Dear Friends:
    I am working with a 39-year old mother who  conceived one baby
spontaneously. She was induced, and insisted on  taking one more hour to push her baby
out instead of having a cesarean section.  (Truly a strong and brave soul.)
    Lactogenesis II never started. When I saw her, on  postpartum day 5, her
fundus (the top of her uterus) was still at the level of  her belly-button.
This is not normal. Her lochia were light in color and amount.  She was pumping
enough to b a r e l y cover the bottom of the bottles; she is  using a
hospital grade pump.
    I suggested she see her OB/GYN. Lack of  Lactogenesis II is a symptom.
Where is the milk? Is there a retained placental  fragment? Is there a
theca-lutein cyst? I gave the mother a list of hormonal  blood levels to have checked:
prolactin, testosterone, and HCG.
    Her physician declined. Her physician said her  uterus was fine. Her
physician said that some women 'just don't make milk' with  a first baby.
So it goes.
    The mother was saying that her physician has been  good with everything
else. (Interesting how this mother forgets about the  intense discussion she
had during pushing to be allowed to continue.)
    I am angry. I told the mother I was angry, not with  her, but with
another healthcare practitioner, that lack of milk is a symptom.  It is true that
some women don't make milk, and why not do everything to find  out why instead
of just blowing it off? I said that if she couldn't breathe, her  physician
would take that seriously, and not say, "well, some folks just don't  breathe."
That made the mother laugh.
    I am presently giving the citation of Betzold et  al.'s lovely article
"Delayed Lactogenesis II: A Comparison of Four Cases" (J  Midwifery Womens
Health 2004; 49:132-137) to the mother. She says she will go  back and see.
    There is no guarantee that this lab work will tell  us anything. However,
it needs to be done. Meanwhile, the mother continues to  pump and is now
getting 3 ounces in 24 hours; baby plays at the breast and has a  good time. She
is supplementing and doing everything that she can do to keep her  breasts
awake.
    warmly,
Nikki Lee RN, MS, Mother of 2, IBCLC, CCE
Maternal-Child Adjunct  Faculty Union Institute and University
Film Reviews Editor, Journal of Human  Lactation
Support the WHO Code and the Mother-Friendly Childbirth  Initiative

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