Laura-
    I, too, have worked with some moms whose milk "doesn't come in" until up
to 14 days post-partum.  Often, but not always, they have had a traumatic
birth with significant blood loss.  The resultant anemia effects pituitary
function, and production of prolactin impaired.  In the past months, however,
I have worked with 2 moms who never did experience a milk surge and I just
don't know why.  They experienced breast changes in pregnancy, had
non-traumatic births (relatively speaking for this sad community!), no
history of anemia, no hormonal contraception or other medication, minimal to
no mother/baby separation, no history of endocrine (hormone) disorders, no
difficulty becoming pregnant, no history of clinical depression (which,IMHO,
may be related to low milk supply).  Assessment demonstrates babies well
attached to the breast who suck well.  Herbs, medication (reglan), and good
electric pumps do not increase supply.  Each mom was able to express drops to
teaspoons only. In both cases, moms were heartbroken.
    In addition to our list of reasons that some women do not produce milk in
abundance, I would like ot add "we just don't know". Sigh.  I wish, that
medical science would work on how to help these moms.  Some med students I
taught told me that they learned that med science can make men lactate.  If
that's so, how about women!
     For moms whose production is delayed, supplementing by feeding tube
device, cup, p-syringe, or even bottle (gasp) is needed  until milk supply
catches up with baby's demand.
      Debi Ferrarello, RN, IBCLC, who wishes very much that every mother who
wanted to breastfeed could do so.