Time to milk ‘coming in’ – Effective initiation results
Time to milk ‘coming in’ is an indicator for efficacy of interventions to support effective initiation. When it occurs within 72 h post-birth, it is an important predictor of milk volume adequacy at four weeks.
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What is time to milk ‘coming in'?
Time to milk ‘coming in’ is the time after birth at which secretory activation occurs.1,2
Milk ‘coming in’ (secretory activation) normally occurs between 24 – 72 hours after delivery of the placenta.3-5
Secretory activation can be indicated by:
- Three consecutive expression volumes of 20 ml or more from both breasts (combined) for exclusively pumping mothers.6
- Physiological markers, such as a feeling of breast fullness for mothers breastfeeding and pumping.7
Why is time to milk ‘coming in’ important?
Delayed secretory activation (>72 hours after birth) is linked to increased risk of persistent low milk volumes and a shortened duration of lactation.3,8
Women experiencing delayed secretory activation are 60% more likely to stop breastfeeding at 4 weeks.8
Milk ‘coming in’ is a one-time event that is critical to continued breast milk synthesis.9
Risk factors for delayed secretory activation identified pre and perinatally include:
How to optimise time to milk ‘coming in’
Develop/revise breastfeeding and expression protocols in order to
- Identify women pre and perinatally who have at-risk factors for delayed milk ’coming in‘
- Provide at-risk women education on the milk journey and the importance of effective initiation: time to first expression, frequency of pumping, using INITIATE breast pump software, double pumping and correctly fitted breast shields.
- Implement and support women to
- Provide mothers with a pumping log to track
- daily expressions and milk volumes
- onset of secretory activation -indicated by 3 consecutive expressions >20 ml from both breasts combined
- Support regular staff education on the importance of the milk production journey
- Ensure staff understand the consequences of a delay in secretory activation and are able to provide increased lactation support to mothers with risk factors
How to monitor time to milk ‘coming in’
• Track the percentage of mothers who have their milk ‘come in’ within 72 hours after birth.
• Identify mothers with delayed (>72 hours) milk ‘coming in’
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