What the nurse is saying is NONSENSE!  Lactogenesis II occurs following a
C/Sec by the same mechanism as following a vaginal delivery.  It is the
delivery of the *placenta* and the sudden drop in progesterone levels which
releases the brake on milk production and causes colostrum to gradually
increase in volume to the extent that it becomes "milk".  This usually
starts happening within 36 - 40 hours regardless of the method of delivery.
Most women with first babies don't seem to really be aware of an increase in
milk volume until about 3 days post-partum, although it is happening whether
they perceive it or not, and if the baby is permitted unrestricted access to
the breast it is possible to identify more swallowing (fewer chomps per
swallow) on Day 2 than on Day 1, and often the mom is charmed, and
reassured, if you can point this out to her.

I have noticed two things about the milk "coming in".  1) If the baby is
nursing frequently and competently from birth there is much less potential
for engorgement on Days 3, 4, 5 - as if the baby becomes really experienced
at the whole thing and drinks the milk up efficiently as it is being
produced, and just gets better and better at it.  If, on the other hand, the
baby has *not* breastfed very often, or at all, in the first couple of days,
then the breasts can *suddenly* appear to fill on the 3rd or 4th day, and
result in apparent massive engorgement within just a few hours.    2) With a
second, third or subsequent baby the milk seems to "come in" sooner than for
a first baby; this has the advantage that mom is less worried about the baby
"getting enough", but has the disadvantage that the potential for
engorgement is increased if the baby is not attaching well and milking the
breast effectively in the first day or so. Thus I would be concerned that a
second baby born by C/Sec needs to learn how to breastfeed earlier than a
first baby born vaginally.

Little fragments of retained placenta (this can happen with a C/sec
occasionally as well as a vaginal delivery) or a large blood loss can
delay/inhibit lactogenesis.  I do notice that there is considerable
individual variation in the quantity of colostrum that is produced in the
first two days until the "milk" becomes more plentiful (actually the first
milk is a mixture of mature milk and colostrum called "transitional milk"
for about 14 days).  Anyone have any ideas about what accounts for this???

Pamela Morrison IBCLC, Zimbabwe
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