You finish reading the referral letter and look at the couple in front of you—32-year-old Virginia and her husband.

Virginia delivered her fifth child vaginally a month ago. The child was healthy, but Virginia experienced primary postpartum hemorrhage due to uterine atony. After uterine massage and multiple uterotonics failed to halt the bleeding, it was finally arrested by hemostatic brace suturing. Virginia recovered rapidly afterwards and was sent home after several days.

Having had four other children before, the postpartum period's challenges were nothing new to Virginia. Everything went smoothly at first—but after a couple of weeks, she found it harder and harder to breastfeed her baby.

After assistance from her midwife proved to be unsuccessful, Virginia's obstetrician referred her to a lactation consultant. The consultant couldn't help either—but she did notice that the underlying issue seemed to be inadequate milk production, rather than poor breastfeeding technique.

Therefore, the obstetrician decided to refer Virginia to your clinic, to exclude a potential medical cause for her lactation failure.