Good questions, Jan.  What I mean is, when I see those moms with swollen
limbs, and they have checked the "hypertension" box on my intake, my next
querry is (since I see moms only after discharge) "Has your milk come in?"
If they say yes, and it's in with normal engorgement and volumes, I don't
give them anything else to worry about.  If they say, "No" or "I can't tell
if it's in" then I give them the info that often I see hypertension delay
the onset of copious milk production.  I inform them that the milk supply
increase seems to be tied in inverse correlation to the swelling going down.
In such circumstances, the babies often have lost a lot of weight due to the
delay in lactogensis.  They typically have sort of given up at the breast
and just get on and sleep.  Or, if they have had bottles, they fuss for some
real milk reward.  Due to the baby's lack of ability/willingness to
stimulate, they often can no longer be counted on to provide enough
stimulation to bring in the milk.  If all the mom is doing is using the
baby, there may be such low-grade stimulation that as the hypertension
resolves, the milk supply trickles back in and then just dies away from lack
of pushing.  I tell these pumping moms "Don't worry if nothing comes out.
This is like Field of Dreams ( that movie where the mantra is: "build it and
they will come") only this is "pump and it will ultimately bring in your
milk".  This usually is the case.  Then, once you have a milk supply to work
with, you can back the baby off the bottles or other supplementation and get
things back to normal (always defined as baby breastfeeding and growing
robustly.)

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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