<< I don't want the mom to mistake my willingness to help for pressure, but 
I don't want her to think
I'm abandoning her either.>>

We struggle with this every day.  We only see outpatients, and we follow 
many for months. This balancing act is VERY challanging.  I think the 
hardest part is that every mom is needing something slightly different, and 
we sometimes misjudge her needs.  We get a lot of mail thanking us for our 
help, but there is an occassional questionairre that says that the mom felt 
pressured or not completely supported in her decision to quit nursing.

In the case os PCOS, there is a physiologic process that may be interfering 
with milk production, and mom deserves to know about it, even if she may not 
want to.  If she did not have any breast changes during pregnancy, then the 
OB or midwife shoulf have determined this and discussed it with her 
previously.  But since this did not happen, it is up to you.  If she DID 
have breast changes, then it is worth suggesting a trial of metformin, 
especially if she required that or a related med to become pregnant.

In any case, don't beat yourself up.  This is a really tough job.

Kathy Leeper, MD, IBCLC
Lincoln, NE

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