I want to clarify my recent comments on women with PIH who demonstate
considerable post-partum edema.  I only see problem cases, so by the time
someone calls me, they are already having trouble.  So I serve a very
self-selected population.  I am sure that there are degrees of difficulty
with PIH and hypertension, and that many of these patients don't have
particularly significant problems establishing lactation.  For the ones who
do, I recommend pumping to keep the prolactin receptors open in order to
protect potential to lactate fully as the physical crisis resolves.  It has
been my experience that for these women who do have problems with very low
levels of milk production, their production increases as edema decreases.
I've seen this in women who have not been treated with Mag Sulfate, which I
used to think was the problem.  Mag Sulfate can contribute to floppy babies,
which can be a secondary cause of poor stimulation resulting in poor
production.

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