I like Cathy Genna's approach, and this is pretty much the way I counsel
mothers. Unfortunately, in my region, babies are typically seen after 2
weeks (once they are discharged from hospital, often at 24 hrs), and quite a
large proportion are born "near term" or preterm, and get the same followup.
I do see almost all bf mothers/babies at 3-5 days postpartum, so these are
moms who will be getting good followup.   I might not say anything in
particular to a mother who states she has PCOS but has quite normal
appearing breasts with abundant colostrum and no evidence of poor milk
transfer in hospital. But I would give her the usual information on how to
tell the baby is getting milk, usual wt patterns, and diaper counts. But I
would be very concerned about a mother with PCOS and obesity with very small
and wide spaced and coneshaped breasts and whose baby has lost more than the
usual amount of weight prior to discharge. To this mother I would mention
there were some risk factors, and how to optimize milk production and milk
transfer and the need for early followup. (but not talking in technical
terms, of course). I would definitely counsel a mother with breast reduction
surgery, as I have yet to have such a client who could fully provide all
babies milk in the early weeks or months. I know this is possible, but the
risk is high of lowered production.

And I have seen a few mothers who could not express any colostrum, nor could
I express any from them, for the first days. I once worked with a mother who
had nothing to express for 8 days, and had to supplement the baby, pumping
all the while with no results, and on 8th day her milk came in fully. This
could have been retained placenta, I don't remember the exact details.

And I hesitate to say this, because I believe peer counseling is a good
thing, but unfortunately I have had several clients who received less than
adequate advice from peer counselors (I verified for myself with the peer
counselor what was said), and I would prefer an IBCLC to follow a mother
with risk factors. Another reason for this is peer counselors in my region
generally assist over the phone, and I strongly believe in face to face
early followup.

Laurie Wheeler, RN, MN, IBCLC
MISSISSIPPI USA

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