IN my greater than 10 years experience, I have noticed this problem of moms
that do not initiate lactation adequately (either with effective nursing or
pumping) developing low supply.  In my practice, typically these were either
moms pumping but not pumping adequately or with ineffective pumps or
committed nursing mothers who believed that everything would go well if they
just kept the baby at the breast enough.  These co-slept, nursed around the
clock, etc.  When they finally came to me, they were usually 6-7 weeks
post-partum with low weight gain or weight loss babies with ineffective
suckling (high palate, short frenulum or other such oral problems too) now
needing supplementation.  Many of these also had "reflux" and ended up unable
to tolerate anything but expensive hydrolysed formulae.  With these moms,
even effective pumping and/or effective latch-on did not necessarily increase
supply to adequate.  This substantiates what Woolrich and Hartmann have said
in their research.  This is why early assessment and intervention is so
important and why we cannot ignore babies who lose weight below the 7 1/2%
mark or who do not gain weight by the 2 week mark.  It is NOT to undermine
breastfeeding and IMHO is not supportive of breastfeeding to pat mothers on
the back and tell them "just take your baby to bed and nurse around the
clock".  Thank God there are more and more knowledgeable pediatricians out
there that do not take this approach.  If we observe closely and keep track
of our clients, we can see that experience usually follows physiology.  We
can take a scientific approach to breastfeeding without fear.  I think that
in the past we promotors of breastfeeding have had an unspoken fear that
somehow breastfeeding as a process cannot stand up to rigorous scientific
study and scrutiny,  I believe the more we work to dispel the myths and
mystery, the more we enable moms and babies to discover that the magic of
mothers' milk is just the expected and anything else is abnormal!

Jane Kershaw
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