Dear Lactnetters, I attended a lecture at my hospital today by Dr. Karin Cadwell and she really sent home the message that if a mom is not producing much breastmilk and the babies are losing weight in the first month really consider retained placental fragments as the culprit in inhibiting lactation. Other culprits can be past injury to the breast especially the 4th intercostal nerve, breast surgery, and hypoplastic breasts. Of course there are always sucking problems but for those 4 women that someone posted about with babies not gaining well in the first month you may want to take a good history (no post partum hemorrhage that could cause partial Sheehans Syndrome), and send them back to their OB to see about the possibility of retained placental fragments even small ones can inhibit lactogenesis. This was just a thought. Dr. Cynthia S. Marske DO Internal Medicine Ft Irwin, CA