Hi all. This is my first time posting so I hope it comes through correctly. I am a IBCLC for 5 years and have learned a lot from your shared insights. At this time I am working with a client who is 5 days postpartum and she seems to have no let-down reflex. On exam the breasts are medium size with intact,erect,nontender nipples.This client has no history of breast surgery and this is her first baby. On the third day postpartum it looked as though the breasts were engorged, so ice, an electric pump, and cabbage leaves were started in the usual manner. By the next day the breasts were "improved" and the client continued to latch her baby on demand for feedings. I received a call from the nursery staff that they were concerned about the baby being fussy and unsatisified after breastfeeding that same night. Babys weight is good but he has been getting IV antibiotics ( + group B sterp) so some fluids are being given per that rout. Baby is full term and has a strong suck when checked by digital exam. Yesterday I did a full feeding assessment, helped latch baby and worked with client for 30 minutes using compression with baby on the breast. This baby was fooling us as he did not gain even .01 oz. We did pumping with the newest best pump out there and only 15 ml was expressed. The breasts are also not easily hand expressed, after repeated massage and handexpression only drops of milk are expressed. It really looks like the client has milk but we can't seem to get it to let-down. After 2 days of treatment with ice, pumping, baby to breast >8 times a day I expected some improvement. What else can you suggest?
PS,  Baby is being fed the small amounts of pumped breastmilk and some formula supplements either by SNS or bottle since we figured out he was not transfering milk. Also he has been skin to skin with my client as much as possible.
Thanks in advance, Cindy Dibb IBCLC Milwaukee, WI

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