About my difficult oversupply case, which seems to be resolving after a
month of wandering in the desert of plugged ducts, mastitis, discomfort and
a rapidly gaining baby (more than 3 lb -1500 g - over birth weight at one
month), it came up as an aside in our most recent conversation that the
mother has well-documented PCOS. We both had a good laugh over that one.

This is why I don't think it is useful to warn mothers with a diagnosis of
PCOS in advance that they should be on guard for low supply. PCOS is not
uncommon, and in my experience it is the exception, rather than the rule,
that low supply accompanies it. Good management from the start should be
the standard for all women and children, and we should take the same
approach that works best for birth: watch and wait, assume the best but be
open to early signs that something is amiss so problems can be fixed before
they get too big.

I don't at all claim that we succeeded in this case, because goodness knows
she has been put through the wringer, but who knows how bad it would have
been without all the follow-up?

Today and tomorrow are my last days in our breastfeeding clinic. The Powers
That Be (hospital management and management of ob/gyn, without input from
pediatrics) have decided it isn't necessary to keep clinic open M-F and are
cutting our hours in half, two days one week, three days on alternating
weeks, so I will be spending all my work hours on the ward instead. There
are plenty of challenges there, like the fact that one midwife and two
maternity care aides are the entire staffing at night, for over 20 mothers
and babies, and I've not had more than 30% of full time in clinic all these
years anyway, but I am deeply saddened and concerned because there is no
one in the community stepping up to assume responsibility for following new
mothers as they establish breastfeeding; the hospital is just *stopping*.
It seems that the wealthiest country in the world can't afford to provide
breastfeeding support. If we can't afford it, I wonder who on earth can.

Feeling more than usually discouraged today,
Rachel Myr
Kristiansand, Norway

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