Hi, I work as an LC in a NICU and I see a lot of delayed lactogenesis, especially with PIH, whether or not they have been on MgSO4.  When I see these mothers prenatally or soon after delivery, I explain to them that it is not unusual for mothers with hypertension to take a little longer than usual to have their milk come in, that it is something we have noted but are not sure of the physiologic reasons (I think edema and fluid shifts, just a guess because their milk comes in about the same time the ankle swelling goes down).  I explain that stress is a big factor, along with preterm delivery.  We do not, at this point, know if it is the preterm delivery itself or the diagnosis which caused the delivery, but we do notice a difference with these mothers, and that they should just keep on pumping, that it will eventually come.  I really notice a big difference with primips, not so much of a difference with multips, especially if they had  a previous successful breastfeeding experience.  It can take sometimes a week or so.  If they have also delayed the start of pumping, it seems to take longer.  I remember one mother who took about 10 days for her milk to come in.  Also, I teach mothers hand expression and tell them that they can collect milk that way as well, because colostrum isn't easily pumped out.  Generally, it's more productive to hand express.  Most of them don't do it (I live in Boston, where women barely admit they have breasts), but they have been educated.  I also preface the teaching of hand expression by telling mothers it's a nifty way to get premature babies to get interested in feeding, to get the breast "jump-started" for them.  So they eventually want to do it.  Just not in the first few days, when I would like them to....Maureen Allen RN, BSN, IBCLC
                             Brigham and Women's Hospital
                             Boston, MA