When Does Breast Milk Come In? Signs, Engorgement and What Helps

When does breast milk come in?

Between 2 and 4 days after birth. StatPearls, the NCBI clinical reference, says breast milk production begins in significant amounts between 2 and 4 days after birth, which is what is commonly described as the milk "coming in", and the NHS says that around 2 to 4 days after birth you may notice your breasts becoming fuller. The trigger is the birth itself: once the placenta is delivered, the pregnancy hormones that held milk production back drop away, and prolactin starts it.

A cesarean birth can push this back. The Children's Hospital of Philadelphia (CHOP) says a cesarean may delay engorgement by one to two days, because the milk may come in later.

When	What a breastfed baby typically takes
Days 1 to 3	Colostrum, about 30 to 60 ml a day in total (StatPearls): 2 to 10 ml a feed on day 1, 5 to 15 ml on day 2 (La Leche League)
Day 3	About 300 to 400 ml in 24 hours, on average (StatPearls)
Day 4	About 30 to 60 ml a feed, colostrum mixed with more mature milk (La Leche League)
Day 5	About 500 to 800 ml in 24 hours, on average (StatPearls)
From about 2 weeks	Mature milk (La Leche League, StatPearls), rising slowly to 700 ml or more a day (La Leche League)

How much milk does a newborn get before and after it comes in?

Drops and teaspoons at first, then several hundred millilitres a day within the first week. La Leche League says colostrum is measured in drops or teaspoons, and StatPearls puts the whole day's colostrum at about 30 to 60 ml for the first 2 to 3 days. By day 3 the average baby takes 300 to 400 ml in 24 hours, and by day 5, 500 to 800 ml, in StatPearls' figures.

La Leche League describes a gradual transition from colostrum to mature milk: by the fourth day most babies drink colostrum mixed with more mature milk, and mature milk follows from about the second week. What the first three days of feeding look like, from colostrum to the first weight check, has its own article.

Is it normal fullness or engorgement?

Fullness is expected; engorgement is fullness that has turned hard and painful. CHOP says some degree of breast fullness is normal as your milk comes in. Engorgement, it says, is caused by congestion of fluid and blood in the breast, and the NHS describes engorged breasts as feeling hard, tight and painful.

The practical problem is the latch. The NHS says the nipple can become a little overstretched and flattened, and the American Academy of Pediatrics notes that hard, painful breasts may stop your baby latching on correctly, which matters because milk leaving the breast is what relieves it. CHOP says engorgement usually happens between day 3 and day 5, may come as late as day 9 or 10, and that some women never experience it.

If the fullness and hardness do not go down by the end of a feed, the AAP reads that as a sign about the baby: your baby may not be drinking enough milk or may be suckling ineffectively, and it is worth having the latch checked.

How often should you feed when your milk comes in?

Every 1 to 2 hours, in CHOP's advice for avoiding severe engorgement. CHOP adds that more time spent breastfeeding in the first 48 hours reduces engorgement, and to let your baby feed on the first breast until it is soft before switching to the other. StatPearls describes a newborn typically feeding every 1 to 3 hours for about 10 to 20 minutes per session early on.

If you are pumping or mixed feeding, the rule is the same: StatPearls explains that removing milk, whether by the baby or by expressing, is what keeps production going. The same rule is behind the run of near-constant feeds around 2 to 3 weeks.

What helps engorgement, and what makes it worse?

What helps, from the NHS and CHOP:

• Feeding often, without long gaps. The NHS notes engorgement usually happens when your baby has not fed for a while.
• Brief warmth before a feed. A cloth soaked in warm water, a warm bath or a warm shower just before feeding or expressing helps the milk flow. The NHS warns not to apply a lot of heat or for too long, as this may increase inflammation.
• A cold compress between feeds, which the NHS suggests for pain and swelling.
• Reverse pressure softening, which CHOP describes as gentle, firm fingertip pressure on the areola for 30 seconds to soften it enough for a latch.
• A well-fitting breastfeeding bra that does not restrict your breasts (NHS).
• Paracetamol or ibuprofen at the recommended dose (NHS).
• Cool cabbage leaves, washed, for 20 minutes at a time or until they wilt (CHOP).

What makes it worse is over-expressing. The NHS says to express only enough to relieve the discomfort, because expressing more makes you produce more milk.

It is worth dealing with early. The AAP says severe, unrelieved engorgement can decrease your milk supply, and CHOP says poor drainage and unresolved pressure can damage milk-producing cells.

Does milk come in if you are not breastfeeding?

Yes. The hormones that start milk production follow the birth, whatever the feeding plan. A University Hospital Southampton NHS leaflet on suppressing milk says engorgement often occurs around three to four days after giving birth and can last about 48 hours, with breasts that feel warm, heavy and tender and may become hard, tight and painful.

What it suggests:

• Cold compresses, such as cooling gel pads in your bra, a well-fitting supportive bra, and ordinary pain relief.
• Cabbage leaves washed, dried and chilled in the fridge, replaced every 20 to 30 minutes as they wilt, and never placed on broken or damaged skin.
• Not expressing as a rule, because the more milk you remove, the more you are likely to make. If you are very uncomfortable, your midwife may suggest expressing a tiny amount.
• A prescription medicine, cabergoline, can stop milk production; the leaflet says most women need only one dose.

When should you get help?

Contact your midwife, doctor, health visitor or a lactation consultant if:

• Five days have passed and your milk has not come in, or your breasts do not feel as though they are filling. The AAP says to have your baby weighed by their pediatrician immediately.
• Your breasts are so hard and painful that your baby cannot latch on (AAP).
• The fullness and hardness do not go down by the end of a feed (AAP).
• Pain is severe enough to interfere with breastfeeding (AAP).
• You have signs of mastitis: a breast that feels hot and tender, a swollen area that may be red and painful to touch, a flu-like feeling, aches, tiredness, tearfulness or a high temperature. The NHS says to contact your GP or NHS 111 if you feel worse at any time, or are no better within 12 to 24 hours of starting self-care.

The NHS adds one thing not to do with mastitis: stopping breastfeeding suddenly will make the symptoms worse and may lead to a breast abscess.