The phrase “milk coming in” describes Lactogenesis II, the process where the body transitions from producing colostrum to creating a copious volume of mature milk. This shift is a normal physiological change after birth. However, the process often takes slightly longer for parents who have had a C-section compared to a spontaneous vaginal delivery. This temporary delay is a result of the surgical process and recovery, but it does not mean successful breastfeeding is out of reach. The baby receives everything necessary in the interim because colostrum, the initial milk, is present from birth.
The Standard Timeline for Lactation Onset
After a spontaneous vaginal birth, the onset of Lactogenesis II typically occurs between 48 and 72 hours postpartum, or within the first three days. This is when the parent usually notices a distinct increase in breast fullness and milk volume. For those who deliver via C-section, the timeline is often shifted slightly, with the full milk volume arriving closer to 72 to 120 hours postpartum, or between three and five days after the surgery.
Colostrum, often called “liquid gold,” is the thick, yellowish first milk that is nutrient-dense and packed with antibodies. It provides complete nutrition for the newborn in the first few days. The baby only needs small amounts of this milk initially, as their stomach is tiny.
The physical signs that the milk has “come in” are noticeable and distinct. Parents will typically feel their breasts become significantly fuller, firmer, and sometimes warmer or heavier. This sensation is often accompanied by a stronger let-down reflex, which is the tingling feeling that occurs as the milk begins to flow actively during a feeding session.
Factors Contributing to Delayed Onset
A C-section can disrupt the hormonal signals that initiate the transition to milk production. The lack of natural labor, and therefore the absence of the significant hormonal shifts associated with it, can delay the necessary drop in progesterone and the subsequent rise in prolactin required for Lactogenesis II. This hormonal environment is a primary reason why the onset of milk production may be pushed back past the 72-hour mark.
The surgical procedure often involves administering large volumes of intravenous (IV) fluids to the patient. This excess fluid can temporarily pool in the body’s tissues, including the breasts, leading to swelling and engorgement. This fluid-related swelling can make the breast tissue firmer and more difficult for the baby to latch onto effectively, which can indirectly contribute to a perceived delay.
Postoperative medications and the effects of surgical recovery also play a role. Pain medication, while necessary for recovery, may make the parent feel sleepy or less alert, potentially leading to fewer early feeding sessions. Additionally, the physical stress of major surgery can contribute to maternal fatigue and separation from the baby, both of which negatively impact the initiation of frequent milk removal, a key driver for establishing supply.
Active Steps to Encourage Milk Production
The most effective step a parent can take to establish milk supply after a C-section is to begin stimulating the breasts as soon as possible, ideally within the first hour after birth. Early and frequent milk removal sends signals to the body to increase production. This stimulation should occur at least 8 to 12 times in a 24-hour period.
Immediate and continuous skin-to-skin contact with the newborn is beneficial, helping to regulate the baby’s temperature and encourage early feeding cues. Placing the baby directly on the chest helps stimulate the release of oxytocin, a hormone that promotes milk let-down and bonding. This contact should be prioritized in the operating room or recovery area, even if the parent is still recovering from anesthesia.
If the baby is too sleepy, separated, or having difficulty latching, the parent should use hand expression or a pump to remove colostrum. Hand expression is particularly useful in the first few days to harvest the small, concentrated drops of colostrum and stimulate the receptors in the breast. Even a small amount of expressed colostrum is beneficial and helps signal the body to prepare for the full milk volume.
Finding comfortable feeding positions is essential when recovering from abdominal surgery. Positions that keep the baby’s weight off the incision, such as the football hold (or clutch hold) or side-lying, can reduce discomfort and make frequent feeding more manageable. If concerns about supply or latching persist beyond the fifth day, seeking assistance from an International Board Certified Lactation Consultant (IBCLC) can provide tailored, evidence-based support.