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Delayed Lactogenesis II: A Comparison of Four Cases


  • Christine M. Betzold NP, IBCLC, MSN,

    Corresponding author
    1. Christine M. Betzold, NP, IBCLC, MSN, graduated from the University of California, San Francisco in 1991 and is board certified in family practice and lactation. Her clinical practice is in Newport Beach, CA, where she combines her careers working as both a nurse practitioner and a lactation consultant.
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  • Kathleen L. Hoover MEd, IBCLC,

    1. Kathleen L. Hoover, MEd, IBCLC, has been in private practice as a lactation consultant since 1986. She has worked as a hospital lactation consultant and is currently the lactation consultant for the Philadelphia Department of Public Health.
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  • Cathy L. Snyder RN, BSN, IBCLC

    1. Cathy L. Snyder, RN, BSN, IBCLC, is a registered nurse and lactation consultant who has been in private practice with Breastfeeding Partners Inc., Hatboro, PA, since 1998. She provides opportunities for clinical observation in private practice for nursing and midwifery students from the University of Pennsylvania.
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Christine M. Betzold, NP, IBCLC, MSN, 901 Dover Dr., #102, Newport Beach, CA 92660. E-mail:


Lactogenesis II is the onset of copious milk production (i.e., the milk “coming in”), which usually occurs between 30 to 40 hours postpartum. When lactogenesis II fails to occur or is delayed, it may be due to a number of underlying hormonal or non-hormonal conditions. Of the various hormonal etiologies, many can be identified with the aid of a few standard blood tests. Gestational ovarian theca lutein cysts may cause delayed lactogenesis II and are fairly easily detected by ordering testosterone levels. Although this condition can delay lactogenesis II for as long as 31 days, with proper management women affected by these cysts have established breastfeeding. Three of the four women reviewed in this article were eventually able to produce 100% of their infants'caloric requirements.