I need to air my thoughts and get some fresh input. I am feeling very
troubled as of late; I long learned that women could relactate when they had
not completely lost their milk supplies, and I have always been very
encouraging to mothers to try to do so when they have had changes of heart.
 Although they seldom reach the goal of pumping 8-12 times a day, I have been
disheartened by how many have "failed" to get their milk back in significant
quanitity. Was it that they just weren't able to follow through on the work?
Was it that they didn't do it long enough?

My rough "rule of thumb" is to tell them that however long it took them to
lose their milk--- whatever the elapsed time---that is how much time it could
take to bring it back. I don't tell them everything is going to be wonderful
in a few days, or a week. I cheer them on, I encourage their every increase.
Often, however, they conclude that they aren't making much progress and throw
in the towel.

In light of the recent discussions that took place on lactnet about "cycles
of the breast" and my own thoughts on the matter, I am now rethinking my past
position on relactation and wondering if I/we have been encouraging mothers
indiscriminately. It makes sense to me that the loss (destruction) of some
alveoli due to severe engorgement and involution may be more devastating for
some women that it is for others, possibly depending on the total amount of
milk-making tissue that they had. Another, further thought:  while it may be
that some women have more to spare than others, maybe another perspective is
the rate of destruction/involution, rather than the total amount of tissue
that we started with; could it happen faster in some women than in others?

This thought, then, leads to my clinical question: how to counsel women who
have let their milk supplies go and then changed their minds, etc..  What
realistic statement can I make to them? When they ask, "is it possible to
bring back my milk?", I used to say "yes, quite often."  But maybe that is
giving too much false hope to someone whose breast has moved too far into the
cycle to reverse. (You know, kind of like trying to bring back a dying plant
with watering---- if it's got some green, you may bring it back, but if it is
withered too much, there not be enough to nurse) How does this all fit
together?  I'm trying to make sense out of theory vs experience and
mysteries, and would love to hear other's thoughts, too.

-Lisa Marasco, BA, IBCLC
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