http://www.foxnews.com/story/0,2933,597983,00.html

I get LACTNET on digest so my apologies if this is a repeat!  -
Jeanette McCulloch, LLL Ithaca, NY

Older Age, Extra Pounds May Delay Breast-Milk Production

Wednesday, July 28, 2010

First-time moms who are older than 30, overweight or have
breastfeeding difficulties on their newborn's first day may have
increased odds of a delay in their full breast-milk production, a new
study suggests.

After giving birth, women produce a precursor to breast milk called
colostrum until their full breast milk comes in; if that shift does
not happen within 72 hours, researchers consider it "delayed
lactogenesis."

The concern with this is that some infants may start to become
dehydrated and lose excess weight (some weight loss after birth is
normal), and that some mothers, worried and frustrated, may give up on
breastfeeding.

However, new moms with a delay in full milk production should not be
discouraged, said Dr. Laurie A. Nommsen-Rivers of Cincinnati
Children's Hospital Medical Center in Ohio, the lead researcher on the
new study.

Instead, she said, they should call their pediatrician or "lactation
consultant" — a specialist in breastfeeding issues who works in some
hospitals and also in private practice.

With some support, Nommsen-Rivers said, mothers with delayed
breast-milk production will "do just fine." She noted that nearly all
new moms — 98 percent — have their milk come in within a week.

For the current study, published in the American Journal of Clinical
Nutrition, Nommsen-Rivers and her colleagues looked at the factors
associated with delayed lactation among 431 first-time mothers who
gave birth at one California medical center.

The researchers focused on first-time mothers because they are
significantly more likely than women who've given birth before to have
a delay in their breast milk coming in.

Overall, the study found, 44 percent of the women took longer than 72
hours to have their milk come in — which was assessed by asking the
study participants whether their breasts felt "noticeably fuller"
three days after giving birth.

Women who were overweight or obese were more likely than thinner women
to have a delay; 45 percent and 54 percent, respectively, compared
with 31 percent of normal-weight women.

Age also appeared to be a factor, as 58 percent of women age 30 and
older had a delay in their breast milk coming in, versus 39 percent of
younger women.

In addition, mothers who said they had "breastfed well" at least twice
during the first 24 hours of their newborn's life — when colostrum is
produced — were less likely to have a delay in their milk coming in:
39 percent to 43 percent of these women had a delay, compared with 65
percent of mothers who reported only one or no instance of
breastfeeding "well" in the first 24 hours.

Another factor related to delayed milk production was nipple soreness.
Women who had more than mild soreness in the first few days after
giving birth were less likely to have a delay than other women.

That soreness, the researchers note, may be an indicator of
more-effective early breastfeeding, which would encourage full milk
production.

It is not clear why relatively older age and heavier weight in the
mother would be associated with a higher risk of delayed lactation,
according to Nommsen-Rivers.

But both, she and her colleagues note, are related to greater odds of
carbohydrate "intolerance" during pregnancy. Problems in sugar
metabolism could be a factor in the higher risk of delays in full
breast-milk production, they speculate.

Whatever the underlying mechanisms for the findings, Nommsen-Rivers
said that the bottom line for women is to seek help for any early
breastfeeding difficulties.

She suggested that during pregnancy, women try to see a provider who
has an affiliation with a lactation consultant. A home visit from the
consultant in the first couple days after a woman gives birth can help
identify and address any breastfeeding difficulties.

Women who feel their milk has not come in within 72 hours should call
their pediatrician, Nommsen-Rivers said. The doctor can weigh and
assess the baby, and watch the mother breastfeed to help spot any
problems.

To help support early breastfeeding success, the American Academy of
Pediatrics recommends that women ask to have their newborn placed in
skin-to-skin contact with them immediately after birth so that they
can breastfeed.

Frequent feedings in the early days are also important, Nommsen-Rivers
said. It is often recommended that women breastfeed every two hours,
but she suggested that new moms try to breastfeed whenever their
newborn "shows an interest," with cues such as "smacking" his or her
lips.

The rate of delayed milk production in this study — 44 percent — is
significant, according to Nommsen-Rivers. Past studies have shown that
compared with U.S. women, those in less-developed nations, such as
Peru and Guatemala, tend to have their milk come in more quickly.

Pinning down the reasons for that difference — including the facets of
modern maternity care that may be involved — will be important,
Nommsen-Rivers said.

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