Initiate. Build. Maintain.™

Mom looking at baby while breastfeeding

In addition to the health and developmental benefits that breastfeeding provides, did you know that breast milk saves health systems and U.S. taxpayers around $1.6 million per 100,000 babies per year?1-4

The first hours and days after birth are critical for ample breast milk supply throughout a parent’s breastfeeding journey. In fact, the milk production process can be described as a continuum of 4 distinct stages:

1. Develop
2. Initiate
3. Build
4. Maintain

The development of breast tissue in preparation for breastfeeding, which occurs primarily during pregnancy when milk-producing cells begin to form.5

After birth, the nipple is stimulated by the newborn sucking and the cells developed during pregnancy are gradually “switched on”. This, along with hormonal changes in the mother after delivery, leads to secretory activation (i.e. milk “coming in”) about 2 – 4 days later.5

Post-secretory activation (after the milk starts to “come in”) is when milk production starts to increase. Frequent breastfeeding over the first month builds strong milk supply to meet the infant’s ongoing and long-term needs.6

By the end of the first month, a full milk supply is usually established, with term infants removing the same volume over 24 hours as they will do at 6 months.7,8

These stages are interrelated, so it’s important to get things right from the start. The Initiate stage between birth and milk coming in is critical for future milk production. When breastfeeding is impaired, stimulating the breast by pumping within the first hour after birth can lead to significantly increased milk production later.9 During the Build and Maintain stages, pumping replaces or supplements breastfeeding if the baby cannot remove milk effectively and/or is unable to nurse.

For more information and helpful resources, see the links below:


1. Prime DK et al. 6th ABM Europe Conference, Rotterdam, NL; 2018.
2. Clinical study. (NCT02496429). 2015.
3. Clinical study. (NCT02492139). 2016.
4. Johnson TJ et al. Neonatology. 2015; 107(4):271–276.
5. Pang WW, Hartmann PE. J Mammary Gland Biol Neoplasia. 2007; 12(4):211–221.
6. Kent JC et al. J Obstet Gynecol Neonatal Nurs. 2012; 41(1):114–121.
7. Kent JC et al. Pediatrics. 2006; 117(3):e387-95.
8. Kent JC et al. Breastfeed Med. 2013; 8(4):401–407.
9. Parker LA et al. J Perinatol. 2012; 32(3):205–209.