is to lower the milk supply. 

A delay may also cause the milk to come in late (Chapman and Perez-Escamilla 1999; Fok et al. 2018; Maruyama et al. 2016; Nommsen-Rivers et al. 2010; Parker et al. 2015).

2) Ineffective milk removal

The breasts may be poorly stimulated if breastfeeding is ineffective or not often enough or if the mother does not express effectively, resulting in a low milk supply.  It can also result in breast engorgement.

References

Chapman DJ, Perez-Escamilla R. Identification of risk factors for delayed onset of lactation. J Am Diet Assoc. 1999 Apr; 99(4):450-4
 
Dewey KG, Nommsen-Rivers LA, Heinig MJ, et al. Risk factors  for suboptimal infant breastfeeding behavior,  delayed onset of  lactation, and excess neonatal weight loss. Pediatrics. 2003 Sep;112(3 Pt 1):607-19

Fok D, Aris IM, Ho J, et al. Early initiation and regular breast milk expression reduces risk of lactogenesis II delay in at-risk Singaporean mothers in a randomised trial. Singapore Med J. 2018 Jun 7
 
Kent JC, Gardner H, Geddes DT. Breastmilk production in the first 4 weeks after birth of term infants. Nutrients 2016;8(12):756
 
Maruyama H, Nakata Y, Kanazawa A, et al. Importance of milk expression for preterm infants. Acta Med Okayama. 2016;70(1):45-9
 
Nommsen-Rivers LA, Chantry CJ, Peerson JM, et al. Delayed onset of lactogenesis among first-time mothers is related to maternal obesity and factors associated with ineffective breastfeeding. Am J Clin Nutr. 2010 Sep;92(3):574-84

Parker LA, Sullivan S, Krueger C, et al. Association of timing of initiation of breastmilk expression on milk volume and timing of lactogenesis stage II among mothers of very low-birth-weight infants. Breastfeed Med. 2015 Mar;10(2):84-91