Dear Readers, as is the wont of Lactnet, we are starting to drift a bit on the original query I posted a few days ago.
You will recall I asked about the mom who is not doing enough enough milk removal in the early days. I now see her, 4 or 6 or 8 weeks later ... and her supply is very low. I understand completely that the care plan would be designed to "re-rev the motors": lots of s2s, lots of suckling (if baby will do it), lots of pumping (if baby won't -- and maybe still then), use of herbal or medicinal galactogogues. Frankly, when I see moms like this, I suggest a shotgun approach: do it all together, right now. In the end, if the milk boosts, mom, baby (and I) don't really care if it was the fenugreek, or the s2s, or the pumping, that did the trick.
But my Q was: what are you telling those mothers, at that first consult, when they give you the teary doe-eyes and the trembling lower lip and they ask "Will this work? Is it worth it? How much milk will I get?"
Karleen Gribble says it is never too late [think re-lactation]; Marcia McCoy says we shouldn't plant seeds of doubt that the body is "incapable" of full lactation.
Back to square one -- and putting Karleen and Marcia on the hot seat: Would you two tell the doe-eyed weepy Mom "You will absolutely get 100% of the needed supply, if you follow my plan. Guaranteed. The body is amazing and it is never too late. You just have to give it the old college try."
Now -- I am being a bit flip here to make my point. Lactation (like everything) falls on a Bell Curve, does it not? How can we *ethically* promise a mother that following an intense care plan, to the letter, will give her results? Someone has to be out-lier who doesn't produce, despite the plan. Just like there has to be the out-lier who will make buckets of milk inthe blink of an eye.
So, I re-pose the question. I want to know *what you say* to re-assure Moms, to get them to commit to this time-intensive plan, without making promises that cannot be kept.
P.S. for those who are scratching their heads about the whole prolactin receptor notion, I commend to you the fabulous new "Textbook of Human Lactation" by Thomas Hall and Peter Hartmann, which truly deserves a space on your bookshelf. See pp 94-101 on the endocrinology of lactation. Fair warning: sections of it are laughably obtuse for us non-scientists. Here is a snippet that ought to really get you scratching: "In brief, binding of prolactin to PrlR [prolactin receptors] induces dimerization of the receptor, which activiates Janus Kinase 2 (JAK2). JAK2 then induces phosphorylation and activiation of transcription factors, STAT5a and STAT5b. STAT5s are members of the signal transducer and activator of transcription (STAT) protein family and are major transducers in cytokine receptor signalling." (at p. 95).
Liz Brooks, JD, IBCLCWyndmoor, PA, USA
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