>>It seems to me that hormone production is an important indicator of BF
success.  When milk supply is not started in a timely fashion and other
causes have been ruled out.  Hormone tests may be the way to go.  I would
like comments from you professionals on what you see in your practice and
what your normal course of action is when a mother is having trouble
establishing a supply.<<

Sara,
I would definitely agree with you that proper hormone production-- along
with appropriate receptors-- is vital to breastfeeding success. Some of this
is pure endocrinology, and some of it is influence by breastfeeding
management. If all known management factors have been ruled out, then
hormones should be tested. I like to start with a general
health/reproductive history just to understand if there are any issues that
we should be looking at up front. A mother with infertility issues needs to
be screened to find out if they were hormonally based or mechanical in
nature, for instance. This information will help determine what tests to ask
for. 

So what tests?  Well, in truth, we're still trying to figure that out. I
think it depends on the clues-- do we suspect delayed lactogenesis or a
primary failure? Did this mother previously successfully breastfeed?
Possible things to test for include baseline prolactin, thyroid,
testosterone, and possibly progesterone or b-hcg (rule out retained
placenta).  Insulin and cortisol may be issues at times. Remember, though,
that such tests don't tell us much about receptor development, which is the
essential second half of hormone function. 

We have so far to go when it comes to assessing for primary insufficient
milk supply. If you have an interest in this, the door is wide-open for
research.

~Lisa Marasco, MA, IBCLC

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