I must agree emphatically with Barbara's hypothesis that genetics, hormone
balance and health at time of delivery are likely high affectors of milk
production. I have been amazed at the number of women who have been
presenting the past few years with what I assess to be true milk supply
problems. I have a local midwife who alone has sent me probably 4 or 5 cases
the past couple of years, a rather high rate for a small practice. These
women had well-cared for pregnancies and non-medicated, non-induced
homebirths. Despite the best of care and a strong positive belief in the
birth process, still they experienced a primary failure of lactogenesis II
of a significant degree. Many, but not all, have personal or family
histories of endocrine problems. In my corner of the world, it sometimes
feels like milk supply problems are becoming epidemic. I do not consider
this all to be of entirely "natural origins," but of whatever origins that
are also causing the inexplicable rising rates of a host of other diseases
and ills as well.

One thing that I learned through my recent research in this area is the need
for compassionate care. Too many of these women have been judged by family
or friends or health care practitioners as not having tried "hard enough."
I agree that there are probably more cases of incorrectly perceived milk
supply problems than anything else, but we must be very careful to
automatically made that assumption of every case. Some women have cried
tears of relief at being told that the problem they were experiencing was
not "their fault."

Just yesterday I sat at a small wedding reception, and was approached by a
young woman on behalf of another young woman. I had seen the small baby
earlier, and I guess someone told them that I was an LC. The problems? They
were two-fold: non-latching 15 day old baby, and low supply. Mom had been
pumping from the beginning and would see 2oz in the morning (no pumping some
hours) and <.5 oz q 2-3hrs the rest of the day. Now I have not done an
official consult yet, but the mother reported that her milk came in (or
didn't come in) the same way with her first baby, who she didn't try to
breast feed. This mom is only 22, and has supportive close family! She also
told me that she took a while to get pregnant and didn't experience breast
changes during the pregnancy. <BIG SIGH> My guess is that her perceptions
are fairly accurate even if her management has not been stellar; we will
see.

I can't explain this phenomena, I can only describe what I see presently.
These women need thorough assessments and compassionate care to help them
develop the best attitude for their circumstances.

Lisa Marasco MA IBCLC

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