We would like to thank Dr Cowley1 for her passionate letter to the Editor that was triggered by our recent publication of a case report describing unilateral postpartum hypogalactia in a woman with hemiplegia due to Brown–Sequard-plus syndrome.

It is evident that both Dr Cowley’s previous publication2 and our recent case report3 raised issues that are of clinical importance for the management of women with spinal cord injury (SCI). Unfortunately, we have only limited data on lactation after SCI. Few previous publications, including our recent case report, described the impaired milk production after high thoracic and cervical SCI.4 Furthermore, as evident from the previously published report of three cases by Dr Cowley,2 the successful maintenance of breastfeeding in cases with tetraplegia was only possible with the implementation of special training and use of various techniques to facilitate lactation. We would like to emphasize that our case report was specifically focused on an evaluation of sensory-autonomic interactions as a possible cause of unilateral decrease in milk production in the woman with Brown–Sequard-plus syndrome. Although we collected some information on the breastfeeding techniques in our case, it was out of the scope of the case report to present the methods of induction of breastfeeding following SCI.

Furthermore, we provided readers with a clear message in the conclusion that clinicians should pay attention when discussing the breastfeeding options for women with SCI. With this respect, data presented in Dr Cowley’s report2 clearly support all previous observations that there is a strong need for additional physiological and pharmacological intervention in order to facilitate breastfeeding in women with high thoracic and cervical SCI. Therefore, as we have indicated in our conclusion, we need further research in this area to delineate the various factors that influence milk production after SCI.