-- [ From: Phyllis Kombol * EMC.Ver #2.5.1 ] --

Re your questions:
1.  What will the post-cancer breast be able to do?--My impression is
that radiation and the scar may preclude functional lactation (per
reading in Ruth Lawrence) but you never know the whole story until you
get there.  Just wouldn't expect much.
2.  Did previous daughter's delay in effective suckling contribute to
low supply?  Yes, oral aversion due to deep suctioning is something I
see fairly often where I practice (5600 births/yr and about 60%
breastfeeding).  On any day, I work with a couple babies who had mec at
birth and were deep suctioned.  Some cope ok; others have oral aversion
that lasts from a few hours to a few days.  We do lots of skin to skin
and gentle repeated offering, but sometimes run out of time (and baby's
blood glucose) and have to give supplemental feedings.  From there it of
course gets more complicated because these babies sometimes are also
aversive or uncoordinated with any liquid in their mouth.  If mom is
persistent, pumps and keeps offering we usually can "get there"
eventually (but many throw in the towel).
Four hours delay in first attempt probably didn't affect milk transition
so much as it affected and/or reflected baby's state & orientation after
rough delivery, interventions and separation.  However the 24 hours
before effective suckling definitely could have affected milk production
..
No real reason why she shouldn't be able to fully breastfeed with the
one breast.
3.  What problems would prevent immediate feeding?  It depends on the
hospital, and almost anything.  It could be long, difficult, medicated
labor, baby or mom with poor tolerance to labor, need for medical
intervention, fetal heart rate changes, initial resp. distress, busy
staff, inadequately trained staff, early/frequent separation, "routines"
etc., etc.  Know the hospital and the staff--be watchful and assertive.
They're way too common where I am and new ones come up daily....:-(
4.  Is this analogous to twins?  Yes, I think it would be.  Getting off
to a better start (pumping early and often if baby can't/won't/don't)
can help alot.  Don't know exact percentages who can exclusively
breastfeed twins; my feeling is nearly all.  I work with a lot of moms
who have preterm babies/twins and they can make tons of milk if
stimulation is frequent and effective enough.  Keep a close eye on
baby's weight and output.  Best wishes to you both!

Phyllis Kombol, RNC, MSN, IBCLC (North Carolina)