Jennifer, Does the mom have swollen ankles? Is her c-section incision
infected? My experience is that delayed onset of Lactogenesis II is more
common in c-section moms, in moms with infections, and esp. when there is
systemic edema (whether from PIH or just water-logging.)  The anemia is
certainly something to think about -- esp. if it is combined with the other
issues, but some moms who are anemic have normal L II.  At any rate, the
impt. thing when it is delayed is to start the mom pumping so the receptors
in her breast stay "turned on".  Otherwise, until she recovers from whatever
the suppressive effect is, the lactation will just involute.  I've seen lots
of delayed moms start to recover and progress to full lactation (over time)
if stimulated adequately.  I think it is more useful to throw metaclopromide
or domperidone at a flagging lactation early rather than late.  After all,
it is more of an endrocrine driven process early, and it would make sense to
give the prolactin jolt then.  At least that's what I do.  After a few days
of no milk rewards, babies of such moms just give up sucking and sleep at
breast.  They can't be counted upon to do the stimulation required to get
the breasts going.  That's why the pumping is so critical.

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