Anne, your message about not using a quick-fix solution to resolve an
inhibited milk ejection reflex made a lot of sense, and I agree with your
rationale of the mom working through the problem that's causing it with her
family and other support networks.

I used to be under the impression that an inhibited let-down was the least
likely cause of a breastfeeding problem, that the let-down became
established within a short time of delivery and was thereafter very hard to
disturb.  Until this year, that is, when I have worked with maybe four or
five women whose breastfeeding "problem" seemed to be directly caused by an
inhibited let-down reflex.  My observation with these few is that it can be
extremely serious indeed and that the situation is *urgent*.  Why?  Because
the baby cannot wait for the mother to work through whatever emotional block
she is having, he needs to eat *now*.  And furthermore, lactogenesis II
occurs as a physical event, unrelated to the mother's emotional state.  That
milk just keeps on coming in.
Several years ago I persuaded a doctor to prescribe buccal pitocin which mom
placed under her tongue, waited for the let-down to occur, then spat out the
tablet, repeating as necessary.  It worked.  This year one mom found that
Rescu Remedy was helpful to some extent, another was able to relax
sufficiently to let down if someone *else* manually expressed for her, but
the milk stopped if she touched her breasts herself, another was able to let
down to a pump beautifully, but froze for the baby.  If I could get hold of
syntocinon here I think there would be a limited place for it, as a last
resort.  Just one more tool, in a rare but fraught situation.

Pamela Morrison IBCLC, Zimbabwe
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