I am attaching a discussion with mother's permission...My advice is that
she should quit working so hard to make milk---it just doesn't work for
her.  Am I missing something?  I really don't think I am---she is so
determined...if it could have worked it would have...is there anyone who
can give me some advice?
Polly Kocher, IBCLC


Ho Polly,
   Thanks so much for looking at this and forwarding it on to the Lact
Net list.
 Bernice

Hi Bernice.
  Some of this will be redundant but I wanted to get it all in one place
and give permission for it to be posted on the lactation list Polly
suggested to get anyone elses advice.  I wanted to try to remember all
the different things I have tried.  I have worked with 6 different
lactation consultants and many midwives and doctors have had input also,
and my memory is poor but.....
    All 5 births have been unmedicated homebirths, Baby with me at all
times and at breast as much as possible.  Full term, good weight babies.
Each of my babies has sucked well, good latch ons etc.  I have also
pumped for weeks (up to 10 weeks)with each child.  I have used an SNS
supplement system with 2 or 3 of them.
  I have used Reglan and thyroid medication.  I have used more mother's
milk tincture (or something like that) with numerous births.  Used more
milk herbal teas.  Alfalfa,goats rue, dank beer because someone said the
hops in it might help.
  Used finger supplementation, no pacifiers to avoid nipple confusion.
With one of them my midwife made me an herbal tincture oil blend to
massage on my breast for the last trimester to encourage breast milk
production.
  I have used none of the medicines that can dry you up, I drink plenty
of water, get good rest.  I have help for the first 2 weeks with my
other kids and meals so I am with my newborn constantly, sleep with baby
etc.  With my last one I tried accupressure and chiropractor care before
and after baby was born.   
   My babies many times can't get enough fluid to even pass their
meconium out completely until they start supplementation.  They have
lost weight, got jaundice, had uric acid crystals in their diaper,
screamed uncontrollably, or been lethargic from lack of breastmilk.
When I pump on both sides for 1/2 hour I have never gotten more than a
1/4 oz all together.  When they weigh my baby and then have me nurse
both sides my babies have never gained more than 1/4 oz.  None of the
methods, or things I have tried so far seem to make any difference in
how much milk I can get.             
   This time I have been reading and something caught my eye about the 2
stages of milk production (Copied from other source)::   edit] Hormonal
influences
> From the fourth month of pregnancy (the second and third
> trimesters), a
> woman's body produces hormones that stimulate the growth of the
> milk duct
> system in the breasts:
> Progesterone - influences the growth in size of alveoli and lobes.
> Progesterone levels drop after birth. This triggers the onset of
> copious
> milk production.[2] 
> oestrogen - stimulates the milk duct system to grow and become
> specific.
> Oestrogen levels also drop at delivery and remain low for the first
> several months of breastfeeding.[2] It is recommended that
> breastfeeding
> mothers avoid oestrogen-based birth control methods, as a spike in
> estrogen levels may reduce a mother's milk supply. 
> Follicle stimulating hormone (FSH) 
> Luteinizing hormone (LH) 
> Prolactin - contributes to the increased growth of the alveoli
> during
> pregnancy. 
> Oxytocin - contracts the smooth muscle of the uterus during and
> after
> birth, and during orgasm. After birth, oxytocin contracts the
> smooth
> muscle layer of band-like cells surrounding the alveoli to squeeze
> the
> newly-produced milk into the duct system. Oxytocin is necessary for
> the
> milk ejection reflex, or let-down to occur. 
> Human placental lactogen (HPL) - From the second month of
> pregnancy, the
> placenta releases large amounts of HPL. This hormone appears to be
> instrumental in breast, nipple, and areola growth before birth. 
> By the fifth or sixth month of pregnancy, the breasts are ready to
> produce milk. It is also possible to induce lactation without
> pregnancy.
> [edit] Lactogenesis I
> During the latter part of pregnancy, the woman's breasts enter into
> the
> Lactogenesis I stage. This is when the breasts make colostrum (see
> below), a thick, sometimes yellowish fluid. At this stage, high
> levels of
> progesterone inhibit most milk production. It is not a medical
> concern if
> a pregnant woman leaks any colostrum before her baby's birth, nor
> is it
> an indication of future milk production.
> [edit] Lactogenesis II
> At birth, prolactin levels remain high, while the delivery of the
> placenta results in a sudden drop in progesterone, estrogen, and
> HPL
> levels. This abrupt withdrawal of progesterone in the presence of
> high
> prolactin levels stimulates the copious milk production of
> Lactogenesis
> II.
> When the breast is stimulated, it becomes erect, prolactin levels
> in the
> blood rise, peak in about 45 minutes, and return to the
> pre-breastfeeding
> state about three hours later. The release of prolactin triggers
> the
> cells in the alveoli to make milk. Prolactin also transfers to the
> breast
> milk. Some research indicates that prolactin in milk is higher at
> times
> of higher milk production, and lower when breasts are fuller, and
> that
> the highest levels tend to occur between 2 a.m. and 6 a.m.[3]
> Other hormones-notably insulin, thyroxine, and cortisol-are also
> involved, but their roles are not yet well understood. Although
> biochemical markers indicate that Lactogenesis II begins about
> 30-40
> hours after birth, mothers do not typically begin feeling increased
> breast fullness (the sensation of milk "coming in") until 50-73
> hours
> (2-3 days) after birth.
> Colostrum is the first milk a breastfed baby receives. It contains
> higher
> amounts of white blood cells and antibodies than mature milk, and
> is
> especially high in immunoglobulin A (IgA), which coats the lining
> of the
> baby's immature intestines, and helps to prevent germs from
> invading the
> baby's system. Secretory IgA also helps prevent food allergies.[4]
> Over
> the first two weeks after the birth, colostrum production slowly
> gives
> way to mature breast milk.[2] 

    I do have small amounts of colostrum that does turn whitish (to
milk) around the 3rd day, but never had more than drops of either.
Never in "copious" amounts.  I also dont have any breast changes during
or after birth.  I am wondering if my problem does not lay in the trying
to increase my amounts.  Since none of the typical efforts have helped,
but if something is happening or not happening to not have my milk "come
in" in the first place.
   I have the after pains when nursing my 2nd through 5th child so I am
pretty sure the prolactin/ ocytocin hormone is being produced.  I would
LOVE to nurse this child (due in 13 weeks).  I am not sure what I will
use for supplement this time if I can not.  I would love to hear what
input or advice you have for me to try.  I appreciate your time and
help. 
 Lisa     

   This is something I just read on line tonight:::  
 Insufficient glandular development. Very rarely, a mother's breasts
will not be able to produce an adequate milk supply for her baby. Simply
put, the milk ducts and glands have not developed well enough to
properly work. Mothers with this condition typically report that their
breasts did not change in size or shape during pregnancy. There may also
be a marked difference in the size or shape of the breasts. There is no
note of the "milk coming in" during the early days postpartum and the
breasts never feel full or engorged. These mothers should still be
encouraged to breastfeed. While their babies will need to be
supplemented in order to receive enough milk, the amount of mother's
milk received will still be invaluable.
   Although there is nothing different in the size or shapes of my
breasts, some of this sounded familiar.  But if someones hormones are
not doing what is necessary or if milk glands did not develop well
enough what could I do about it????
 
 




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