Recognizing and Treating Delayed or Failed Lactogenesis II

Nancy M. Hurst, RN, DSN, IBCLC


J Midwifery Womens Health. 2007;52(6):588-594. 

In This Article

Delayed and Failed Lactogenesis II

Delayed lactogenesis II denotes a longer than usual interval between the colostrum phase and copious milk production, but whereby the mother has the ability to achieve full lactation. Failed lactogenesis II is a condition wherein the mother is either able to achieve full lactation but an extrinsic factor has interfered with the process, or one or more factors results in failure to attain an adequate milk production. Failed lactogenesis can be described further in the context of two types of conditions: a primary inability to produce adequate milk volume, or a secondary condition as a result of improper breastfeeding management and/or infant-related problems.

Although actual rates of failed and delayed lactogenesis are unknown, estimates ranging from 5% to 15%, respectively, have been reported.[24] A variety of situations and conditions have been implicated as potential contributing factors to a delay or failure in the onset of lactogenesis II ( Table 1 ). As previously stated, some hormones indirectly influence mammary gland responsiveness and thus maternal conditions with a hormonal etiology (e.g., diabetes, hypothyroidism, or obesity) may cause a delay in lactogenesis II. Additionally, some delivery modes and conditions that result in a delay in breastfeeding initiation and/or breast stimulation (e.g., preterm, cesarean, or a prolonged second stage of labor [> 1 hour])[4,25] can also delay the onset of copious milk secretion. Examples of primary lactation failure include conditions in the mother such as anatomic breast abnormalities or hormonal aberrations. Insufficient mammary glandular tissue, postpartum hemorrhage with Sheehan syndrome,[26] theca-lutein cyst,[27,28] polycystic ovarian syndrome,[29] and some breast surgeries have been implicated as possible causes of lactation failure. While minor breast surgeries (i.e., lumpectomy) may have little effect on lactation, procedures that require invasive manipulation of the nipple/areolar complex,[30] such as the placement of breast implants, or reduction mammoplasty,[31] may disrupt normal lactation. Possible causes of secondary lactation failure include any condition in the infant that results in an ineffective/weak suck (i.e., prematurity, tongue-tie, palatal anomalies, or congenital heart defects); any condition in the mother that results in incomplete breast emptying (i.e., improper latch-on, timed/scheduled feedings, overuse of pacifiers, the unnecessary use of supplements); and some maternal medications (i.e., pseudoephedrine, progestin-only and/or estrogen containing birth control methods). It should be noted that any of the factors implicated in a delay in lactogenesis II can lead to a secondary failure of lactation if not effectively managed.


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