I was intrigued by the phrase Lisa Marasco used:  "prolactin resistance".  I
have observed that postpartum women with swollen extremities often have a
delayed onset of copious lactation.  The relationship between edemic legs
and hands and an initially low milk supply seems so consistent in my
clinical experience, that I typically make a prediction to the mothers that
if they just keep pumping and trying to let baby nuzzle, the milk will come
in in an inverse ratio to the subsiding of their swelling.  In trying to
understand the relationship between the delay in an engorgement phase caused
by this phenomenon, I've wondered if something about edema "distracts"
prolactin away from target receptors in the breast.  Prolactin has
other "jobs and duties" in the body  such as control of homeostasis.  Do
these duties
take precedent over lactation in a hypertensive crisis, for instance?  It is
these other roles of prolactin, and the factors which control and inhibit
prolactin activity that have not received enough of our attention in terms
of trying to understand why galactagogues may or may not work.
previously not attended to.

If certain conditions rob prolactin from the breasts and re-target it
elsewhere, perhaps galactagogues do work, as Lisa suggests, because they
flood the defensive blocks.   Or perhaps they supply such a surfeit that
there is enough prolactin for all the current body needs, and the body
doesn't have to sequester or re-direct prolactin in order to protect the
mother's survival.

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

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