Dear Betsy,
Concerning the first mother in your group of three - is there any possibility
that there is a retained placental fragment? This will inhibit milk production
in the dramatic manner that you described so early in the postpartum. Other
thoughts that come to mind - any history of breast surgery?, or any breast
trauma from an accident? You also might want to read a recent article in the JHL
(June 1995, page 123, "Insufficient Milk Syndrome Associated with Maternal
Postpartum Hemorrhage, by C.Willis and V.Livingstone), if this mother had any
excessive blood loss during the delivery?

Usually with hand expression so soon after birth and with a well-latched and
sucking infant you can at least see a drop or so of milk coming from the pores
of the nipples. There are other more rare causes for the hormones that support
lactation, especially in this early phase, to be out of kilter enough to
inhibit/not produce a milk supply - but I've not worked with a mother in these
circumstances - so, you might want to check Riordan and Auerbach's BREASTFEEDING
AND HUMAN LACTATION, and Lawrence's BREASTFEEDING: A GUIDE FOR THE MEDICAL
PROFESSION.

Good luck supporting these women!
Jeanine Klaus, MS, IBCLC
Oakville, Ontario