Hi V.,
I am a Lactation Consultant and have worked with far too many women in your situation. Many of them have felt guilty for not being able to produce milk for their babies and I just hurts my heart because they didn't do anything to feel guilty for. Frustrated, hurt and mad - sure! But they didn't make a choice to use formula when they had plenty of milk - they HAD to use formula - the had no choice!
Some things to consider this time around. It sounds like you never got any answers as to WHY you did not make milk. This is one of my Pet Peeves - moms who work with some lactation consultant and try everything but never have an answer as to WHY they are not making milk...ALL of the moms I have worked who did not produce milk got an answer from me as to WHY they weren't - and there were many different reasons. Having answers makes it easier to understand and also easier to cut yourself some slack and stop kicking yourself for something you may very well have absolutely NO control over - which then relieves You of ANY guilt. :)
So - why would a mom not have enough milk (or any) and why no breast changes?
1)PCOS - Polycystic Ovarian Syndrome - this is a hormonal condition that has many different presentations and many different symptoms. It can often cause moms to have few if any breast changes and little milk. I have however, worked with moms who had PCOS who did just fine with the milk supply.
2) retained Placenta - if even a tiny piece of placenta is left in the uterus (and yes it CAN happen with a c-section - I've seen it a number of times) the body will NOT make milk. Usually mom will have other problems with bleeding, possible uterine infection etc...she will have to go in for a D&C. Then after that piece of placenta is removed, typically the milk will come in.
3) Hypothyroid - Low thyroid can certainly cause many problems with milk supply - get this checked!
4) Low - no prolactin - Prolactin is the hormone that produces milk. Usually we are at about a 10 when we are not lactating or pregnant. After delivery the prolactin levels jump from between 200 and 400! My advice for moms who have had problems in the past is to get their prolactin levels drawn around day 2, then again day 4 (especially if the milk is not coming in) and see where they are at. You should be working with a Lactation Consultant who has a clue about this (some don't!) and can help you decipher what these numbers mean for you. After day 10 postpartum, the prolactin levels start to drop - so if there is any problem at all it is imperative to get that bloodwork done early.
5) Hypoplasia - this is a genetic condition - you are born with it and there is nothing really you can do about it. This is a lack of glandular tissue - the tissue that makes the milk. There are physical signs of this - spacing between the breasts that is more than 1.5 inches (or more than 3 fingers-width). Breasts that are triangular in shape, or long and tubular...I can look at a woman and know most of the time if she has hypoplasia. Now - this being said, some women with hypoplasia make milk - in varying amounts. It is important to work with a Lactation Consultant who is experienced with this (not all are!) who can guide you in determining how much milk you do have. Some women will have 3/4 of what their baby needs others less.
6)Anemia - caused by hemorrhage during birth or severe anemia during pregnancy and after. Both can complicate matters seriously. There are ways to help this - but you must work with someone who understands what is going on and knows what questions to ask to help you find the right treatment.
My bottom line here, V., and any other woman who is dealing with this is to find a Lactation Consultant who actually KNOWS about these things. Throwing herbs and pumping and such at a mom whose milk is not coming in WITHOUT finding out WHY her milk is not coming in is just Wrong in my opinion. It is possible that all the work done for baby number one will help with the supply for baby number 2 - we have seen this happen many times. BUT - it is very important that you work with someone who has a clue...
Oh, a c-sec can delay the milk coming in for up to 7 days - but it shouldn't stop it from coming in.
Lastly - ANY of you are welcome to call me any time if you have questions about your situations. It can be hard to get answers from Drs who may very well not know why you have no milk and don't know what to look for to find out why. I have been in this field for just over 14 yrs now and I have worked with many, many women in your shoes...I have a clue. :) I am happy to help you find your answers.
Good luck to you...
Warmly,
J. Simpson, IBCLC, CIIM
www.breastfeedingnetwork.net
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