There are a few articles that talk about the kinds of events that have been
observed to delay lactogenesis II. Unscheduled C-sections (and vaginal
delivery with prolonged stage 2 labor) are certainly known to delay it,
although usually only by an extra day or two.  Obesity (noted in the Chapman
study cited below) and diabetes can delay it.  I am unaware of any studies
focusing on and exploring the hypertensive issue directly, although the
article I posted about yesterday from J Pediatr did identify hypertension as
a risk-factor for early cessation of breastfeeding.

In the Chapman study (cited below), 98% of subjects perceived onset of
lactation. Delayed onset was defined in the Chapman article as > 72 hrs
postpartum.  They found that women with serious medical conditions were more
likely to report onset of lactation > 72 hrs. Just as these authors observe,
it has been my clinical experience that women can tell when the milk comes
in.  I agree with the findings of Hill and Humenick in their wonderful
articles on engorgement in JHL 1994; 10(2).  They  identify low levels of
reported engorgement (i.e. no reported or barely perceptible breast changes
during the first week postpartum) to be a risk factor for poorly established
lactation. I get these mothers going with pumping, hand expression, and
sometimes start galactagogues then in order to protect them from the effects
of low-grade stimulation (which is bound to ensue if baby loses weight and
weakens, or loses interest in vigorous suckling due to the quicker milk
reward of alternative feeding.)  You do have to feed the baby while you are
waiting to establish lactation, so this last bit can't be helped.  A feeding
tube device can help if mom is willing to use one.  If not, I tell the moms
to use the breast as a pacifier after they've alternatively fed so the baby
maintains some positive identification with the breast.  If the baby is
there hanging out and the milk shows up eventually, the baby gets the idea
and it makes it easier to back out of the alternative feeding intervention.

  I'd like to see some focus on the issue of hypertension and see if a
prospective identification of hypertension and then a monitoring of time of
onset would confirm the clinical impression that the milk comes in (so long
as the breasts continue to be stimulated) as the swelling goes down and the
BP stabilizes.

Some good refs. on delayed lactogenesis II are:

Chapman, D and Perez-Escamilla,R:  Identification of risk factors for
delayed onset of lactation, J Am Diet Assoc 1999; 99(4):450-54.



Chen,D. Nommsen-Rivers,L. Dewey,K. Lonnerdal,B:  Stress during labor and
delivery and early lactation performance, Am J Clin Nutr 1998, 68:335-45


Neubauer,S. Ferris,A. Chase,C. et al: Delayed lactogenesis in women with
insulin-dependent diabetes mellitus, Am J Clin Nutr 1993, 58:54-60.



Willis,C. Livingston,V:  Infant Insufficient Milk Syndrome Associated with
Maternal Postpartum Hemorrhage, J Hum Lact 1995, 11(2):123-126.





Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html