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Subject:
From:
Nikki Lee <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 28 May 2004 13:06:07 EDT
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Dear Friends:
    I am working with a mother who has delayed Lactogenesis II. I saw her on
day 5. Her baby transferred 0.5 ounce after an hour of bf at both breasts; mom
pumped another 1/8 oz total from both (soft) breasts. Mom's anatomy is
perfect, baby's anatomy is perfect, baby can suck, but isn't vigorous at breast (not
enough flow to sustain interest), and can bottle-feed effectively. The mother
has hx of regular periods, easy conception, spontaneous onset of labor at 41
weeks, vaginal delivery (with epidural but not operative delivery), 1 stitch
for a small tear. Uterus is firm, down 4 fingers, midline. Lochia is still
bright red, but only 3 pads per day, probably because mom has been very active,
running up and down stairs.
    Where o where is the milk?
    Nancy Betzold, Kay Hoover, and Cathy Snyder have published an article in
J of Midwifery Women's Health 2004; 49:132-137 "Delayed Lactogenesis II: A
Comparison of Four Cases. This article has been very helpful.
    Now, in addition to STS and cue-based breastfeeding and bilateral
simultaneous pumping with a piston pump and bottle-feeding in breastfeeding style,
the OB can check TSH, hCG, prolactin, and testosterone levels. It feels good to
be able to know what to look for, from an evidence base. The mom will do what
she can to wake up her breasts, and the medical support system can do
something also.
    warmly,
Nikki Lee RN, MS, Mother of 2, IBCLC, CCE, CIMI
Maternal-Child Adjunct Faculty Union Institute and University
Film Reviews Editor, Journal of Human Lactation
Support the WHO Code and the Mother-Friendly Childbirth Initiative

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