Robin Murisal posted a question about the longest delayed lactations people
have seen.  I think I've posted this case before, but I worked with a 40 yo
primip with gestational diabetes who was "soft" for 13 days before finally
experiencing mild engorgement and onset of lact.  It was a low milk supply
which took about 6 weeks of work with pumping and SNS use to build to what I
would characterize as a low-normal supply.

I see plenty of c-sec moms who don't have onsets until day 5-6.  Sometimes
mag sulfate delays lactogenesis.  Sometimes youre looking at a primary
gladular insufficiency.  Its rare, IMHO, but I see it occasionally.  Retained
placental frag. or heavy blood loss (severe anemia?) pp. are other avenues to
pursue.  Any use of combined antihistamine/decongestants?  Its allergy season
here in Austin, and I saw a mom yest. on day 7 with 3/4 total from both
breasts after 12 min. double pumping.  Queries about current meds revealed
chronic sinus complaints and current use of sinutabs every 4-6 hrs.  I
suspect these were drying up secretions in ALL her sinuses.

When I see delays I get a GOOD history and try to draw some conclusions from
that and from what I observe watching pumping and trying hand express.  I get
other clues from the shape and texture of the breasts.  When in doubt I say
lets pump and see what happens.  Baby must be fed in the meantime, and here
is when we hope we do have access to good ABMs.

 BTW, has anyone got any citations on the SOY formula ban (in New Zealand)
rumor we heard about a few weeks ago?
Barbara Wilson-Clay, BSE,IBCLC
Austin, Tx