Barbara writes:
< I can almost predict that the milk supply
will come in at the same rate that the swelling in the limbs diminishes.
I've speculated that the edema somehow interfers with prolactin
receptors,
so I was intreigued at the idea that pitocin augmented deliveries might
cause upregulation of oxytocin.  I don't guess having extra oxytocin
helps
you much if there isn't any milk to work with.
Have any of the rest of you observed that connection with soft breasts
and
delayed onset and these moms with hypertension around delivery and
swelling
in the extremeties?>

It's difficult to sort out whether this edema is a direct result of the
pitocin itself, or is somehow related to the overhydration that results
from its dilution for infusion, or combined with overhydration
deliberately administered before the epidural.

Sometimes this also ends up with interstitial breast tissue full of edema
and providing too much pressure on the ducts for any even small amount of
milk to be brought forward.

(I am convinced, from numerous prenatal nipple function
assessments/demonstrations of fingertip expression, that there are far
more droplets of colostrum already present in the breast before delivery
than we have heretofore suspected.)

The mystery seems to be why this infused oxytocin does not result in an
MER effect so that more is available at the front of the breast after
delivery.

I, too, have been speculating on this phenomenon for a long time.
Oxytocin itself, I learned from veterinary literature, can itself have
somewhat of an anti-diuretic effect. It has a chemical structure that in
part, resembles ADH (antidiuretic hormone), which is secreted by the same
lobe of the pituitary.

An endocrinologist told me it may be that the two hormones might compete
for binding sites. I have wondered whether there is a complementary
relationship (an "agreement to stay balanced" struck up within the
pituitary between the two hormones) when they are secreted endogenously
(naturally secreted into the brain itself).

If so, perhaps that relationship that might be drastically altered by the
administration of exogenous (from outside the body), artificial oxytocin
directly into the blood stream.

This is a fertile field for research, both direct and through reading
what may already be in the literature from other disciplines.

I suspect that finding some answers might have the potential to convey to
the medical profession that "management of labor" has a greater impact on
initiation of breastfeeding than they are now willing to admit.

Jean
**********
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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