Dear Barbara,
In your post, you asked "what else could it be?", and now I can't resist
asking why we don't look at the emotional state of the mom.  This may sound
crazy, but I know there are studies to support (Woolridge,etal) the idea
that if there are constant, sustained high levels of adrenaline pumping
through mom's system during lactogenesis, then we may have a problem
establishing supply.  I think Lawrence mentions this also.  Even though
there are arguments against this (wartime, natural disasters, etc, and those
moms assumed to have established supply), I don't know.  But I do know that
years ago I saw the exact same thing happen, and all testing came up
negative, maternal history came up empty - everyone baffled.  Mom finally
told me that her family was going through a horrible lawsuit in which she
and her husband stood to lose the farm (literally!), and that they were
losing sleep over this during her third trimester and throughout her
postpartum.  When I look back on it, she was a very "tightly wound"
individual, and just *maybe* her body never was able to get out of a "fight
or flight" state enough to establish milk supply.  I don't really know.
Unfortunately, she and her husband chose to counter sue a year later and
brought this whole episode up, and I was called in, what a nightmare!
Lastly, the gulf war comes to mind.  At the time, I was living in Monterey,
CA  next door to Ft. Ord, and half the troops were overseas.  All of a
sudden, us counselors were besieged with calls from army moms who were
claiming to have dried up almost overnight.  We all compared notes, and
after realizing that these moms were plastered in front of CNN looking for
word on their husbands, we suggested they turn off the tv, turn to
themselves for support and get out of the house and have some fun somewhere
else.  Amazingly, many of them reported their milk "coming back".  All these
years, I just chalk it up to the power of the mind, and perhaps adrenaline.
Again, I wish there were some absolute rules with this issue, but we all
know that unique individuals will handle stress, real or perceived,
differently and sometimes not too well, at that!

Just a thought,

Alicia Burgett, CLE, IBCLC
Spokane, Wa
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