Nobody Told Me That How My Birth Went Could Show Up in My Milk

This article is part of the Nella Vosk Breastfeeding Nutrition & Milk Supply: Evidence-Based Guide for Australian Mothers — your comprehensive resource on nourishing yourself and your baby through every stage of the feeding journey.

This article is part of Nella Vosk’s Nobody Told Me series — a growing collection of posts about the information gap that too many mothers encounter after birth. Every article in this series starts from a moment a mother wasn’t told something she needed to know, and works back through the clinical truth behind it. You can find the full series at nellavosk.com.au/pages/nobody-told-me.

This article discusses difficult birth experiences and birth trauma. If you are experiencing distress related to your birth, or if your breastfeeding difficulties are connected to a traumatic experience, support is available. PANDA (Perinatal Anxiety & Depression Australia) — 1300 726 306 — supports mothers experiencing perinatal mental health challenges including birth trauma. The Australian Breastfeeding Association helpline (1800 686 268) can also support mothers navigating breastfeeding difficulties after a difficult birth.

Nobody told me that how my birth went could show up in my milk.

I had a long, difficult labour that ended in an emergency caesarean. I was separated from my baby for the first three hours while I was in recovery and my son was in the NICU for observation. By the time we were together, the window for the first feed had closed. My milk was four days coming in. I blamed myself for all of it. I assumed my body had failed at something it was supposed to do automatically. Nobody had told me that the interventions in my birth — the synthetic oxytocin, the blood loss, the separation, the cortisol flooding my body for thirty-six hours — had all created the exact conditions most likely to delay lactogenesis.

This post is not about caesareans specifically — the Nobody Told Me article on breastfeeding after a caesarean covers that in depth. This post is about the broader picture: the ways in which birth experience across all delivery modes can affect the initiation of breastfeeding and the timing of milk coming in, and what to do about it when it happens.

How Birth Physiology Sets Up Lactation

To understand how birth experience can affect milk supply, it helps to understand how birth is supposed to set up breastfeeding.

The transition from pregnancy to lactation — specifically the transition from colostrum to the higher-volume mature milk, known as lactogenesis II or milk “coming in” — is triggered by the dramatic fall in progesterone that follows the delivery of the placenta. Progesterone has been suppressing milk production throughout pregnancy despite the presence of prolactin (the hormone that drives milk synthesis). Once the placenta is delivered and progesterone drops, prolactin can act unopposed, and within 30 to 96 hours the mature milk supply is typically established.

But this hormonal cascade does not occur in isolation. The events of labour and birth — the prolonged oxytocin exposure of contractions, the physical effort of pushing, the hormonal surge of birth — prime the prolactin response and the let-down reflex in ways that a birth that bypasses labour does not. And the events immediately after birth — skin-to-skin contact, the first feed, the baby’s suckling — provide the stimulation that kicks the supply-demand mechanism into gear in those critical first hours.

When birth does not follow this expected sequence — because of intervention, complication, separation, or trauma — the lactation initiation process is disrupted at one or more points, and the milk may be delayed in coming in, arrive at lower volumes, or be more difficult to establish.

The Specific Ways Birth Experience Can Affect Milk Supply

Retained placental fragments

The trigger for lactogenesis II is the delivery of the placenta and the subsequent fall in progesterone. If placental fragments are retained in the uterus after birth, they continue to produce progesterone, which continues to suppress the prolactin response and delay the transition to mature milk. Retained placenta is one of the most commonly overlooked causes of delayed milk coming in or milk that fails to establish despite consistent feeding and expressing.

Signs that retained placental fragments may be the issue: milk that is significantly delayed beyond day five, colostrum that does not transition to higher-volume milk despite frequent feeding, and ongoing heavy postpartum bleeding or foul-smelling lochia. This is a medical issue that requires assessment by a GP or gynaecologist rather than simply more feeding or expressing. If you are experiencing significantly delayed lactogenesis II and your milk is not establishing by day five despite adequate feeding frequency, retained placenta should be considered and investigated.

Significant blood loss and haemorrhage

Postpartum haemorrhage (blood loss exceeding 500ml for a vaginal birth or 1,000ml for a caesarean) affects approximately 6 to 10% of Australian births. Significant blood loss triggers a cascade of physiological responses including reduced blood pressure, reduced tissue perfusion, and pituitary involvement that can in rare cases include Sheehan’s syndrome — a pituitary infarction caused by severe haemorrhage that permanently affects prolactin production.

Even without Sheehan’s syndrome, significant haemorrhage creates a physiological stress state that is not conducive to lactation initiation. The body prioritises basic survival functions over milk production in the immediate aftermath of major blood loss. Mothers who had haemorrhage may find their milk is delayed and establishes at lower volumes than they expected, particularly in the first week.

The nutritional recovery from haemorrhage — specifically iron repletion — is also relevant to supply maintenance over the weeks that follow. The iron-rich foods and supplementation guidance in the postpartum iron recovery article is particularly important for mothers who experienced significant blood loss.

Synthetic oxytocin and its effect on natural oxytocin

Synthetic oxytocin (Syntocinon or Pitocin) is used routinely in Australian hospitals to induce or augment labour, and in the third stage of labour to manage the delivery of the placenta and reduce haemorrhage risk. It is one of the most commonly administered drugs in obstetric practice.

Research has raised questions about whether high-dose synthetic oxytocin administration during labour may affect the natural oxytocin response that supports breastfeeding. The proposed mechanism involves oxytocin receptor downregulation: when oxytocin receptors are exposed to high concentrations of synthetic oxytocin for extended periods, they may become less sensitive to both synthetic and natural oxytocin, potentially affecting the let-down reflex in the early postpartum period.

The evidence on this is not conclusive, and the clinical significance appears to vary between individuals. But mothers who had prolonged synthetic oxytocin infusions during labour and who subsequently experienced difficulty with let-down or slow milk establishment may be experiencing a real biological phenomenon, not a personal failure. Frequent feeding and skin-to-skin contact support the recovery of the natural oxytocin response in the days after birth.

Maternal-infant separation

The first hours after birth represent a critical window for breastfeeding initiation. Skin-to-skin contact in this window triggers the strongest oxytocin response, activates the baby’s natural feeding reflexes, and provides the first prolactin-raising stimulation of the feeding relationship. When mother and baby are separated in this window — because the baby is in the NICU, the mother is in recovery, or for any other clinical reason — this initiation opportunity is delayed or missed.

Separation does not make breastfeeding impossible. Many mothers whose babies spent days or weeks in the NICU have established full breastfeeding. But separation in the first hours means the early hormonal advantages of the immediate postpartum window are not fully realised, and supply establishment typically requires more deliberate effort — hand expressing from the first few hours, pumping frequently, and using NICU lactation support.

The article on skin-to-skin contact with newborns covers what skin-to-skin does for breastfeeding initiation and how to advocate for it even when birth has been complicated.

The cortisol of traumatic or frightening birth

Birth that is experienced as traumatic — whether because of emergency intervention, perceived loss of control, inadequate pain management, a frightening clinical event, or any experience that activates a threat response in the mother’s nervous system — floods the body with cortisol and adrenaline.

Cortisol is directly antagonistic to oxytocin. High cortisol states suppress the let-down reflex, impair the early bonding behaviours that support breastfeeding initiation, and can contribute to difficulty with feed latching and milk release in the hours and days after a frightening birth. A mother who is in a prolonged cortisol-elevated state after a traumatic birth is a mother whose body is working against the oxytocin system that breastfeeding depends on.

This is not a reason that breastfeeding cannot succeed. But it is a reason why a mother who is struggling to establish feeding after a difficult birth deserves to understand that her biology has been affected, and that this is not a reflection of her commitment to feeding or her adequacy as a mother. Addressing the cortisol state — through skin-to-skin, warmth, calm, being physically comfortable, being supported rather than rushed, and having adequate pain management — is part of the clinical picture of breastfeeding initiation after a traumatic birth.

Pre-term birth

Babies born before 37 weeks may not have the suckling strength or coordination for effective direct breastfeeding. The mother’s milk may also respond to the earlier delivery differently than it would to a full-term birth, as the hormonal priming of late pregnancy is less complete. Pre-term lactation is a specialised area requiring dedicated NICU lactation support, early and frequent expressing, and a longer timeline for establishment. Mothers of pre-term babies are encouraged to access specialist lactation support within the NICU environment rather than relying on general breastfeeding resources.

What to Do When Milk Is Delayed Coming In

If your birth experience has been complicated and your milk is delayed coming in, the following actions in the first days give you the best chance of establishing supply:

Hand express from within the first six hours, even if you can’t feed directly

Hand expressing colostrum within the first six hours of birth — even when the baby cannot yet feed directly, even in small amounts — sends a critical early prolactin stimulus. Colostrum expressed by hand can be given to the baby and simultaneously activates the hormonal machinery that will eventually produce mature milk. Do not wait for the milk to feel established before you begin: the expressing is part of what makes it establish.

Prioritise skin-to-skin

As soon as it is clinically safe, prioritise skin-to-skin contact between you and your baby. If you cannot do skin-to-skin immediately, your support person can do it. Skin-to-skin is not just a comforting ritual — it is a specific hormonal stimulus that supports both the mother’s oxytocin response and the baby’s feeding reflexes. Even with a baby in a NICU, skin-to-skin (kangaroo care) should be facilitated as early and as frequently as possible.

Feed or express at least eight times in 24 hours

Supply is driven by stimulation frequency, and the window immediately after birth is the most responsive period for prolactin surge. Aiming for eight to twelve feeding or expressing sessions per 24 hours in the first days — including at least one overnight — gives the prolactin system the maximum stimulus during the period when it is most responsive.

Request a retained placenta assessment if milk hasn’t come in by day five

If your milk has not transitioned from colostrum to a higher-volume supply by day five despite consistent feeding and expressing, and particularly if you are also experiencing ongoing heavy bleeding or have had a complicated third stage, ask your GP or obstetrician to assess whether placental fragments have been retained. This is a specific medical question that deserves a specific medical answer.

Get lactation consultant support early

A birth-affected breastfeeding situation is exactly the scenario for which IBCLC support is most valuable. An IBCLC can assess your specific situation, guide your expressing and feeding schedule, support you with latch once the baby is ready to feed directly, and help you understand what is happening and why. The article on when to see a lactation consultant covers how to access this support in Australia.

When the Birth Experience Itself Needs Support

The breastfeeding challenges that follow a traumatic birth often cannot be fully addressed by lactation support alone. A mother who is experiencing intrusive memories of her birth, hypervigilance, emotional numbing, difficulty bonding with her baby, or significant distress about what happened during her birth may be experiencing birth trauma — a real psychological response to a frightening experience that deserves clinical recognition and support.

Birth trauma is not the same as having a “bad” birth or a complicated birth. It is about how the experience was processed in the mother’s nervous system. A mother who had an uncomplicated vaginal birth but felt terrified, unheard, or out of control may experience trauma. A mother who had a life-threatening emergency may not. The subjective experience is what matters.

If the emotional aftermath of your birth is affecting your feeding relationship — making it harder to feel connected at the breast, creating anxiety around feeds, or overlaying feeding with difficult emotions from the birth experience — this is worth naming with your GP, midwife, or a perinatal mental health professional. Breastfeeding can coexist with birth trauma processing, and both deserve support.

If you are finding the emotional experience of your birth difficult, PANDA — Perinatal Anxiety & Depression Australia — offers confidential support: 1300 726 306, Monday to Saturday 9am to 7:30pm AEST, or visit panda.org.au.

Nutrition After a Difficult Birth

A mother recovering from a complicated birth — with haemorrhage, surgical intervention, NICU stress, or trauma — has higher nutritional demands than a mother recovering from an uncomplicated birth. The metabolic cost of recovery, the immune demands of managing a major physiological event, the elevated cortisol of a traumatic experience, and the superimposed demands of trying to establish breastfeeding all draw on the same nutritional reserves.

Practical nutritional priorities after a difficult birth:

• Iron: particularly if haemorrhage occurred. Request a ferritin test as soon as practically possible. Do not wait for the six-week check if your blood loss was significant or your fatigue is disproportionate to your sleep deprivation

• Protein: every meal and snack, consistently. Wound healing, recovery, and milk synthesis all require protein

• Calories: adequate overall food intake supports both physical recovery and the hormonal conditions for milk production. This is not the moment for caloric restriction or skipping meals

• Hydration: dehydration worsens everything in the postpartum period including supply establishment

For practical nourishment ideas when the logistics of recovery make consistent eating difficult, the article on best postpartum snacks for energy and milk supply covers accessible, one-handed options. The article on 10 proven ways to increase your milk supply covers the full supply-building framework once the immediate birth recovery period has passed.

Keep Reading

These posts connect to the birth experience and breastfeeding picture:

Nobody Told Me My Milk Might Take Longer to Come In After a Caesarean

Skin-to-Skin with Newborns: Benefits, Timing & Tips

Lactation Consultants 101: When to Get Help & What to Expect

Iron-Rich Foods for Postpartum Recovery

10 Proven Ways to Increase Your Milk Supply

Power Pumping to Increase Milk Supply

Best Postpartum Snacks for Energy and Milk Supply

A complicated birth asks a great deal of the body and the spirit. The Nella Vosk Day Night Breastfeeding Box Set is formulated by a Certified Postpartum Nutrition Professional to support the breastfeeding mother through the full day and night feeding relationship — including the slower, harder starts that a difficult birth can create.

ABOUT THE AUTHOR

Kelly Northey is a Certified Postpartum Nutrition Professional (CPPNP) and founder of Nella Vosk, an Australian maternal and family wellness brand. She specialises in breastfeeding nutrition, lactation initiation, and the clinical realities of establishing feeding after complicated births.
Learn more about Kelly.