Hi Everybody:
   Dr. Peter Hartmann, from Western Australia, has found  that women either
grow bigger breasts during pregnancy, or in the first week after delivery. So
a woman with no breast changes during pregnancy might do all her breast growth
in the first week, and would have no problem with lactation.
   I worked with a mother who made no milk at all for her first baby. He lost
a pound in the first 6 days of life! Never could figure out why. She went on
to exclusively breastfeed her second baby, who thrived. I think a lot of these
cases are mysteries. That is the only one that I have worked with in 10 years,
although I have had mothers only able to partially breastfeed secondary to
breastfeeding mismanagement in the first weeks, before they came for a
consult.
     Networks where mothers and babies are followed in the first two weeks of
lactation would prevent babies from showing up at the first pediatric visit a
pound or more under birthweight. As it stands now, many dyads vanish off the
face of the earth after hospital discharge, only to surface at the first
pediatric visit which could be as long as 4-6 weeks in some places. Warmly,
Nikki