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epidural revised 3.2(Click here for printable pdf of image.)

Babies are born with tiny stomachs; they hold about a teaspoon of milk per feeding on day 1. But as they grow, their tummies grow and need more colostrum and then mature milk. Most new mothers see their colostrum change to mature milk by the third day after giving birth. In a recent study of over 2300 new mothers, milk “came in” within 3 days for over 88% of mothers who delivered vaginally without labor pain medication;  53% of these moms already saw mature milk by day 2!

But mothers who gave birth with labor pain medications (including spinals/epidurals) were more likely to have their milk transition from colostrum later than expected. Mothers who received labor pain medication had approximately 2-3 times higher odds of milk transitioning later than mothers who delivered vaginally without medications.

Overall, over 23% of the mothers who gave birth with any labor pain medication experienced a delay in their mature milk transitioning from colostrum. Over 42% of mothers who gave birth via emergency cesarean section with a spinal/epidural and another medication saw their milk “come in” after the expected 3 days. 24-29% of mothers who delivered via a planned cesarean also saw a delay in lactation.


Epidural medication (including bupivacaine, meperidine, fentanyl, and sufentanil) crosses the placenta into your baby. Many studies have shown that epidurals affect newborn breastfeeding behavior, including diminished early suckling, latching effectively and extracting milk. Poorly stimulated breasts could also affect the onset of lactation.

Oxytocin is a hormone that plays a major role in lactation: it releases your milk from your breasts. However, when mothers receive artificial oxytocin, known as Pitocin, during labor, it decreases their natural plasma oxytocin levels. This may explain why labor pain medications were associated with increased odds of delayed lactation.

Hospital Practices

The hospital’s post-birth practices also affected the onset of lactation. Five of the Ten Steps of the Baby-Friendly Hospital Initiative (BFHI) a mother experiences may influence the onset of lactation: breastfeeding within an hour of birth, giving only Breastmilk, rooming in, breastfeeding on demand, and not giving pacifiers. A sixth step, providing information on post-discharge breastfeeding support, could have an effect if mothers are discharged while producing colostrum.

The study asked mothers about the number of Baby-Friendly Hospital practices they experienced. The fewer BFHI practices a mom received, the greater her odds that lactation was delayed.


Separating mothers and babies decreases the opportunities to breastfeed, and increases the opportunities for someone to put something else into the baby’s mouth. Breastfeeding early and often increases the “demand” on your breasts, which increases the “supply” of milk they’ll produce.

How can YOU avoid delayed onset of lactation?

  • Learn how your body’s hormones and your baby work together during labor and delivery. Knowing what to expect during normal labor can help prevent a traumatic birth experience.
  • Learn methods of pain management that do not involve drugs. Many mothers find that having personal emotional support during labor and delivery provided by a doula or birth partner can help avoid a medicated delivery. Talk to your obstetrician or midwife about your plans to manage labor pains. Discuss the American Congress of Obstetricians and Gynecologists’ 2014 guidelines for reducing cesarean deliveries.
  • Ask your hospital if it follows the Ten Steps of the Baby Friendly Hospital Initiative.
  • Tell your health care team that you plan to hold your baby skin to skin immediately after birth, breastfeed within an hour, and keep your baby close (not in the nursery) so you can continue to breastfeed whenever your newborn shows signs of hunger.
  • If you have a c-section, your partner or family member, or even a nurse, can hold your baby to your breast while your obstetrician closes your incision.
  • Breastfeed early and often so your breasts know there’s a hungry baby who needs milk.

The more time you spend with your baby, the more opportunities you’ll have to breastfeed and increase your milk production. The more time you spend with your baby, the earlier you’ll learn her cues and personality, and the more confident you’ll be as a new mom!

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