Several frustrations lately have led me to post this to the list.
Many of our "Classic texts" describe what the problem could be but never how
to deal with them.  I have been faced with this question several times in the
past few weeks: "OK what do we do now?"
For example
CASE 1--Suspected retained placental fragments: What tests should be run?
What should the results be?
I had a mom whose milk did not come in, She was still producing drops of
colostrum (yellow, clear) at 3 weeks pp.  No history of pp hemorrhage.  Has
one risk factor for acretta placenta-first trimester bleeding.  At 4 weeks
post partum her pregnancy test was positive (results showed positive for a
preg at 1-2 months gestation).  The doctor did a pelvic exam but did not find
anything "unusual." A OB/GYN friend of mine said what she needs to rule out
retained placenta is an ultrasound with saline infusion--so they could
visualize the uterine wall.  (yeah right--in an HMO environment?) I could not
convince the docs that the ultrasound should be done to prevent uterine
infection and impaired fertility much less the lack of milk supply.
 This mom gave up the idea of breastfeeding because we could not find the
reason that her milk did not come in.

Case 2-- G3P3 mom at 2.5 months pp with low supply.  States her milk never
came in with this baby like it did the others.  Had post partum hemorrhage.
Blood tests showed she was still slightly anemic and the prolactin level was 5
post feeding.
Sheehan's syndrome, right?  So now what do I do for this mom?

Case 3-- FTT baby who I feel has a major problem but the docs (all of them)
say is OK just needs to be fed.

I fully realize that LC's, most of us any way, are not doctors.  I haven't the
education to  know all about these things.  When there is a medical problem
involved I RETURN the patient to the CARE of HER PHYSICIAN.  Unfortunately,
the doctors don't have a good background in lactation problems either.  So
they come to me wanting to know what should be done next.  Ruth Lawrence wrote
her book for the medical profession but most areas simply discuss the problem
but not how to treat it when it occurs.  I really feel lost here.  I have read
everything I can get my hands on but am frustrated that treatment modalities
are not discussed at any length in any text.

Anyone what to author a recipe book for medically related lactation problems.
Well,  I can hope.  ;-)
Marie Davis