Barbara Wilson Clay writes:

>My experience is that delayed onset of Lactogenesis II is more
>common in c-section moms, in moms with infections, and esp. when there is
>systemic edema (whether from PIH or just water-logging.)

My experience has me agreeing with Barbara.  Recently I had a client with
the worst edema that I have ever seen. Her milk was *not* there.  I
refreshed my memory with a post from Barbara W-C in my Lactnet files and
Mom took steps to reduce her edema.  Meanwhile she did take domperidone and
pumped as much as she could after feedings.  Baby was fed donated human
milk with the approval of the Pediatrician and, as Barbara stated in her
earlier post, as the edema was reduced the breastmilk increased.  Mom was
daily aware of this inverse effect.

Fortunately the baby in this case was a good breastfeeder and was easily
transitioned to all breastfeeding.  The parents chose to use finger feeding
for most of the supplementing.

In cases where I believe that anemia is a compounding factor I recommend a
food-based iron supplement for the mother.  It assures a much quicker
resolution of the anemia over ferrous sulfate, which is the form in
prescription iron supplements.

>I think it is more useful to throw metaclopromide
>or domperidone at a flagging lactation early rather than late.


I, too, am suggesting domperidone more often in cases of delayed
lactogenisis II. It has been my experience that the first two weeks is a
crucial time for establishing the potential of a long-term milk supply.  We
can get there later but it is much harder to do so.

Patricia Gima, IBCLC
Milwaukee, Wisconsin

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