10 At-Risk Conditions Impacting Breastfeeding Success

Evi Dewhurst / June 2017


“The breast is the only organ in the body that does not have a diagnostic test to measure its adequacy.”1

Imagine a mother in your care who is struggling with breastfeeding or pumping human milk for her hospitalized infant. You try everything you can to reduce those struggles and improve milk production, because you know human milk is the number one nutrition resource for her baby.

While the ability of the body to produce breast milk is a natural function, it does not always work according to need. When breastfeeding problems occur, efforts are made to treat them in the healthcare setting.

But what if we could assess issues before lactation begins?

What if obstacles to successful breastfeeding could be identified beforehand, and a care plan created to ensure postpartum breastfeeding success?

If only there was a way to turn back time for your patients.

Thankfully, we don’t need a time machine to make improvements for future mothers and their infants. We can start right now, with preventative care combined with a postpartum breastfeeding plan.

Lactation success should no longer be addressed after birth… it should be considered before.

There are 10 specific at-risk conditions to consider before and after birth that may impact breastfeeding or human milk production success. As such, mothers with these conditions should be educated with regard to their breastfeeding challenges. Additionally, this information should be available for future care workers as needed: postpartum, lactation, and neonatal intensive care, in order to inform them of necessary steps to achieve successful lactation initiation after birth.

Lactogenesis: A quick review

Lactogenesis occurs between pregnancy and lactation. Lactogenesis is a two-part process:

Lactogenesis I (Secretory Differentiation): This stage occurs during pregnancy and initiates mammary gland synthetic capacity

Lactogenesis II (Secretory Activation): This stage occurs after delivery and initiates plentiful milk secretion

In addition, there are 3 phases of lactation:

  • Initiation
  • Building a milk supply
  • Maintenance of established lactation

A primary reason for wanting to prevent early milk production difficulties is that “a delay in lactogenesis II can lead to a secondary failure of lactation if not effectively managed.”2 This means that successful lactogenesis II initiation could be stopped in its tracks, effectively cutting off plentiful milk secretion and leaving behind long-term difficulties to ever achieve full milk production. That leads to a very unhappy mother and an infant who will miss out on the benefits of human milk.

You can make a difference in this cycle of difficulty by preparing in advance, especially for at-risk conditions.

Catching problems early is good; preventative care is better; and a prepared postpartum treatment plan is best.

4 pregnancy at-risk conditions: delayed lactogenesis II

Here are 4 at-risk conditions during pregnancy that may contribute to postpartum milk production delays, along with statistics to shed light on potential impact:2,3

Primiparity, especially older mothers:  The mean age of first birth mothers rose from 24.9 years in 2000 to 26.3 years in 2014.3

Maternal obesity: 23.4% of women are obese before becoming pregnant5

Diabetes: The prevalence of gestational diabetes mellitus (GDM) in the United States may be as high as 9.2%6

Hypertension: Hypertension is the most common medical problem encountered during pregnancy, complicating 10% of pregnancies7

Additional complication factors include a history of breast surgery and breast hypoplasia.

6 birth or postpartum at-risk conditions: delayed lactogenesis II

Here are 6 at-risk birth and postpartum conditions that may contribute to milk production delays:2,3

Stressful labor and delivery

Unscheduled cesarean section: The United States caesarean section rate has been reported to be 31.1%. Nearly half were unscheduled.8

Prelacteal feeds; delayed first breastfeed episode

Low perinatal breastfeeding frequency

Psychosocial stress / pain

Larger infant

Additional complication factors include nipple discomfort and elevated cortisol concentrations in the mother and the fetus.

Steps to enable timely lactogenesis II

Clearly a sizable percentage of the maternal population is at risk for delayed lactogenesis II. This impacts not only your patient and their infant, but your hospital as well, with readmission rates, incidents of infant dehydration, malnutrition, and more.

Four steps you can engage in right away to combat these at-risk conditions:

  • Outline a breastfeeding/human milk plan of action for your hospital
  • Perform a clinical lactation assessment on maternity patients
  • Educate hospital staff
  • Prepare hospital units with the proper breastfeeding support tools

Hospitals can outline a plan of action for their facility: how will mothers be attended to, depending on their condition? Which departments will be accountable for providing education, tools, resources, and follow-up?

Perform clinical lactation assessments on pregnant mothers well before birth. Keep this assessment on record to prepare future clinical providers and hospital units for a patient’s initial breastfeeding experience and beyond.

In addition, educate your staff on the stages of lactogenesis, delayed lactogenesis, and the milk production process.

Prepare your maternity, postpartum, lactation, and neonatal intensive care units with breastfeeding tools such as hospital-grade (multi-user) breast pumps and breast pump kits to combat delayed lactogenesis immediately. When the above at-risk conditions are present, it will be likely that these tools will be necessary to enable mothers to begin a successful breastfeeding journey.

Stop delayed lactogenesis II beginning today

Mothers in your care deserve the best opportunity to successfully breastfeed or provide milk to their infants. Delayed lactogenesis II not only negatively impacts this success, but cements it with difficulty for the duration of a mother’s breastfeeding journey.

Proactive steps from healthcare professionals just like you can circumvent delayed lactogenesis II occurrence and help mothers achieve their breastfeeding goals.

And thankfully you won’t need a time machine to do it.

Learn more about the SymphonyPLUS Breast Pump, which helps moms of preterm or term infants initiate, build and maintain their breast milk production.


  1. Hartmann P, Cregan M. Lactogenesis and the effects of insulin-dependent diabetes mellitus and prematurity. J Nutr 2001; 131:3016S-20S
  2. Hurst, NM, “Recognizing and treating delayed or failed lactogenesis II,” JD Midwifery Women’s Health (2007) Nov-Dec;52(6): 588-94
  3. Nommsen-Rivers, et al, “Delayed onset of lactogenesis among first-time mothers is related to maternal obesity and factors associated with ineffective breastfeeding,” Am J Clin Nutr 2010; 92:574-84
  4. “Mean Age of Mothers Is On the Rise: United States 2000 – 2014.” CDC, accessed May 23, 2017. cdc.gov/nchs/products/databriefs/db232.htm
  5. “The State of Obesity: Prenatal and Maternal Health.” State of Obesity, accessed May 23, 2017. http://stateofobesity.org/prenatal-maternal-health/
  6. “Gestational Diabetes Prevalence High, CDC Says.” Medscape, accessed May 23, 2017. medscape.com/viewarticle/827315
  7. “Hypertension and Pregnancy.” Medscape, accessed May 23, 2017. emedicine.medscape.com/article/261435-overview
  8. “An Attempt to Control the Increasing Trend of Cesarean Section.” Medcrave, accessed May 23, 2017. medcraveonline.com/OGIJ/OGIJ-05-00178.php