To those who remember my posting several weeks ago about the mom whose milk
never "came in":

Review- 1st week mother bends over backwards (figuratively!)  working to
bring milk in; passing many clots, had breast changes in early preg, none
since baby born. HCP contactedto let know milk not in, no interest in any
question answering intervention.   Ends up with SNS to feed baby, at end of
second week, baby is eating ABM by bottle.

At 6 week checkup, uterus is noted to be spongy and squishy, still bright
red bleeding.  3 day course of Methergine prescribed, cramping occurs,
bleeding continues.  Upon ultrasound examination, bright spots are noted,
D&C scheduled. Upon pathological examination of uterine contents, placental
fragments are noticed. However, no breast changes occur after uterus is
evacuated of leftovers.

I have learned from this episode to be les nambypamby about questionning. To
be more assertive with HCP office staff in regards to one of these
infrequent occurances. I hope I will be able to follow through on this
resolve the next time it happens.

What do you all do in the cases of no lactogenesis?  What would be protocol
to follow, the scenerio that would be most likely to get intervention? Is
there already an outline of events out there, researched and validated? Part
of the problem is that  attitude of "oh, well, there's always formula..."
What would YOU do if this was one of your mothers?  I'd love to hear a lot
of responses from as many of you as possible- do it!
Karen Foard, IBCLC          State College, PA