How to handle your milk supply after delivery

Allison Tannebaum, MS, RDN, CDN

What to Know

Understand what breast changes to expect in the days and weeks after delivery
Learn the steps you can take to help minimize discomfort as your milk supply diminishes

Our body naturally starts producing milk once our baby is born, whether we intend to breastfeed or not. In fact, colostrum – the first milk your body produces – begins to develop during pregnancy. Some women experience leaking of this yellowish milk prenatally, typically after week 16.

Once your baby is delivered, changes in hormones cause the body to produce milk. This usually results in engorgement, including tissue swelling when your breasts overfill with milk. At this time your breasts may feel firm, warm, heavy, and generally uncomfortable. The onset of engorgement may occur anywhere between 2 and 5 days after birth and the symptoms may last anywhere between 2 and 3 days, longer if not breastfeeding.

There are no approved drugs on the market to speed up the process of drying up your milk. Some moms report that herbs such as sage and peppermint help to reduce milk production; talk to your doctor before taking any supplements.

There are many reasons why someone would want or need to suddenly dry up their milk supply. This process is especially difficult after infant loss or stillbirth. Many moms find that donating the breast milk they have and/or will be pumping can help. Visit http://www.hmbana.org for more information. Milk banks typically waive minimum donation requirements for bereaved mothers.

Here are some tips that may help alleviate some discomfort and assist in preventing the body from continuing to produce milk:

Avoid pumping or hand expressing to the point of emptying your breast. Milk production is based on demand, the suckling on and emptying of the breast triggers your body to produce more milk. Express or pump just enough to relieve discomfort by pumping for just a minute, or so. The less you empty your breast, the quicker your body will realize it doesn’t need to produce more.
Using a cold pack for 15 to 20 minutes each hour may help to alleviate some pain and swelling.
Speak with your healthcare provider about taking ibuprofen, which may also help reduce pain and swelling.
Wear a supportive, well fitted bra, but not one that is too tight or binding.
While there is limited research on the use of cabbage leaves for the alleviation of engorgement, some breastfeeding advocates and moms support the use of green cabbage leaves to soothe engorged breasts. Wash the leaves first, place in the refrigerator to chill, then place them between the breast and bra, leaving them until they wilt. If you find this helpful, apply new leaves as often as needed for comfort.
If you find you have a “let-down” reaction (release of milk from the breast) in the shower, try facing away from the stream of hot water.
If you find holding your baby when she is crying results in a let-down, a normal biological reaction when you sense your baby is hungry, you may decide to give your baby to your partner or someone else for a short duration to help reduce discomfort.

Some women feel the let-down sensation weeks after their milk has dried up. This is a normal response; know that it will pass eventually.

Other potential, though uncommon, side effects

Occasionally engorgement may lead to a clogged duct or mastitis. A clogged duct is when milk flow becomes obstructed. You may notice a hard lump or small area of engorgement in one breast. That area may feel tender, hot, and may look red. To help unplug the duct, use heat such as a hot shower, hot wet pads, or a small hot water bottle to help loosen the plug. Gently massaging the area when the breast is warm a few times per day may also help. Wear a looser fitting bra to help prevent clogged ducts.

If the clog does not resolve, it may be necessary to express a bit of milk to help break up the plug and move it out of the breast.

Mastitis is when bacteria begin to grow and cause an infection in breastmilk when the breast is not drained appropriately. This typically feels like you have aches and fever associate with the flu, along with burning, redness, or pain in the entire breast. If you feel any of these symptoms, call your doctor immediately as antibiotics may be necessary.

Please see the What To Do section for more information on mastitis and clogged ducts.

Stay the course

Even if it is rather uncomfortable now, know that your symptoms will begin to improve in a few days and will not last much longer after that.

If you experience symptoms that you are unsure about, reach out to your health care provider for more information and guidance.

What to Do

Getting through the discomfort

While our bodies are biologically set to produce milk, you can try some of these tips to help reduce the discomfort associated with engorgement.

Avoid pumping or hand expressing to the point of emptying your breast.
- You can hand express or pump for just a minute or so, to alleviate your discomfort, but not to the point of emptying your breast.
Use a cold pack off and on for relief from pain and swelling.
Talk to your doctor about taking ibuprofen.
Wear a supportive, well fitted bra, but not one that is too tight or binding.
Try using green cabbage leaves as a compress.

Clogged Ducts

When milk doesn’t move through the breast well, a clogged duct or nipple pore may develop.

Symptoms:

A lump or wedge-shaped area of engorgement.
Pain, heat, or redness in that one area.

Correction:

Gentle massage
Heat: hot shower, warm wet pad, or warm water bottle
Drink adequate fluids (at least eight {8 oz} cups of fluid per day) and eat a well balanced diet.
A clogged milk duct can lead to mastitis if not properly treated. If you are unable to unclog the duct, it may be necessary to express a bit of milk while gently massaging that area to help move the milk through the duct.

Prevention:

Wear a supportive, well fitted bra, not one that is too tight or binding and,try to avoid those with underwire. The underwire may put too much pressure on one area, potentially creating a clogged duct.
Sleep on your back to avoid prolonged pressure on the breast in one area.

Mastitis

Mastitis is a bacterial infection in the breast brought on by the introduction of bacteria from baby’s mouth through the nipple pores. Because of this, mastitis is a bit less common in women who are not breastfeeding, though not unheard of.