Barbara says,

> I've often
> observed delayed onset of copious milk production in hypertensive mothers.
> These delays contributes to excessive infant weight loss, early
> supplementation, and lack of confidence in milk supply.  If the mom isn't
> instructed to pump to bring in the milk during the delay, the increasingly
> disinterested baby generally gives up and the milk supply never
> establishes.
>
The question is, Barbara, do you see that if a mom pumps in addition to
putting the baby to breast that the milk comes in in the *usual* timeframe
rather than if she just puts the baby to breast?  Are you postulating that a
hypertensive mom needs that extra stimulation -- or that a mom with delayed
lactogenesis due to hypertension (often compounded with Mag Sulfate) won't
have enough to keep the baby interested, hence not enough stimulation?

I guess I'm not quite seeing the correlation between pumping causing the milk
to come in any sooner than putting the baby to breast causes the milk to come
in at the usual time.  If hypertension is delaying lactogenesis II (or
whatever the new terminology is), how will pumping overcome that?

And what is the mechanism at work here?

If Lactogenesis II is delayed (for whatever reason), then in most cases, the
infant will have to be supplemented to prevent the weight loss -- thus
causing the mother to doubt her milk supply anyway.

Secondary question:

It's very discouraging for a mom to have to pump 7 to 8 to 10 full pumpings
with a hospital grade pump and barely get dampness around the flange....I see
this frequently in moms who have babies going to the NICU and who wait 8 to
10 hours to start pumping.  If it is a full term baby who needs to be fed
(possibly by NG tube for transient tachypnea), then most likely it will get
formula because mom isn't getting anything from the pump.

Is anyone else seeing this, or is this peculiar to my hospital setting?

Jan Barger, RN, MA, IBCLC, RLC
Lactation Education Consultants
www.lactationeducationconsultants.com

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