Becky -

If this mother's prolactin levels were low during pregnancy, that could have
compromised her breast development.  Lawrence says "prolactin is essential
for complete lobular-alveolar development of the gland" (p 64 current
edition).  She might still have had some enlargement, but perhaps not enough
to support a full milk supply.  Just boosting her prolactin levels after
birth might not be all that effective for her because the tissue *on which
prolactin acts* may just not be there.  But that's not all bad news.

As far as I can see, that puts her in the same category as an adoptive
mother: she needs to create tissue through sucking.  It takes time, but it
works.  If she can learn to love a feeding tube (along with prolactin
boosters), I'll bet she'll see a gradual and definite increase in supply.
The keys would be patience and plenty of nursing - no overnight fix.

Diane Wiessinger, MS, IBCLC  Ithaca, NY

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