I'm just composing a letter to the nursing unit manager of the hospital
where my sister in law had her baby and had such difficulty getting someone
to help her begin expressing. Before finish writing I want to know that I
know what I am talking about, if you know what I mean, and so I have some
questions.

Everything I have read says that breastfeeding should begin as soon as
possible after birth or if mother and baby are separated, expression should
also begin asap.

However, if I understand rightly, Lactogenesis II is driven purely
hormonally and the switch from hormonally driven lactation to autocrine
driven lactation (ie Galactopoiesis) doesn't occur until 3 or so days after
birth. If this is the case, why is early breast stimulation/milk removal
(in the 1st 3 days) so important? Why are there studies that show that the
sooner after birth that breastfeeding is initiated the greater the probable
length of breastfeeding duration? Can lack of stimulation of the breast
delay galactopoiesis or depress the magnitude? Is this why delaying
breastfeeding is potentially detrimental to the breastfeeding relationship
or is it more to do with the baby than the breast? I'm just trying to
puzzle out why it is best for someone in my sils situation to "begin milk
expression with a hospital grade breast pump as soon as possible after
delivery"- Riordan and Auerbach. Why would waiting a couple of days matter?

Hope my questions are not too stupid. I'm trying to learn.

Karleen Gribble
Australia
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