Yes this is lactation failure or failure of lactogenesis 2, however you want
to say it, the milk surge did not happen. I think the reasons are
multifactorial, as most of these cases are.
It sounds like the baby did not get off to a vigorous start. I am thinking
due to the C/S birth, there was some mother-baby separation, and delayed
initiation of bf, and possibly infrequent early feedings. Was mother induced
due to blood pressure? I frequently see inductions resulting in babies who
are less interested in feeding, at least that is what it seems to me.
I think that mother's breasts may be of the type where it is hard to get a
secure latch, and hit the "sweet spot" where either the ducts dilate or the
nerve endings need to be stimulated, or whatever is the exact perfection of
latch. But it seems that some of these large and "fluffy" breasts (as I call
them), while with probably normal glandular tissue, are sort of loose and
stretchy at the nipple/areolar complex, and hard for baby to grasp. You say
nipples are flattish too. So basically you had very little milk removal and
milk transfer in the early days or even weeks. Is the mother heavy? Seems
there is reason to believe that overweight and/or obese women have higher
chance of lactation problems, could be due to positioning, latch, or
estrogen stuff.
So what to do now? If this were my client I would work as best as I could
trying to get an effective latch. Perhaps even a nipple shield would help
baby grasp. I suggest galactagogues (I like the Motherlove mixtures, they
seem to have pretty good results), we have reglan as a prescription
galactagogue that can be used with the herbs. I do *not* recommend a pump in
style type pump but feel a rental pump is needed in these situations (Elite,
Classic, Symphony, e.g.) because this is *not* a mother who has been bf a
vigorous and thriving baby and now has to miss a few feeds a day to return
to full time employment after at least 6 wks. So I don't recommend a
'working moms' pump in these situations. The regular milk removal is
critical, so mom would have to do by hand or pump if baby not transferring
milk. I would suggest mom consider a lactation aid to supplement at breast.
Keep at this for several weeks. I would expect to see increased supply in 3
wks and hopefully full supply possibly by 6 wks. Just to give mom an idea,
it is not going to be an immediate fix I wouldn't think.
Laurie Wheeler RN MN IBCLC
Mississippi USA

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