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
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
You are not producing a daily total of at least 16 ounces of milk by 7 to 10 days
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
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.
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.
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:
Cesarean (surgical) delivery
Infection or illness with fever
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:
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
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
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
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.