Here is another confounding situation that may speak to the possibility of
the prolactin receptor theory.  I have worked with women who have had bad
bleeds during and following delivery, and women who have been very ill with
infections.  Several times they have been old clients whose families called
me almost immed. for advice, so I was able to initiate early interventions.
My standard protocol in these situations is to tell them that the mother may
not experience any notable engorgement at the normal time, and that it may
look as if her milk does not 'come in'.  However, they are to rent a pump
and help her pump at 3-4 hr intervals (more if possible) in order to hold
open the option to breastfeed.  They are not to worry if no milk issues
forth during pumping.  I have explained it by saying things like: "Imagine
the breasts are rooms with many light switches on the walls.  The power
plant is off-line due to a storm (the illness, loss of blood, etc).  If you
keep the switches on, when the power comes back on, there will be light in
those rooms.  Pumping keeps the switches in the "on" position."  The women
(if they have not hx of other hormonal issues) typically recover slowly, and
their milk supplies increase gradually to normal levels.  The worst bleed
I've seen (just short of Sheehans's) resulted in a two month delay until
return of full lactation.  There was no apparant inhibition from FIL as
there was never any early breast fullness, just increasing levels of milk
production over time.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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