Pumping every 3 hours may not be enough, especially with twins. There is 
some evidence that milk production is calibrated earlier than we 
thought, and that very frequent feeding or expressing is required on day 
two to help establish optimal milk production. This effect was strongest 
in multips (not statistically significant in primips) in

Chen D, Nommsen-Rivers L, Dewey K, Lonnerdal B:  Stress during labor and 
delivery and early lactation performance, Am J Clin Nutr 1998, 68:335-45.

It is possible this particular mom is struggling with hormonal issues, 
but I'd start with very frequent bf/hand expressing (up to every hour 
when mom is otherwise awake) for a few days to see if we can get milk 
production to upregulate. Since the pump is not working, but hand 
expressing is, I'd ditch the pump, or try an Ameda pump (the Medela and 
Ameda pumps have slightly different suction curves, and sometimes one 
works better than the other for an individual mom). Other things that 
have been helpful for moms with PCOS can be tried, such as metformin to 
help regulate glucose metabolism (which improves the hormonal issues). 
This mom's thyroid could be checked as well, just in case (sometimes the 
problems co-occur).

Catherine Watson Genna, IBCLC  NYC

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