Sara asks,

> Is there any empiracle evidence to suggest that mothers who had severe
> engorgement in the first week, also had problems with milk supply down the
> line (despite having perfect latching babies

Here's an 'n' of one (well, 5):  Mom w/ 5th baby.  In every case she's
experienced sudden, severe engorgement -- full, very painful breasts.  She
couldn't let down.  Milk supply impaired.  The first baby was breastfed a la
Ezzo, therefore no hope of regaining supply.  She quit at three months w/ a
severely FTT infant.  Babies 2 & 3 lasted about 2 weeks before she realized
she was going down the same road and started giving formula.  Baby 4 she
lasted a month.  This is baby 5.  I saw her yesterday:  Baby has gained
approximately 6 oz/week since regaining bw at 3 weeks.  Same thing happened
w/ engorgement.  She didn't try to relieve it w/ cabbage or icy cold
compresses -- just massage and baby nursing.  She has a very poor let-down --
can take up to 45 minutes to "empty" a breast, and at that point, she will
have -- oh -- maybe 2.5 ounces.  In a 1.5 hour session here, the baby took a
total of 3.1 ounces in two separate nursing sessions (that's what baby likes
-- that's what baby gets!)

I suspect her decreased supply (it's just barely OK, not stellar, despite
herbal galactogogues and extra pumping) is r/t the severe engorgement and her
inability to let down appropriately.  I'm not sure what the mechanism behind
her ability to release oxytocin is -- it's just there.  Baby has to nurse for
quite awhile before she starts getting milk -- mom doesn't "feel" let-down;
takes a long time on the pump.

Another one of those interesting conundrums.

Jan Barger, RN, MA, IBCLC -- Wheaton IL
Lactation Education Consultants
www.lactationeducationconsultants.com

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