The sudden increase in milk volume, commonly known as “milk coming in,” is a physiological event called Lactogenesis II, which typically occurs between two and four days after childbirth. This transition from producing small amounts of colostrum to copious milk supply is driven by a rapid hormonal shift following the delivery of the placenta. For various personal, medical, or tragic reasons, some individuals may choose or need to prevent this process from establishing a full milk supply. The primary goal of lactation suppression is to signal the body to halt milk production safely and effectively, minimizing discomfort and avoiding complications like infection.
Understanding the Physiology of Lactation Suppression
Lactogenesis II is triggered by a significant drop in the pregnancy hormone progesterone after the placenta is delivered. This drop removes the inhibitory effect on the mammary glands, allowing the milk-making hormone, prolactin, to stimulate the production of large volumes of milk.
The principle of suppression relies on the body’s local feedback loop, where milk removal stimulates further production. By strictly avoiding milk removal, the milk-producing cells become distended, increasing pressure within the breast. This pressure signals the body to slow down and eventually stop milk synthesis, as the lack of demand is interpreted as a signal to cease production. Avoiding stimulation also prevents the release of prolactin and oxytocin, hormones necessary for milk secretion and let-down.
Non-Medical Strategies for Halting Milk Production
The most effective approach to preventing a milk supply is the complete avoidance of nipple and breast stimulation. This means refraining from suckling, pumping, or manual expression of milk. Vigilance is necessary for the first few weeks, as accidental stimulation can occur from sources like a shower stream, clothing friction, or touch.
Wearing a firm, supportive bra, day and night, restricts breast movement and provides gentle compression, aiding the suppression signal. The bra should be snug but not so tight as to cause pain or risk blocked ducts. Applying cold therapy directly to the breasts is also helpful, as cold constricts blood vessels and reduces swelling. Chilled green cabbage leaves, placed inside the bra and changed when they wilt, are a traditional method recommended for their cooling properties and ability to conform to the breast.
Managing Pain and Engorgement During Suppression
Despite preventative measures, breast engorgement—the painful swelling caused by fluid build-up—is common and can peak around three to five days postpartum. Engorgement can make the breasts feel hard, warm, and tender. Managing this discomfort without encouraging milk production requires a delicate balance.
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are recommended to alleviate pain and reduce inflammation. Consistent application of cold packs or ice wrapped in a towel for about 20 minutes can help reduce internal swelling.
In cases of severe, throbbing fullness, minimal hand expression may be necessary to relieve pressure and prevent potential complications. The technique involves expressing only a small amount of milk, just enough to soften the areola and take the “edge off” the pain, without fully emptying the breast. Expressing too much milk sends a signal of demand to the body, counteracting the goal of suppression. The need for this minimal expression should gradually decrease over several days to a few weeks as the body adjusts.
When to Seek Medical Guidance
While non-medical strategies are the primary means of lactation suppression, monitoring for signs of complications that require immediate medical attention is important. Warning signs of potential infection, such as mastitis or a breast abscess, include a fever of 101°F or higher, flu-like symptoms, a localized, painful, red area on the breast, a hard lump that does not resolve, or red streaking.
Pharmacological suppression is rarely used for routine cases due to potential side effects, but options like Cabergoline, a dopamine agonist, may be prescribed in certain medical circumstances. Medications are typically reserved for situations like stillbirth, neonatal death, or specific maternal health conditions where rapid suppression of prolactin is necessary. A healthcare provider must be consulted to discuss the benefits and risks of any prescription option.