# how does milk know to come in after a planned c-section?



## folkymom (Mar 7, 2003)

This is just a general question I've always wondered about, and I never know who to ask! Now that I'm pregnant and so open about my homebirth, it seems like I have planned C-section acquaintances coming out of the woodwork, so my wondering is at an all-time high, lol. I don't even know if anyone here will know, but I am insanely curious: if there are no hormones at work when the baby and placenta are extracted before the right time, how does the mother's body know to start the lactation process? I know the milk ducts are readying themselves during the pregnancy, but that colostrum-to-third-day-milk process seems so precise. DOES milk come in on the third day(ish) for these women, or is it dependant solely on a supply-and-demand thing after they finally get the baby to nurse? And if they don't nurse, does the milk never come in?


----------



## CallMeMommy (Jun 15, 2005)

The delivery of the placenta, whether "natural" or surgical, signals the body to start making milk. You'll make milk whether or not you nurse, it just won't stay around for long. Three days is kind of a rough estimate for when the milk comes in, for some women it can take up to a week.


----------



## Storm Bride (Mar 2, 2005)

IME, it doesn't. I've had four sections, one of them without labour. In my labour-free section, we had to supplement once, and probably should have done so a couple more times. I've heard the removal of the placenta triggers it, as the pp said, but that hasn't been the way it worked for me. DD lost over a pound in 3 days. I wasn't producing _anything_ at first, including colostrum. By the 3rd day, she was getting something, but I didn't see any actual milk for about 5 days. With all my others, colostrum was present almost immediately, and my milk was in quickly (eg. ds2 weighed 10lb. 8oz at birth, and 3 days later, he was only down 7.5 oz...to me, that suggests he was starting to get milk before I left the hospital). Skipping labour definitely affected my production...we'll see what happens this time.

As far as hormones go, they do load you up with pitocin/oxytocin via IV before the surgery. The "prep" includes waiting, with an IV in place, for an hour before going to OR.


----------



## clovergirl33 (Jul 2, 2008)

Quote:


Originally Posted by *Storm Bride* 
IME, it doesn't. I've had four sections, one of them without labour. In my labour-free section, we had to supplement once, and probably should have done so a couple more times. I've heard the removal of the placenta triggers it, as the pp said, but that hasn't been the way it worked for me. DD lost over a pound in 3 days. I wasn't producing _anything_ at first, including colostrum. By the 3rd day, she was getting something, but I didn't see any actual milk for about 5 days. With all my others, colostrum was present almost immediately, and my milk was in quickly (eg. ds2 weighed 10lb. 8oz at birth, and 3 days later, he was only down 7.5 oz...to me, that suggests he was starting to get milk before I left the hospital). Skipping labour definitely affected my production...we'll see what happens this time.

As far as hormones go, they do load you up with pitocin/oxytocin via IV before the surgery. The "prep" includes waiting, with an IV in place, for an hour before going to OR.

Storm Bride -- I can't imagine an instance where they would give pitocin before a scheduled c-section. The do hydrate with plain IV fluids, but giving pitocin pre-op would induce labor which wouldn't go over well in general.


----------



## ckberkey (Jan 7, 2006)

#3 was an unexpected emergency csection, my milk came in just like the previous 2 natural births: unnoticed in a few days. I am glad I didn't know that my milk coming in might be an issue, as I am sure I would have worried and obsessed until it did and probably questioned it thereafter.


----------



## dewi (Jul 26, 2004)

Without including the personal stories of milk not coming in.

The science of how hormones and our body works:

The milk comes in after the placenta is birthed.


----------



## liseux (Jul 3, 2004)

Its definitely the placenta, but one thing to do to get milk to come in sooner with a section is to nurse constantly the first day and night. I did this with both of my sections and had my milk fully in both times at 24 hours post surgery. With my natural births it took 5 days the first time, 3 the second time.


----------



## BeckiCNM (Jun 21, 2006)

The placenta produces both progesterone and estrogen during pregancy. When the placenta is removed (either spontanously or extracted during a c-section), progesterone and estrogen levels drop. Prolactin, which stimulates the breasts to make milk, is also high during pregnancy, but the high levels of estrogen/progesterone keep prolactin from really doing its job. When the estrogen/progesterone levels drop, prolactin can stimulate the breasts to make much more milk than the small amount made during pregnancy. Oxytocin helps move the milk out of the milk glands to the baby.

So as long as the placenta is removed during the c-section, milk production should start.


----------



## 2xy (Nov 30, 2008)

I had two sections....one after a long, horrible, pitocin-induced labor, and the next one was planned.

After the first section, I didn't have milk for a week. I pumped on day 5 and got about an ounce of colostrum. We supplemented for a couple of days, because my +9 lb. newborn was hungry! I was loaded up with hormones for over 24 hours, so I always attributed my lack of milk to a lack of blood in my body....I lost over half my blood volume during surgery.

After the 2nd section, I had real milk on day 3. No, I didn't have any pitocin during my prep. With both surgeries, I was staff at the hospitals where they were done, and I have my operative reports. The IV prior to surgery is to ensure hydration and is part of anesthetic management.


----------



## kltroy (Sep 30, 2006)

My first birth was a scheduled section (breech) and my milk came in before I left the hospital - on day 3 I think. I nursed on demand as I would have, had the birth been a normal one. My second birth was a VBAC and milk was in about 36 hours after the birth, but I attribute that difference to the fact that it was the second time, not the mode of birth.


----------



## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *clovergirl33* 
Storm Bride -- I can't imagine an instance where they would give pitocin before a scheduled c-section. The do hydrate with plain IV fluids, but giving pitocin pre-op would induce labor which wouldn't go over well in general.

Well, maybe they just lied to me about what was in the IV. It wouldn't be the first time. I was told it was oxytocin to "get me ready" or some such.


----------



## folkymom (Mar 7, 2003)

Thanks for your replies, everyone.

Becki, that was very informative, and just what I was looking for. Thank you!


----------



## TzippityDoulah (Jun 29, 2005)

the placenta signals it... but that also doesn't mean that it works the same effectiveness as having a vaginal birth. in other words in some woman perhaps having the placenta taken out and without the contractions of a vaginal birth (in the insatnce of planned c/s) milk doesn't get signaled in the same way. or perhaps, for lack of a better wa fo putting it - it's less effective.

truth is we can never know EXACTLY how the body works all together. some things are just not seen, or evidenced in a way we can measure. and I know alot of c/s moms do have trouble BFing... so it certainly seems plausible.


----------



## April422 (Nov 28, 2007)

Quote:


Originally Posted by *HennyPenny* 
the placenta signals it... but that also doesn't mean that it works the same effectiveness as having a vaginal birth. in other words in some woman perhaps having the placenta taken out and without the contractions of a vaginal birth (in the insatnce of planned c/s) milk doesn't get signaled in the same way. or perhaps, for lack of a better wa fo putting it - it's less effective.

truth is we can never know EXACTLY how the body works all together. some things are just not seen, or evidenced in a way we can measure. and I know alot of c/s moms do have trouble BFing... so it certainly seems plausible.

Cesarean birth brings with it increased trauma and blood loss (typically) to the mother's body. The body needs to protect itself and regain what it's lost and then focus on lactation. It's really not uncommon to see a delay in lactation after physically traumatic births.

Also with manual removal of the placenta as opposed to waiting on natural delivery the provider may miss small, even microscopic pieces of the placenta, and we know that retained placental fragments can impair lactation. So you also see an increase in the risk for this with cesarean.

We do know that lactation is initiated by the delivery of the placenta which results in a drop of some hormones and a surge of others. It's called lactogenisis II and of that we *are* sure.


----------



## georgia (Jan 12, 2003)

Moving to Breastfeeding, since it's about lactation


----------



## EdnaMarie (Sep 9, 2006)

Just to say, that three-day thing is like the 40 week thing. Just a kind of an estimate. Mine apparently takes 36 hours, but then, my babies take 41 weeks to come out, so there you go. Do not know about the scheduled c-section thing but I know several people who have successfully breastfed after c-sections and two who did after scheduled c-sections (sadly scheduled because otherwise they would not have been able to get any medical care, these were post-emergency c-sections...).


----------



## Llyra (Jan 16, 2005)

It's the placenta detaching, right? And yeah, milk will come in even if you don't nurse. Even if baby dies, and never suckles, milk will still come in. It just won't stay long.

I labored with DD1 and got to the second stage of labor, and then had a c-section. My milk took almost 7 days to come in. But I must have had some of the hormonal whatever that happens, because of laboring. Then I had a scheduled C with the twins, and my milk STILL took 7 days.

I've never heard before of colostrum not being produced for awhile though; I had colostrum for weeks before delivering.


----------

