Basics of Breastmilk Production, Part 2: Labour, delivery and early post-partum

In this post, we’re continuing the discussion around the basics of milk production. Find Part One here.

Labour and delivery. Phew.

For those who experience it, labour involves a physical, emotional and hormonal journey, and for some, a profoundly spiritual one. Much of the hormonal changes that occur during labour help to prepare the body for breastfeeding and bonding with your pēpi. Labour can be wonderful, and terrifying, and traumatic, and blissful, and painful, and confusing. Caesarean sections can also be wonderful and terrifying and traumatic and blissful and confusing (hopefully not painful at the time!), and pregnant people can also have accompanying feelings of grief if they hadn’t chosen to have the caesarean.

Certain medical interventions, such as synthetic oxytocin and caesarean sections, can potentially increase the risk of breastfeeding issues, though the exact reasons for this are unclear. If you have a planned induction of labour or caesarean section coming up, you can start preparing by talking to your maternity carers about wanting early skin-to-skin and breastfeeding, avoiding unnecessary separation of you and your pēpi, as well as considering antenatal expression of colostrum, and/or an antenatal consult with a breastfeeding medicine specialist or IBCLC.

For the first few days after delivery, your body will produce colostrum. This is a thick, yellowish milk filled with highly concentrated goodness - your baby will only need to drink small amounts at a time to be satiated. Your healthcare providers should ensure that you and your baby get early skin-to-skin, with the first feed happening as early as possible (usually in the first hour). If this isn’t possible, then someone should be there who can help you hand express your milk.

Delivery of the placenta leads to the levels of progesterone plummeting, causing the tight junctions (gaps) between the cells in the breast to close up shop. Lactose is shuttled into the breastmilk with water following closely behind, leading to an increase in the volume of milk produced - this is lactogenesis II, or the “milk coming in”. Many (but not all) breastfeeding people experience engorgement (enlarged and often painful breasts), which is primarily caused by an increase in fluid in the interstitial tissue surrounding the milk glands/ducts rather than the breasts “filling up with milk”. Not getting engorged doesn’t mean that your milk hasn’t come in.

In these early days, frequent and effective milk removal is crucial. The signal to your breasts to make breastmilk comes from milk being removed from the breast - frequent and effective breastfeeding or expressing is key to setting up your long-term milk production.

The keywords here are frequent and effective. Things that interfere with either of these things can cause issues with breastfeeding, both immediately and also later down the track. Frequent feeds mean at least 8-12 feeds per 24 hours, usually more. It means feeding whenever your baby cues, day and night. It means being physically close enough to your baby so that you can respond quickly when they signal.

Effective means: not painful. It doesn't mean “easy”, as breastfeeding is rarely easy while you’re both learning. But it should be tolerable and not horrible. Effective means that your baby is actively swallowing and can feed for as long as they want to; yes, including those little flutters while they’re asleep on the breast. Effective usually means offering both breasts, at least initially (some babies will always need both breasts per feed, some babies will only need one, and for some, it depends on how hungry they are). It means lots of wet and dirty nappies, a baby who is alert at least some of the time and has a good feed before falling asleep - a very drowsy baby, who needs to be woken for feeds, and/or who falls asleep straight away on the breast should be assessed by a midwife, obstetrician/paediatrician or lactation consultant/breastfeeding medicine specialist.

Expressing / pumping

Effective may also mean hand expressing and/or machine pumping milk if you are separated from your baby, have too much pain to latch directly, or if they are not able to effectively feed from the breast directly, such as in premature infants, NICU admissions, jaundice, or for anatomical reasons such as cleft palate or oesophageal atresia.

Events that occur in the first days and weeks that interfere with normal physiological breastfeeding can actually set someone up for hypolactation, or not making enough milk for their baby. It is not necessarily about how hard parents try; it’s also about the systems and culture in which we have our babies. Parents are not failing; they are being failed.

Many parents can increase breastmilk production, even after a rough start, by increasing the milk removed from the breast. This can be achieved through increasing the number of feeds your baby has; optimising the fit and hold for better milk transfer and more comfort for both parent and baby; increasing the amount of breastmilk baby receives each feed through breast compressions and switching sides frequently, offering top-ups (of expressed breastmilk and/or formula) via a supply line; pumping breastmilk while you or someone else feeds baby milk. Some parents also benefit from galactagogues in the form of herbs or medications such as domperidone or metformin.


If you are having issues with breastfeeding, seek help. Find a good IBCLC or breastfeeding medicine specialist who can help you get things on the right track - don’t wait until the wheels fall off, as the earlier we intervene, the easiest it is to support you in your goals. If you’re struggling and need support, please get in touch with us to make an appointment; we would love to help you.