Given the case history, I'm not sure the "re" in "re-lactation" applies.   It
sounds like this mother has had low supply from the get-go, and most likely
it is the insulin resistance that is the culprit here.   Her health history is
full of it:   no breast changes during pregnancy, no noticeable "engorgement,"
postpartum--in fact, she felt like her milk "never came in," previous history
with first child of low supply, overweight, fertility problems, in fact, she
had diagnosed PCOS.   A lot can be reported via email/mail, but to determine
if this is good old-fashioned acquired low supply or pathological low supply,
one would have to see her breasts in the crucial period of time (e.g. day 4, 5,
or 6) and actually take a good look at what is going on.   My educated guess
would be that the supply is innately low, but I haven't seen her.   Sounds
like a good Metformin candidate, but she may have missed the window, since she is
on day 32 now (or thereabouts).

Switch-nursing for these moms tends to be the best thing, as the babies stop
swallowing when the flow slows, so the whole foremilk/hindmilk thing is moot;
the baby never *gets* the hindmilk if there is no flow.

Heather Kelly, MA, IBCLC
NYC, NY

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