>Pat states:
>One thing that I have found interesting is that all of my clients
>who had
>BR surgery had plenty of colostrum, satisfying their babies to good
>weight
>gain, only to find that the mature milk flow was inadequate to
>nourish
>their babies.  This delayed failure seems to be a greater loss to
>them than
>if they had not had a promising beginning.
>
>I wonder if the problem in these cases is disruption of the
>innervation to the nipple.  The hormone shifts that occur with
>removal of the placenta may have been enough to supply "plenty of
>colostrum" but if there is disruption to the innervation of the
>nipple, then there is not that stimulation to keep the supply
>adequate once the initial hormone change has subsided.
>
>Winnie

Winnie,

This is precisely my operating hypothesis and it seems to hold true for the
many BFAR mothers who have had extensive damage to the fourth intercostal
nerve.  In fact, I make it a point to gently warn BFAR mothers not to put
complete stock in an initially complete milk supply.  It's a fine
balance.  I don't want to undermine their confidence, but I don't want them
to believe that they are out of the woods and "home safe."  They need to
continue to watch the output, weight, and hydration status to ensure the
baby is receiving adequate milk transfer for at least the first three to
four weeks.  A quick (simplistic) education about the changeover from
endocrine-driven to autocrine-driven lactation and the role of
nipple/areolar innervation in the process of autocrine-driven lactation
help mothers become better prepared for this possibility.


Diana West, IBCLC
Executive Director
BFAR, Inc.
http://www.bfar.org
Breastfeeding After Reduction

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