Carolyn Griffith Kelley, PhD

My Insufficient Milk Supply
I stared in disbelief at my physician as she diagnosed my four week-old daughter with "failure to thrive". Rose weighed about her birth weight after a month of nursing on demand. The physician threatened to hospitalize her if we refused to supplement immediately with infant formula. With our lactation consultant, we developed a plan of syringe-feeding Rose formula at the breast every three hours and pumping after each feeding.
Rose gained 8 ounces in 48 hours. Hurray! Unfortunately, this round-the-clock schedule of feeding at the breast and pumping failed to increase my milk supply and served only to make me exhausted. After seven months, I abandoned pumping. I continued to feed Rose with formula through a supplemental nursing system (SNS) until her second birthday. We developed a beautiful breastfeeding relationship, but I was frustrated that I could not breastfeed "normally". I had exhausted the resources available and still wondered what was wrong and if there were anything to do about it.

Link with Polycystic Ovarian Syndrome
Interestingly, the month I began experiencing my breastfeeding challenges, Marasco, Marmet, and Shell published three case studies and proposed a link between polycystic ovarian syndrome (PCOS) and insufficient milk supply. (1) My surgeon had diagnosed me with PCOS during a laparotomy procedure, so I contacted Lisa Marasco, MA, IBCLC, to learn more.
PCOS is a significant health issue, affecting between 5-10% of women. (2) Women with PCOS may have excess hair growth, obesity, infrequent or absent menses, insulin resistance, and difficulty achieving and maintaining pregnancies.

Marasco's work illuminates the fact that even successful pregnancy and delivery does not guarantee successful lactation in women with PCOS.

Risk Factors
In her master's thesis, Marasco describes women with documented lactation failure and their commonalities, focusing on infertility issues and related endocrinopathies. She elucidates that many of these mothers experience insufficient mammary development, with wide-set uneven breasts that do not grow during pregnancy. Consistent with Marasco's characterization, my own first pregnancy yielded almost no change in my breasts and a low milk supply. My second pregnancy (after which I breastfed successfully), I saw both more prominent veining and darkening of the areolae, and I experienced a one cup size increase after delivery.

Intervention
What type of intervention might help for women with PCOS and low milk supply? The first issue is to set in place the good lactation management practices of frequent feeding and full drainage to insure that milk production is maximized and then to decide, with a medical professional, what prescription medications and/or herbal galactogogues to employ.
Because the root of the lactation problem is unknown in women with PCOS, prescription medications and herbal remedies have produced variable and rarely impressive results. Women with the

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