Thank you for your reply and your references.

What is frustrating is that I think we would all be unanimous that frequent 
suckling in the first 24hrs is important.  However, in the 6th edition of 
Lawrence under Lactogenesis 2 it states that breastfeeding in the first 24hrs 
has no impact on milk transfer at day 5.  Also, though suckling increases 
prolactin levels, both Lawrence and Hale/Hartmann state that prolactin levels 
in the first few days are the same in breastfeeding and nonbreastfeeding 
women, which could suggest that the prolactin response to suckling in the 
first 24hrs doesn’t make a huge difference.

In Hale/Harmann 2007 they state that the impact of early milk removal on the 
onset of lactation in inconclusive.  However, in a table of factors and possible 
causes for delayed lactogenesis 2 they list inadequate stimulation and lack of 
colostrums/milk removal as possible factors in the delay of lactogenesis.

I was disappointed by the lack of reference (that I could find anyway) to the 
prolactin receptor theory in either Lawrence or Hale/Hartman as these would 
be excellent sources to have referenced that theory.

I think that I will have no difficulty encouraging nipple stimulation on day 2 as 
lactogenesis 2 occurs sometime after 30+ hours (i.e. day 2) and I’m not 
meeting any argument on the importance of stimulation in that time frame.

What I really need to be able to do is to refute the argument that nipple 
stimulation in the first 24hrs in the absence of a suckling baby is not 
important.  .  I’m really meeting resistance with encouraging frequent 
suckling/stimulation in first 24hrs.

So far I’ve got your references (thank you!) and a brief mention of the 
prolactin receptor theory in The Core Curriculum for LC practice as well as 
Breastfeeding Management by Marsha Walker.

Also, I wonder about colostrum production prior to lactogenesis 2, wouldn’t 
more colostrum be produced once colostrum has been removed? So, could you 
say that the more often the breasts are emptied even in the first 24hrs, the 
more total colostrum is produced?  Does FIL play any role at this point?

Much appreciation in advance for anyone with thoughts or ideas on this.

Thanks,

Casey Clubb
   

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