Last week I was reading with interest the postings regarding the 
mother who is having trouble getting her supply of milk started.  Being a 
student and a bit naive, I thought that as a long as a baby was put to 
breast enough, the mother's milk would come in.  This is a concerning 
issue for mothers and lactation consultants.  I have done a bit of 
research to find causes of this problem.  I found there are commonly known 
reasons, and perhaps, some less understood causes of inadequate milk 
supply, including obesity and ovarian cysts.  I hope some of you find this 
an interesting issue and can add some of your own experiences in regard to 
this problem.
     Marasco, Marmet & Shell (2000) state, between 2-15% of new mothers 
are unable to produce enough milk to maintain their baby's health.  They 
go on to explain professionally accepted causes for this condition such as 
uncontrolled diabetes, low thyroid hormone, pituitary problems, 
hemorrhaging and breast surgeries.  Hoover, Barbalinardo & Platia (2002) 
also give retained placental fragments, mag. sulfate ues, obesity, 
Sheehan's syndrome, radiation therapy, cigarette smoking, and some meds as 
reason for delayed milk supply.
     Marasco et al.(2000) looked at women with poly-cystic ovarian 
syndrome and their high rates of BF failure.  These authors concluded that 
these women need to be followed closely, but the reason for BF failure in 
these women was not completely understood.
     In 2002, Hoover et al. published a case report stating information on 
gestational ovarian theca lutein cysts.  These cysts appear during 
pregnancy and substantially raise the mother's testosterone level.  The 
authors relate the hypothesis of the endocrinologist is the high level of 
testosterone had delayed lactogenesis II (the onset of a substantial milk 
supply).
     Hill, Aldag, Chatterton and Zinaman (2005) published a study in the 
Western Journal of Nursing Research that looked at the correlation of 
psychological stress, fatigue and low milk supply in term and pre-term 
mothers.  The researchers found no correlation between the mother's 
percieved stress and milk volume.  Stress has received its share of blame 
in low milk supply, so it is good to know that may just be an old wives 
tale.
     A study by Rasmussen and Kjolhede (2004) indicates a link in the 
amount of prolactin produced by overweight and obese mothers.  Prolactin 
levels are significantly below normal 2 & 7 days post-partum, and could 
also inhibit lactogenesis II.

References:
REFERENCES:
Hill, P. Aldag, J. Chatterton, R. and Zinaman, M. (2005) Psychological 
distress and milk 
   volume in lactating mothers. Western journal of nursing research.  27
(6): 676-693.

Hoover, Barbalinardo & Platia (2002)  Delayed lactogenesis II secondary to 
gestational ovarian
    theca lutein cysts in two normal singleton pregnancies. Journal of 
human lactation 18(3): 
    264-268

Marasco, L. Marmet, C. & Shell, E. (2000) Polycystic ovarian syndrome: A 
connection to
    insufficient mild supply?  Journal of human lactation. 16(2):143-148.

Rasmussen, K. & and Kjolhede, C. (May, 2004) Prepregnant overweight and 
obesity diminish 
    the prolactin response to suckling in the first week postpartum. 
Pediatrics 113(5): 465-470.

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