How does milk coming work?

At the time of childbirth, your body naturally prepares itself for breastfeeding (even if you do not wish to breastfeed). A few days later, the milk coming in occurs. What is it and how can you manage it? May explains.

What is milk coming in?

“Milk coming in” refers to when milk production rapidly increases in the breasts. It generally occurs between the second and third day after childbirth.

Following the expulsion of the placenta, pregnancy hormones (progesterone and placental lactogenic hormone), which until then inhibited milk production, drop. Milk production then begins under the action of two hormones: prolactin and oxytocin. Colostrum (the first yellow or orange milk produced from mid-pregnancy) then gives way to what is known as transitional milk.

Good to know: milk coming in may be delayed after a cesarean section, in women with obesity, in women with diabetes, or after a long and difficult birth.

How long does milk coming in last?

Without breast stimulation, milk coming in stops after two weeks.

Milk coming in can be uncomfortable for the mother. The discomfort associated with this phenomenon can last around 24 hours, depending on the woman. Don’t worry—if you follow our tips to relieve it and your baby nurses regularly, these discomforts will quickly diminish. We recommend continuing your reading to discover our tips.

How can I increase my breast milk supply?

Breast milk production depends on the stimulation of your breasts. The rule is simple: the more they are stimulated, the more milk you will produce! This is why, especially at the beginning, it is recommended to breastfeed your baby frequently as soon as you notice signs of wakefulness (bringing hands to the mouth, moving, opening the mouth…), without schedules and without limiting the number or duration of feedings. You can also pump your milk with a breast pump.

Your baby’s position at the breast is also important for milk production: make sure you are in a comfortable position and that your baby’s mouth is wide open (covering the nipple and a large part of the areola). Their head should be slightly tilted back, lips flanged, chin touching the breast, nose clear, tongue cupped under the nipple, and the belly facing your body (alignment of ear, shoulder, hip).

❗Be careful not to place your hand behind your baby’s head when offering the breast. Otherwise, the baby may reflexively push against your hand and pull on the breast.

Good to know: breast size does not determine the ability to produce or store milk.

What discomforts may be associated with breastfeeding?

Breastfeeding may lead to certain discomforts. Milk coming in is part of this, as it can be uncomfortable: the breasts are full, and tingling or prickling sensations may appear. Other mild to more significant issues may occur—here are the most common breastfeeding problems:

Latching issues due to breast engorgement (breasts are too full)

• Signs: it is often bilateral, breasts are tight, swollen, sensitive to painful, and there is little or no fever.
• Prevention: an optimal position and effective feedings, fully emptying one breast before switching to the other (it is not recommended to arbitrarily limit duration), and frequent feedings (minimum 8 in 24 hours) help relieve breast engorgement.
• Treatment: it is recommended to apply cold between feedings and heat during and after them (hot shower, bowl of hot water), apply cabbage leaf compresses every two hours (previously refrigerated and rolled flat), express milk (preferably manually) to relieve without fully draining, perform areolar massage and reverse pressure softening before latching, and adopt the “Biological Nurturing” position to move edema into the body.

Mastitis (breast inflammation)

• Signs: it is unilateral and localized. There may be a red area or a sensation of heat. There is no defined duration and it is painful. Sometimes, it may be accompanied by flu-like symptoms (fever equal to or above 101.3°F / 38.5°C and chills).
• Predisposing factors: nipple trauma, infrequent feedings / fixed feeding times / limited feeding duration, skipping a feeding, poor latch, pressure on the breast (bra, seat belt, baby carrier…), a milk blister, stress, fatigue, or untreated engorgement.
• Treatment: it is advised to empty the breasts adequately, starting with the unaffected breast, position the baby with their chin toward the red area, massage the breast during feeding or relieve tension under a warm shower until the breast is comfortable, rest, hydrate, alternate hot and cold on the breast. If no improvement occurs after 24 hours of local care, a medical consultation and an antibiotic treatment may be necessary.

Cracked nipples (lesions on the nipple)

• Things to check: baby’s position (belly-to-belly, straight head-body alignment), mouth opening and flanged lips, nipple appearance at the end of feeding (pinched, color, wound, bleeding), overly engorged breast (soften before feeding with areolar massage), proper breast pump use, and correct flange size.
• What may help: breast milk compresses covered with plastic wrap, silver nursing cups, pure lanolin cream, pharmaceutical-grade honey (do not use these methods in case of thrush). You can also try varying nursing positions, using the “Biological Nurturing” position, supporting the breast, or holding it sandwich-style.

If there is no improvement after 48 hours, if the crack is deep, if breastfeeding becomes unbearable, or if fever develops, it is recommended to consult a healthcare professional.

Want to learn more? Feel free to download the May app, where you’ll find plenty of resources to support and guide you throughout your journey as a new parent.

How can I relieve milk coming in?

To relieve milk coming in, it is recommended:

• To breastfeed the baby or pump when sucking is insufficient or absent. For women who do not wish to breastfeed, you can express a little milk by massaging your breasts under a warm shower, for example.
• To avoid tight underwear.
• To apply cold to your breasts.
• To massage your breasts under a warm shower.
• To take acetaminophen.

When should you use a breast pump during milk coming in?

A breast pump can help during milk coming in, especially when your baby’s sucking is insufficient or absent, or if there is a decrease in milk production. The goal is to increase the effectiveness of stimulation and breast emptying to improve milk production and ejection. You can use it:

• On the second breast while your baby nurses on the first.
• After feeding.
• Between feedings.
• Instead of feeding sessions.

It all depends on your situation and your storage capacity.

Good to know: it is preferable to choose a double electric breast pump or a hospital-grade breast pump. Before milk coming in occurs, manual expression is recommended.

What is a lactation consultation?

When you have difficulty breastfeeding or simply have questions about breastfeeding, it is entirely possible (and recommended) to schedule an appointment with a lactation consultant, certified breastfeeding professionals holding an international certification such as the International Board Certified Lactation Consultant (IBCLC) or a university diploma. This consultation may take place before and/or after childbirth.

During the consultation, if you are breastfeeding, the consultant may observe a feeding and verify whether there are positioning issues or whether everything is going well. If there is a problem, follow-up may be recommended to ensure proper breastfeeding progress.

Good news: the May team includes many lactation consultants ready to answer all your questions from 8 a.m. to 10 p.m., 7 days a week. Don’t hesitate to download the app for professional guidance.

Milk coming in is natural and may be uncomfortable, but there are always solutions to relieve it, whether you choose to breastfeed or not.

This text was translated from French by an artificial intelligence. The information, advice, and sources it contains comply with French standards and may therefore not apply to your situation. Make sure to complement this reading by visiting the May US/UK app and consulting the healthcare professionals who are supporting you.