Pamela asks:

> Could these values be used to identify delayed
>lactogenesis?  For instance, you state that at 3 days the sodium content is
>17.9 +/- 4.5 mmol/l (411 +/- 4mg/l), and at 7-9 days it is 14.1 +/- 4.9
>mmol/l (324 +/- 113mg/l).  What if at 7 days the sodium content was still as
>high as it usually is at 3 days?

There are four major indicators that can be used for the onset (or failure
thereof) of lactogensis II - of which sodium is one.  The others are
citrate, lactose and total protein.

Mark Cregan has a very interesting study where he used these indicators to
measure the success of lactogenesis II in women who were expressing for
their pre term babies (31-35 weeks N=22). In short, if none of the 4 markers
are present - full milk production occurred (average 800ml/24 hours); if one
of these indicators is present (ie lactose remains low, the other three are
normal) then milk production was halved. If two indicators are present (can
be any two of the four eg: low lactose and high sodium) production was
halved yet again. Three indicators -  halved yet again. Four indicators
present is defined as complete failure of lactogensis II to occur. 82% of
these women had at least one marker present at Day 5 post partum (none
failed to intitiate - that is none had all four markers.) This demonstrated
that there was compromised initiation in 82% of these women at Day 5
(previous research has shown mums expressing for pre term babies have lower
volumes of milk at 10 days than either breastfeeding mums or mums expressing
for full term babies).

ALL of these women had NORMAL MILK PROLACTIN levels.
(SIGH - another theory out the door! certainly should make us question the
efficacy of using galactogogues on the premise that they increase prolactin
levels - but perhaps they work in some other way - perhaps they increase the
efficiency of the prolactin receptors ???? - or perhaps they don¹t do
anything at all and production would have increased anyway given time and
frequent milk removal and/or a placebo) A great study waiting here for
someone.

Cathy Fetherston
Perth Western Australia

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