>I too totally agree with Pamela, Heather and Barbara.  I too have worked
>with women who have an initial engorgement but don't present to me until 6
>weeks with a baby with poor weight gain (but gaining nevertheless) who has
>never attached well and a low supply - trying to get that supply up to
>required levels is very difficult if not impossible. In the presence of
>doing 'everything right' from then on with no 'cure' I'd started to think
>it was a congenital problem - then I saw too many of them... :(

I also agree here, Denise, and I believe this is much of the basis of
the generally-held concern about not having enough milk. In the past
(and unfortunately still in the present in some places) there was not
enough attention given to ensuring a good transfer going from breast
to baby from Day 1, and the belief that engorgement was 'normal'. I
know this was the case when I had my first, 15 years ago - as long as
baby's mouth and nipple were in contact, then this was
'breastfeeding'! My hideous engorgement was a direct result of a baby
too zonked by labour drugs to know what to do for 3 days. So this
(drugs given in labour) is also a huge factor in the series of events
leading to this 'later low supply' scenario, I believe.

Perhaps this is also related to the reputation of Australian mothers
being able to make larger volumes of milk than their sisters in other
countries (no, it's not the Vegemite! ;-D), as I get the impression
that hospital practices and staff attitudes here may be above average
compared to other Western countries. We certainly don't seem to get
lots of the horror stories like we read about on Lactnet as happening
still in some hospitals, with regard to attitutes of some staff, etc.
I apologise if this sounds like a sweeping statement, and I know
there are some wonderful staff in hospitals in US and UK, etc and
some woeful ones in Australia, but it is more of an overall cultural
thing about expectations that mothers will breastfeed.

>I haven't read the rest of my Lactnet digest yet, but I daresay someone
>will say - but what about relactation and adoptive breastfeeders.  I'm
>looking forward to the discussions.

This is a good point, Denise, and I think with this, as with low
supply after a 'bad' start, that it is possible to bring the supply
up, but it takes a lot of effort and commitment on the mother's part.
Peter Hartmann talks about being able to increase a breast's capacity
to make milk by *sustained* increased stimulation. Over time, any
breast with sustained increased demand on it (whether it starts from
zero or from a low level of supply) will undergo changes that see
milk-making cells dividing and increasing in number. I suppose this
would vary from one mother to another, as reflected by the varying
success of adoptive mothers.

So I disagree that there is no 'cure', but 'treatment' for the cure
may be beyond what many mothers are willing to accept. The other
non-tangible in all this, which I think plays a big part in
breastfeeding, is the mind, the attitude. If a mother is *determined*
and *believes in* the system, and that she will be able to make more
milk, then it goes a long way to it happening. Who was it that said,
'Breastfeeding is a confidence trick. If you believe in it, it will
work.'? Perhaps Kittie Franz? Anyway, whoever said it, I love it and
use it a lot.
******************************************************************
Joy Anderson B.Sc. Dip.Ed. Grad.Dip.Med.Tech. IBCLC
Nursing Mothers' Association of Australia Breastfeeding Counsellor
Perth, Western Australia.   mailto:[log in to unmask]
******************************************************************

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html