Dear Debi,

I, too, am frustrated and saddened by the number of mothers that I have had
with no apparent success in developing/initiating a milk supply. I thought
that milk supply initiation is supposed to happen just because the placenta
was delivered, regardless of sucking effectiveness in the first few days.
Even in a small private practice,  with an average to high BF initiation
rate population, it seems to me that this is a real problem and it is more
and more apparent that the oft stated 5% of moms won't make milk is
real....is it?

Today's digest also had a post from the guru of CCK, Chris Mulford, and it
made me think that we *do* have our gurus for a variety of other bf related
topics such as medications use or thrush or sucking/swallowing
difficulties.  Who can be our guru of milk supply initiation?  This does
seem to be an issue  that we need a checklist or set of guidelines for in
order to explore the probable multifaceted reasons why this could and does
happen.  Just as treatment for thrush has become more and more generally
accepted (I know not everywhere!), I think we need some diagnostic and
treatment guidelines for this phenomenon, ideas that these women's primary
care physicians will find to be mainstream concepts. Guidelines that will
help us understand which of these circumstances are the tincture of time
kinds of situations, and those which may need more medical jumpstarts, and
others, no matter what we do, are the ones that support for the grieving
process that the moms may/will experience will be the most important part
of our role.

Many of you do very well understand the relationship between labor and
birth practices and the initiation of breastfeeding, others of you are
really great with the biochemical aspects of breastfeeding--- who out there
is really *into* this topic of no milk initiation? Where do we go from here
to get some protocols and procedures?

Karen Foard, IBCLC,   State College, PA

PS I am still collecting your handout info, preferably referenced,  on
collecting and storing human milk, especially for healthy, non-hospitalized
babies, ie for moms returning to work or for occasional not at the breast
feeds, for the review article I mentioned a couple days ago. Thanks to
those who have responded. The M----a handout is used by quite a few of you!