Children's Health and Wellness

Milk Production and Your High-Risk Baby

Preparing to breastfeed your high-risk baby

Breastfeeding has important health benefits for your baby and helps the two of you bond. The benefits are even higher for babies who are born high-risk. Babies in the NICU need a mother's breast milk to help support their immune systems, improve their digestion, and decrease the risk of a serious condition called NEC (Necrotizing Enterocolitis). If you are expecting a high-risk baby, providing your child with breast milk is something only you can do, which makes you an important member of his or her healthcare team. Below are some suggestions for how you can get ready to make enough milk for your high-risk baby:

  • If possible, start pumping within 60 minutes of delivering your high-risk infant. Evidence shows that this can help make more milk than  if you start later.

  • Use breast massage and warm your breasts before you pump.

  • Start expressing milk by hand, then use a pump as needed, to get your milk started.

  • Listen to relaxing music as you pump. Evidence has shown that this can help women to make more milk, possibly by reducing stress.

When milk production is delayed or not enough

You may have a delay in the time when your milk comes in after the birth of a high-risk baby. Also, it is not unusual to have a drop in the amount being pumped after several weeks. A drop may be gradual or it may occur suddenly.

Do not wait to get help if milk production is ever a concern. The sooner you intervene, the better. Ask a certified lactation consultant, your baby's nurse, doctor, or a breastfeeding support leader to help you figure out what might be affecting milk production if:

  • You are not producing a daily total of at least 16 ounces of milk by 7 to 10 days after birth.

  • You begin obtaining less and less milk each day for 3 or 4 days in a row.

  • The daily total dips below 12 or 13 ounces for more than 2 or 3 days in a row.

Possible causes for delayed or low milk production

Are you pumping often enough?

Not pumping often enough or not fully emptying your breasts is the most common reason milk is delayed or not enough milk is made. A review of the number and length of pumping sessions should always be first thing you do if you are ever concerned about milk production.

It is easy to fall into the habit of letting more and more time pass between pumping sessions when recovering from birth and visiting the baby in the NICU. Also, a mother may initially obtain more milk quickly when several hours pass between pumping sessions. However, without frequent and effective milk removal, the breasts soon get the message to slow milk production. Within a day or two, a mother who pumps less and less often will start producing less milk.

Equipment checks

If your breast pumping routine does not seem to be the problem, it may be the breast pump you are using. Many mothers find that a hospital-grade, double electric pump works best when pumping for a high-risk infant. Some women find that manual (hand), battery-operated, or smaller electric breast pumps are not effective at establishing and maintaining a milk supply. If you do not have a hospital-grade pump, you can sometimes rent one from a local hospital, lactation consultant, or mother's group. Once you have your pump, pay attention to how well it is working. If you suspect that the pump is not working properly, call the rental station or manufacturer.

Adding strategies

These strategies may also help increase your milk production:

  • Don't forget to use breast massage and warm your breasts before you pump.

  • If you are pumping, consider adding in some hand expression, especially at the beginning and end of the pumping session. You can do this while the pump is still on and it will help to empty your breasts.

  • Don't forget to relax. Listening to relaxing music has been shown to help women to make more milk, possibly by reducing stress.

Maternal factors for delayed or not enough milk production

  • A delay when milk "comes in." Occasionally, a mother has a health condition that may temporarily delay the large increase in milk production usually seen between 3 to 5 days after birth. In these cases, large amounts of milk are not seen until 7 to 14 days after giving birth. If this happens to you, do not feel discouraged. Keep pumping.It can be hard to keep pumping at least 8 times in 24 hours (for more than 100 total minutes) when getting only drops of milk with each session. However, it is extremely important to keep expressing milk frequently. This kind of delay does not mean a mother will have trouble producing enough milk once the milk does "come in." Usually, she has plenty of milk as long as she has been pumping often enough.Some conditions, or treatments, that may possibly delay milk  include:

    • Stress

    • Cesarean (surgical) delivery

    • Postpartum bleeding

    • Maternal obesity

    • Infection or illness with fever

    • Diabetes

    • Thyroid conditions

    • Strict or prolonged bed rest during pregnancy

  • Not enough milk. Rarely, a delay in the time when milk "comes in" turns into an ongoing problem of low milk production. Some of the conditions associated with a delay may also have an ongoing effect on milk production, including increased stress, severe postpartum bleeding, leftover placental fragments, and thyroid conditions. If a mother had a breast surgery that cut some of the nerves, milk-making tissue, or milk ducts, she may have trouble making enough milk to fully feed her baby.Other factors can also lead to low milk production. These include the following:

    • Maternal smoking

    • Some medicines and herbal preparations

    • Hormonal birth control, especially any containing estrogen. However, some mothers report a drop in milk production after taking a progestin-only contraceptive during the first 4 to 8 weeks after birth. Consult your doctor for more information.

    If you still have trouble making enough milk and your pump is working properly, consider the following:

    • Increase the frequency of milk expression to 9 to 12 pumping sessions. You can also increase the time of each pumping session. Do this for several days.

    • Begin or increase the amount of skin-to-skin contact you have with your baby during visits to the NICU.

    • Ask your doctor or a certified lactation consultant to review your health history with you to learn if there may be a health condition, treatment, or medication that is altering your milk production.

    • Ask your doctor or a certified lactation consultant  about medicines or herbal preparations that may increase milk production. 

    • Think positive. Although insufficient milk production usually can be reversed, any milk you produce, even drops, is valuable for your baby.

  • Overproduction of milk. Some mothers consistently make much more than 25 to 27 ounces of milk in 24 hours. Their freezers are overflowing with containers of expressed breast milk. When mothers are making a lot more milk than even a full-term baby or twins could handle, some find they can drop 1 or 2 daily pumping sessions. It is important for these mothers to continue pumping for 100 minutes in 24 hours. These mothers can often achieve this in fewer sessions of pumping. If the daily amount pumped ever drops below 25 ounces (750 ml) for 24 hours, add another pumping session.Making too much milk is usually not a problem, so there is no reason to interfere with a successful plan for milk expression unless it is hard to maintain. If you are "overproducing" and considering changing your pumping routine, it is recommended that you:

    • Discuss your situation with a certified lactation consultant  or your baby's doctors and nurses before making any changes.

    • Do not make changes if you are pumping for multiple children (twins, triplets, or more). 

    • Monitor the volume of your milk closely and have a clear plan to increase your pumping frequency or duration if your milk supply decreases. 

    • If you truly don't need the extra milk, consider donating it to other mothers in need.

Most mothers would much rather make more than their baby needs than to discover they are no longer making enough. If the amount you are making is causing you discomfort or pain, consult a certified lactation consultant or your doctor.

Print Source: Becker, GE, Methods of Milk Expression for Lactating Woemn, COchrane Database (2015), 2, pp. 1-103
Online Source: Breastfeeding a Baby with a Health Problem, Office on Women's Health
Online Source: Breastfeeding Pumping and Breastmilk Storage, Office on Women's Health
Online Source: Providing Breastmilk for Premature and Ill Newborns, American Academy of Pediatrics
Online Editor: Metzger, Geri K.
Online Medical Reviewer: Dozier, Tennille, RN, BSN, RDMS
Online Medical Reviewer: Rosen-Carole, Casy, MD, MPH
Date Last Reviewed: 9/14/2015
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