Alicia wrote, "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."

This is fascinating.  Alicia, if you can find the references, I would love
them! I have worked with three moms now whose milk never came in (Type A) no
apparent cause that anyone could identify, totally baffling.  I have also
worked with one or two whose emotional state, as you describe, could have
been a strong contributing factor to "lactation failure" (Type B)  However,
the distinguishing feature seems to be whether the milk comes in or not.  In
the Type A cases the milk simply never came in - i e there was *none*.
Whereas with the Type B cases the breasts became "full" and even engorged
within 3 - 4 days, but would not let down no matter what was tried, and over
the next several days breast fullness appeared to dwindle fairly quickly.

I have also worked with two mothers with established supply (with
exclusively breastfed babies 3 and 4 months of age) whose milk production
appeared to "shut down" temporarily as a result of a life-threatening event.
The first had suffered an extremely serious car accident and was in the ICU
for three days.  When the panic was over and thought was finally given to
the fact that this mom was lactating I was amazed to find that she was *not*
engorged, although it was very easy to manually express a moderate amount of
breastmilk.  She subsequently rebuilt her supply in the next three months
before she was healed enough to go home.  The second mom had brain surgery
and had booked me in advance to help with maintaining breast drainage so
that she could continue breastfeeding her baby after she went home.  She was
also in the ICU for 3 days and, once again, the potential breast fullness I
had anticipated simply never occurred.  As her condition improved over the
next week or so, milk production gradually returned - apparently
spontaneously as we were able to express progressively larger amounts at
each attempt.  I would love to know the "cause" of this apparent
safety-valve of sudden under-supply in times of extreme stress.

Pamela Morrison IBCLC, Zimbabwe