On 11/3/03 6:57 AM, "Automatic digest processor"
<[log in to unmask]> wrote:
> She breastfed for a few days following the birth until it was clear that
> nothing was happening. She did have colostrum at first, but by 3 days could
> express nothing at all, either by hand or by pump. She has continued to
> pump 6 times per day (the most she felt she could manage), and now, at one
> week, she still obtains nothing with the pump and has no sense of fullness.
>
> Is this most likely connected with maternal illness and all we need is
> patience? Is there anything we could be doing? Domperidone?
Initiation of lactation has been found to be delayed for up to 1-4 days in
IDDM mothers compared with non-diabetics. The mechanism is not clear,
however it is thought one contributing factor is glucose availability, which
plays an essential part in the regulation of lactose synthesis (and
consequently milk volume) during initiation. In IDDMs, there has been found
to be a delay in the increase in intra mammary glucose in the post partum
period and while concentration of glucose remained low, lactose synthesis
was also less than half-maximal.
Your mother has had this situation compounded by illness which I would
think, due to the increased requirement for insulin and unstable glucose
levels, would further delay glucose uptake into the lactocytes, exacerbating
the delay in initiation. In her situation I donšt think it would hurt to
support her lactation in all the ways that you have at your disposal,
including in addition to pumping, domperidone, bedding in, skin to skin when
the baby is settled (if mum is well enough) and encouraging suckling at the
breast even if mum feels there's nothing there (while of course supporting
baby nutritionally with other means).
I have had experience of numerous mothers with delayed initiation (causes
unknown, and also perhaps had a bit better supply than you describe in your
mother) who with patience, motivation and good support have eventually
attained a full supply at around 4 weeks. I wish you both eventual success,
it is a hard road when these problems are made so much worse due to illness.
Regards
Cathy Fetherston
Perth, Western Australia
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