As a followup to my previous post on no lactogenesis, I share this other case:

Several years ago,a P5G5-L4 presented with needing a pump for a 28 week
premature csect delivery.  Turns out this baby was a twin-  with a
hydatidaform molar pregnancy as the "twin". Definitely an out of the
ordinary delivery. As far as I know, this mom needed no followup with this
molar pregnancy, however, a friend years ago did have chemo, and was under
advisement to absolutely not become pregnant for a least a year when she had
a h. mole..

 For mom above, pumping did not go very well  at all, and by the end of
first week, it was evident that milk was not flowing.  This mom kept up the
pumping and at end of second week, HCP prescribes Syntocinon (nasal oxytocin
spray) because "since you're so tense, your let-down must not be working, so
this will give you a good let-down." Mother has a puff or two of spray, no
milk happening; within  a few hours of puffs, mom expelled an extremely
large clot; within 24 hours,  milk was flowing copiously.

Again, I call for your input- what do YOU do when you are presented with
milk not coming in within normal parameters? Thanks for sharing!
Karen Foard, IBCLC          State College, PA