‘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 factors^1,2 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 weaning^1,2.

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.