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Milk 'coming in'

Milk 'coming in'
Milk 'coming in'

Words by
Feminin Botanik

Your milk will 'come in' 2-8 days after birth -- as your breasts switch from producing colostrum to mature milk. 

The process of your milk 'coming in' is kick-started by the delivery of the placenta, which causes progesterone levels to drop rapidly, starting a cycle of increasing milk production. The symptoms and milk volume increase usually levels off after about 4-5 days. 

 

In this article:

Can I feed my baby before my milk 'comes in'?

What does milk 'coming in' feel like?

Can milk 'coming in' cause other symptoms?

How can I relieve the symptoms of engorgement?

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Can I feed my baby before my milk 'comes in'? 

Yes, colostrum production begins just 16 weeks into pregnancy (this is called lactogenesis, stage 1). Your breasts get bigger as fat droplets accumulate in the cells, and plasma concentrations of lactose increases. In mid to late pregnancy, your body is able to produce milk.

At birth, you feed your baby a thick, sticky, golden fluid called colostrum. It's perfectly designed for newborn tummies, super protein and nutrient dense. 

Then usually within 2-3 days (but sometimes up to 8), your milk 'comes in', and you transition to mature milk (this is called lactogenesis, stage 2).

Mature milk is more watery and whiter, with an increase in lactose and fats, and a decrease in sodium, chloride and protein. If your pumping, you'll be able to see the difference in colour and consistency.

What does milk 'coming in' feel like?

Most women notice their breasts feeling full, hard and warm when their milk 'comes in'. This is called engorgement.

For many women it's uncomfortable, with symptoms like breast swelling, heat and pain, leaking milk and sometimes even a fever. Some women describe the feeling as being run-down or 'flu-like'. For others, milk 'comes in' more gradually and is barely noticeable.

Can milk 'coming in' cause other symptoms?

Many women experience additional symptoms when their milk 'comes in', often caused by the hormonal and physical changes that follow birth.

Swollen lymph nodes are common, particularly when breast swelling extends under the armpits. If swollen lymph nodes persist beyond a few days you should see your lactation consultant or doctor to ensure you don't have mastitis or another infection.

Milk fever and a general feeling of exhaustion is also common. 

Nipple or chest pain is experienced by many women as their milk 'comes in' and sometimes later in breastfeeding. When there is a rapid tightening of blood vessels in any area of the body, it causes a reduction in blood flow and oxygen. This is called vasospasm. When a baby feeds with a shallow latch it can trigger nipple vasospasm, which feels like painful stabbing or burning sensations in the nipple). If the constriction of vessels happens deeper into the breast, it can cause stabbing or shooting pains known as mammary constriction syndrome.

Headaches in the early days following birth are often related to hormonal changes, and usually resolve as your body regulates after birth and you find a supply-demand feeding rhythm with your baby. Some women report headaches every time they feed (on let down), which experts think might be a result of a surge in oxytocin. Monitor your headache symptoms and seek professional advice if they are severe and persist beyond the first week after birth.

How can I relieve the symptoms of milk 'coming in'?

In most cases, symptoms of milk 'coming in' will pass within the first 8 days after birth.

If your symptoms are related to engorgement following the below advice may help:

1) Feed on demand, with your babies feeding cues, and don't limit time at the breast. Ideally 8-12 feedings every 24 hrs while you're suffering engorgement.

2) If your baby is sleeping for long periods, wake them every 3 hours at minimum to feed (allowing one longer stretch of up to 5 hours overnight).

3) Fully empty each breast when you feed, before you switch sides.

4) If your baby is having trouble latching to an engorged breast (i.e. flattened nipple), try hand expressing a small amount of milk before you feed. If your baby is not well attached it can result in nipple damage and poor milk removal (which means more engorgement and less milk for baby). If you need to relieve some pressure and soften your breasts for better attachment, try hand expressing in a warm shower or bath or after using a warm compress, to encourage milk flow.
5) Use warm or cold compresses, with gentle massage to relieve pressure.
    If you've been breastfeeding exclusively up until your milk 'comes in', just focus on consistently feeding. Milk removal is key to establishing a healthy supply-demand rhythm with your baby, and to relieving engorgement symptoms. If milk isn't being removed while you are engorged, milk production will begin to shut down.

    Many cultures and traditional medicine practices, have additional advice for both encouraging milk to 'come in', relieving engorgement and self-care postpartum.

    "Chinese medicine is very particular about nutrition for nursing mothers post-birth. The focus is on bone soups and protein, while cold food, raw food and anything refrigerated is not recommended. These cold foods are thought to cool the milk, and make it less palatable for the baby," according to Rebecca Mar Young (BA Health Sciences, Traditional Chinese Medicine & Partner at Red Tent Mums). "A mother’s food should be simplified and bland during breastfeeding. Chinese medicine suggests that nursing women avoid stimulants like caffeine and sugar to make digestion easier for the baby."

    Rebecca notes that Chinese medicine doesn't "endorse feeding on demand," but rather suggests that "every four hours is best." Personally, Rebecca thinks that you "you need to be more flexible when you have a newborn and your milk production is being established." Read our full interview with Rebecca

    For engorgement, mastitis and supply issues, Chinese medicine offers specific protocols, including herbs, acupuncture and food recommendations. 

    The bottomline

    The process of your milk 'coming in' can sometimes be uncomfortable, but rest assured it's temporary and normal. For most women, symptoms will resolve within the first two weeks after birth, and they find a supply-demand rhythm with their baby. 

    Keep feeding, rest as much as you can, and be gentle with yourself.

    Related reading

    Guide to starting out breastfeeding: attachment, the let down reflex

    Guide to breastfeeding problems: engorgement, mastitis, sore and cracked nipples 

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