<I am wondering if anyone out there has a research reference concerning the above. I have noted that women with a low haemaglobin (below 74g/l) often have difficulty lactating - especially the primipara....> Verity Livingstone and Claire Willis wrote up a case series of ten women who had a severe postpartum haemorrhage and insufficient milk supply. I have copied the abstract from PubMed, below. I cannot believe this was published in 1995! I've pulled out my copy of JHL to confirm this - and found this was the issue with the great editorial by Di Wiessinger - the story of three sisters (worth re-reading). There was also a study published in Birth (see abstract below). I think you need to read the whole paper as the association between low supply and anaemia was "suggestive" in their study, rather than conclusive. This may be because the sample size did not have enough "power" to identify a difference between women with low Hb and "normal" Hb (or other methodological problems). Lisa Amir MBBS, MMed, IBCLC in Melbourne, Australia PS. I am still waiting for my Feb JHL - do any other Aussies have it yet? J Hum Lact 1995 Jun;11(2):123-6 Infant insufficient milk syndrome associated with maternal postpartum hemorrhage. Willis CE, Livingstone V. Insufficient milk syndrome is defined as failure to thrive in infants due to insufficient daily breastmilk intake. This discussion examines a possible association between insufficient milk syndrome and maternal postpartum hemorrhage. Ten consecutive cases of insufficient milk syndrome associated with maternal postpartum hemorrhage were identified. The mothers presented between 3 and 35 days postpartum. Maternal postpartum blood loss ranged from 500-1500 ml in eight cases (mean: 963 ml); in two cases, blood loss was noted as 400++ and 200++, respectively. Six mothers experienced a drop of hemoglobin by > 30g/L; two had a drop in blood pressure > 30mmHg for > 20 minutes. All infants were failing to thrive. Five infants suffered hypernatremic dehydration with serum sodium levels ranging from 148-166mmol/L. Breastmilk electrolytes were measured in six cases, and elevated sodium levels, ranging from 21-100mmol/L, in five cases. These data serve to heighten awareness of insufficient milk syndrome as a potential consequence of postpartum hemorrhage. Early postpartum review of all breastfeeding mothers and infants is strongly encouraged. Birth 1995 Jun;22(2):86-92 Anemia and insufficient milk in first-time mothers. Henly SJ, Anderson CM, Avery MD, Hills-Bonczyk SG, Potter S, Duckett LJ. Insufficient milk is a poorly understood problem that is often identified as a major reason for early discontinuation of breastfeeding. This study explored the relationship between anemia and insufficient milk in 630 first-time mothers. The frequency of anemia (postpartum hemoglobin < 10 g/dL) was 22 percent. Anemic mothers reported a higher level of symptomatology associated with insufficient milk and were more frequently classified as having insufficient milk syndrome. Mothers with the syndrome reported a shorter period of full breastfeeding, and weaned at an earlier age. They identified not having enough milk, baby nursing too often, and baby not gaining enough weight as the main reasons for discontinuing breastfeeding, compared with baby's disinterest and conflicts with school or work as main reasons among mothers not reporting symptoms related to insufficient milk syndrome. The study results suggest that anemia is associated with the development of insufficient milk, which in turn, is related to duration of full breastfeeding and to age at weaning. *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html