I have found the discussion on breasts which don't make milk very
interesting. I have also seen a couple of mothers who don't seem to be able
to make enough milk, even though they did all the right things. One was
very dedicated and used a Supply Line (Aussie version of SNS) for about six
weeks and still didn't make any milk. A couple of others just couldn't get
more than about a half supply.

I have a question for you all about a current client I am seeing. She is a
41 year old primip and she wanted a homebirth, with a homebirth midwife.
After 16 hours of labour at home, it was deemed necessary that she have a
caesarean, so she went to a local hospital and had the c/s under epidural.
She is very strict about not wanting any sort of drugs or interventions, so
refused any pain relief after the c/s. Baby weighed 3950g at birth, and fed
at the breast when 15 minutes of age. Everything seemed fine. About a day
later, the baby's glucose level was low, and the hospital staff recommended
a bottle of formula. The parents refused consent, but had the mother's
sister came to hospital to feed the baby (she is currently feeding an 8
month old). This fixed the glucose problem temporarily, but mum had a rough
time without any pain relief, and baby continued to lose weight, so sister
came in to feed baby again once on the 3rd day. Came home on 4th day (to
escape pressure from hospital, I think, more than anything) and are being
cared for by homebirth midwife and their own family doctor. Baby contined
to lose weight (3100 on day 9) and supply seems *very* low. Both midwife
and doctor are very supportive of breastfeeding, but are very concerned
about the parents' stand on formula supplementation. Sister is helping with
feeding as a wet nurse and doing expressing as well. Mum has small electric
pump now, but is only getting about 5 mls at a time. Altogether, they still
are not getting enough for this baby. I feel they will very soon have to
give in and accept the use of formula, at least temporarily. My question
(finally, you are all thinking!) refers to the lack of supply - it is being
said that the reason her milk has not come in normally is because of the
pain and stress she is experiencing because of her refusal to take
medication. Have others seen this effect on early milk supply? It doesn't
seem to be a primary insufficient milk situation, as she had breast changes
during pregnancy, and it seems unlikely to be a thyroid problem. Is it
possible to have retained placental fragments after a c/s? (That's the only
other thing I can think of.)
I hope some of you will give me some thoughts on this case.

Joy Anderson
Western Australia