I recently read a woman's writing, wondering why her milk had taken so long to come in after a medicated hospital birth. It took about a week for her milk to come in, and she had a vaginal birth. So, so, SO many women hear that their body just can't make milk. This is not the case in LITERALLY all but a half percent of the human population (and those women are GENERALLY people with thyroid issues, those who have "low glandular tissue," or women who have had breast surgery in the past). Here is what I wrote in response to her questioning:
As far as your milk coming in, many factors can cause it to come in later than "normal."
First, was the baby birthed directly to your chest and left there until it nursed, and then left there longer, at least the first hour, optimally the first two hours? Studies have shown that this has a strong effect on your milk, both in the overall supply, and in how quickly it comes in, as well as in the efficiency the baby has in nursing. Your body is tossing hormones out like GANGBUSTERS when your baby is born and put on your chest. There, where humans are meant to be warmed, the baby soaks those bonding and nursing hormones in like a sponge. They teach the baby what you smell like, that you are the food source, and encourage the baby to ask to nurse often (some babies in the first days of life nurse as often as every 20 minutes, others as often as every two hours). It also, for some reason, effects the baby's ability to latch well.
Were you encouraged to be skin to skin with your baby (rather than having the baby swaddled) while you were in the hospital? The more you have the baby skin to skin, the better the baby gets those hormones that you are(still) tossing out (though not as potently in the general post partum period as in the first two hours after birth, it is still crucial that you bond skin to skin with your baby after birth)! The more hormones the baby soaks in during your post partum period, the more the baby wants to nurse and the better the liklihood that you will get a good latch down.
Was the baby taken to the nursery at any point? If so, this separation, and the STRONG probability (especially in our area) that the baby was given a bottle. This can lead the baby down a confusing path of nipple confusion, full belly, and difficulty nursing.
When you nursed, were you encouraged to watch the clock and take the baby off of the breast at a given TIME, or were you instead encouraged to let the baby nurse until it was done, latching off on it's own? I often hear from mothers that their baby was "using them as a PACIFIER." My response is that a baby is physiologically designed to ask to nurse often, and to stay on the breast to be near the mother. Anthropologically, if the baby was separated from the mother out in the "wild," how long would the baby really survive? A baby's need to nurse is programmed into them for many reasons. Manipulation is not one of those reasons. A newborn does not have the cognitive ability to manipulate it's mother to be near it. Babies have a neurological need for skin to skin contact with their mothers, and nursing is the perfect way to get that contact. Many mothers find that a sling or baby wrap lets the baby nurse/be near Mama, and still gives them the arms and ability to continue to fill other needs in the household or on a personal level (you have to pee sometime, and Mamas with babies who have a great need for contact learn early on to pee with a baby in a sling!).
Were you encouraged to do breast compressions while the baby was nursing? Doing so properly helps the baby get more colostrum, which is "viscous"--thick and harder to draw out than breastmilk. Doing so also helps to better drain the breast, thus helping the milk supply to come in more quickly and more fully. Lastly, breast compressions are WONDERFUL at getting a sleepy baby interested again in the job at hand--EATING!!
Was the baby a "sleepy baby?" Babies whose mothers have had narcotics and often epidurals tend to be sleepier. The narcotics hit the baby's drug stream at EXACTLY the same dose it hits YOUR bloodstream (so, if you got 100cc's of stadol, the BABY got 100cc's of stadol...your body does not dilute it at all, and it can be tens of times more than is considered "safe" to give to a neonate--THEN they have what is called an "immature" liver--it is not fully developed--, which can therefore take up to six to eight weeks for the liver to clear all of the drugs from the baby's system). This can cause the baby to sleep more than naturally birthed newborns will, and nurse less, and nurse for shorter periods of time, not fully draining the breast before they fall asleep while feeding.
When you brought the baby home, was the baby in your room, or in another room to sleep at night. We know that your prolactin levels (prolactin is the hormone that causes us to make milk) are highest at night. SO, if the baby is away from you, it is physiologically more likely to sleep longer periods. That causes the prolactin, when it is at it's highest levels, to not be stimulated as often, and therefore it can deeply effect your milk supply.
When you had your baby, were other people holding it a lot, or did other people take care of YOU, and have YOU hold the baby (preferably skin to skin) while they took care of YOU and the house? The second scenario is ideal.
Breastfeeding works on supply and demand. The more frequently the baby eats, the more fully the baby drains the breast, and the more the baby eats at NIGHT and drains the breast at THAT point (see, babies DON'T have their "days and nights mixed up," really...they are designed to nurse often when the milk hormones are at their hightest, which causes you to make more milk overall!), the more milk you make, the more quickly your milk comes in. Again the more you hold your baby, especially skin to skin, the more often they are likely to want to nurse as a newborn. The more a newborn nurses, the more the milk supply increases. It's a wonderful cycle!!
If you lost a lot of blood with that fourth degree tear, and your hemoglobin levels were low, that could also have an effect on how quickly your milk came in. A post partum hemorrhage can also cause a low milk supply.
If you were not paying close attention to staying hydrated, if you were not eating very well, or very often, those things, too, could effect how your milk came in and when. I often suggest to families when they are preparing for a birth that they invest in a crockpot. It is very easy to make a pot of soup and leave it on the counter, so that the new mother can fly by and grab a cup or bowl of it when she gets the chance. It will be hot and ready to go all day, whenever she has time, and the smell of it might entice her to MAKE time more often. It is also a WONDERFUL idea to have things like cubed cheese and whole grain crackers at hand. Baby carrots and hummus. Yogurt and granola. Smoothies already made and in the fridge. Sandwhiches made and bagged and in the fridge ready to go. Boxed organic salad greens from costco. Apples, pears, and oranges, sliced and ready to go. Grapes rinsed and ready to grab and eat... If the food is THERE, even if the mother's support system is gone at work for the day, she is MUCH more likely to be well nourished and able to supply her baby the milk it needs to thrive.
Much of milk supply issues in our culture DOES have to do with how you birthed, not necessarily JUST the drugs, but also how the care providers cared for the baby immediately after birth, and how they supported you with information and breastfeeding help...and THEN how your support was at home.
Milk supply is a finicky thing and can be affected by several factors. However, it definately DOES give an advantage to babies who are not recovering from the effects of narcotics in their blood stream as WELL as birth!