January 20, 2020
Delay in Lactation
‘Delay in lactation’ is a term used to describe a situation where the newborn is still losing weight and there is no sign of milk “coming in.” The mother perceives a lack of breast enlargement and/or fullness by the end of day 3 for a multip and day 5 for a primip.
Risk factors1,2 for a delay in lactation are several, including primiparity, high body mass index, high gestation weight gain, insulin resistance, prolonged labor, and cesarean birth.
A delay in lactation results in the need to supplement the infant because of excessive weight loss. A thorough evaluation by a lactation specialist is recommended in these situations. The mother is usually instructed to begin expressing milk after breastfeeding, by using a breast pump along with manual expression. The infant will need supplementation with whatever expressed breastmilk is available, in addition to pasteurized donor milk or formula. A firm feeding plan and close follow-up are needed to support the dyad. Mothers with a delay in lactation have an increased risk of premature weaning1,2.
If the mother is able to express sufficient milk after nursing, this is not a delay in lactation but rather a situation where the infant is not transferring milk well. Infants who are not transferring well also need an evaluation by a lactation specialist.
- Huang L, Xu S, Chen X, Li Q et al Delayed Lactogenesis is Associated with Suboptimal Breastfeeding Practices: A Prospective Cohort Study J Nutr 2019; 00:1-7
- 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;92:574-84