Hi Pam.
I'm new the list so I'll introduce myself briefly. I joined LLL in '92
with my second child, and was a LLL Leader from '95 to 2003. I've been
an IBCLC since 2002 and I have six children, ranging in age from 16 to
10 months.
Through my personal experience, and the experiences of the mothers I've
helped, I have come to believe that there are three over-riding factors
that influence when the milk comes in. The first is whether or not this
is a first baby, the second is what does the liver have to contend with
besides pregnancy hormones, and third is breast emptying.
Even with drug-free birth and frequent breastfeeding I think first-time
mothers experience delayed onset when compared with multiparas-
prolactin receptor theory offers a pretty plausible explanation. While
prolactin receptor theory explains delayed onset in first-time mothers,
I believe this physiologic delay is exacerbated by maternal
behavior...I tend to think that virtually no first-time mother really
understands what unrestricted breastfeeding means, unless her mother is
an LC or LLL Leader :-) To me unrestricted breastfeeding means holding
the baby at the naked breast allowing the baby to nurse as much as he
will. For some babies that means they will have the breast in their
mouths for 12 hours at a stretch and be at the breast continually
except for bathroom breaks for 2-3 days.
I think infant behavior is a good indicator of when the milk is
plentiful because in the unmedicated baby he will actually spend less
time at the breast when the milk is in than he did previously. In the
multiparous mom without complications the baby never seems unhappy at
the breast. My observation has been that primiparous moms should be
prepared to have expect to have unhappy baby for period of hours, a
night, or a day, before the milk comes in. If the baby unhappiness
persists beyond 24 hours I think the mom should seek the help of an LC
as to me this unhappiness is a red flag.(Medicated, or compromised
babies of course often invert this, not going to breast early and often
and being ravenous when they finally awake from the drug-induced,
jaundice-exacerbated stupor.)
In the postpartum period I am convinced that liver function in the mom
is of paramount importance in establishing a permissive state. We know
that the liver must metabolize the hormones of pregnancy for the milk
to come in. I am convinced that if the mother's liver has to contend
with metabolizing drugs in addition to the hormones of pregnancy it
slows the process down. The more drugs the slower the permissive state
is established. Also there are pathologies that impair optimal liver
function.
My experience has been that in healthy multiparaous mothers, who have
minimal to no drug exposure, Lactogenesis II commences much earlier
than 2-3 days postpartum. I think the permissive state begins to be
established as soon as the entire placenta is delivered and is fully
established when all of the progestrone from the placenta has been
excreted. I believe when breastfeeding is truly unrestricted and
colostrum is removed from the breast early you can see evidence of milk
12-18 hours and full lactation by 48 hours in the multiparous mom.
In this same vein of thought I'd like to share that I think it can be
normal for a baby to excrete roughly 7- 10% of birth weight in meconium
and urine. (Many babies are puffy at delivery with extra water weight.)
I think the baby's lowest weight is often not known because the baby
isn't being weighed on an hourly basis (I'm not advocating that babies
be weighed more often). With good breastfeeding management in the
multiparous mother the milk is coming in fast enough to compensate for
this weight loss and thus weight loss is not observed. I think in the
baby of the first-time mother, because of the later onset of milk
production, we actually get to *observe* the weight loss from meconium
and extra fluids that is normal for all babies. I think in the
first-time mother especially, we ought to focus on the stooling pattern
during the 3-5 day of life as evidence of good breastfeeding management
rather than how much weight the baby lost during the first 48 hours. It
could be that good breastfeeding management in the first-time mother
actually makes the baby lose more weight at first because of the
laxative effect of colostrum and suckling, and that in case of poor
breastfeeding management there is less weight loss due to retained
meconium.
At least that is how it looks from my vantage point and I am curious
about what you all have observed.
Jen O'Quinn IBCLC
On Jul 14, 2005, at 9:14 AM, Pam Hirsch, RN, BSN, CLC wrote:
> I have been wondering for a long time if moms who experience a home or
> home-
> like birth undergo lactogenesis II in less than 24 hours. I have a few
> anecdotal stories (including my own) that seem to bear this out. My
> milk
> came in copiously at hour 18 post-partum with my 3rd baby. The
> hospital
> stay kept decreasing with each of my children. My first stay was 5
> days -
> should have been 7-10 days because 24 years ago that was the average
> hospital stay after a C-section, but I threatened to sign out AMA. My
> 2nd
> stay was a little over 24 hours (unmedicated VBAC) and the only reason
> I
> stayed that long was my baby was a healthy 35 weeker and my ped was
> experiencing palpitations at the thought of such an early discharge. I
> felt sorry for him and agreed to stay overnight - full rooming-in and
> SSC
> of course. My 3rd stay (also unmedicated VBAC) was 9 hours from the
> time
> of admission in labor to discharge. I stayed for 6 hours post-partum.
> The
> next morning at hour 18, I was experiencing full leaking breasts.
> Makes me wonder if we all gave birth in the way that Mother Nature
> intended, if it is indeed "normal" to expereince an abundant milk
> supply in
> less than 24 hours. Has anyone else had expereince with this?
>
> Pam Hirsch, RN,BSN,CLC
> Clinical Lead, Lactation Services
> Advocate Good Shepherd Hospital
> Barrington, IL USA
>
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