Someday, I would love to do a work swap and go work where Karleen Gibble works.  She asked 
about whether or not my population had success increasing supply because they had already 
lactated.  

What I encounter frequently enough is women who have deluded themselves into thinking that the 
few drops their baby gets before the baby nurse drowns the baby in 3-4 ounces from a fast flow 
bottle tilted upside down  to "top up" is actually a milk supply.  Yes, I do get the women who are 
producing much more, but it is not an uncommon scenario where I am really helping a woman to 
almost completely relactate (even though I may never mention to her that the 0.2 oz that her baby 
is getting during the 4 feedings she does during the day really means she has just about dried 
up).  

The women I work with are, for the most part, very concious of body image, even those on the 
West Side where I live.  To give you some perspective, when our son was in nursery school about 
20 blocks south of where we live, one of the school auction items was a Botox treatment and 
someone actually bought it.  They had a harder time auctioning off my services than the Botox.

This is why it is a total relief to me when I go work in the homeless shelter every three months or 
so.  I know that some of you are dealing with some very difficult low income populations, but I 
would pit these women against most of my private clients in a reality TV show Nursing Challenge. 

I can't remember whether or not it was Karleen or an offnet question about the efficiency of the 
pump when supply is low.  In MY population of clients (which may differ from some of yours) the 
pump still gets more out in a low supply situation after doing the frequent feeding, breast 
compressions, breast switching and every other trick I have up my sleeve for increasing baby's 
efficiency INCLUDING the SNS.

I repeat that I still think hand expression can do the same job when you have a population that is 
open to the idea, for women who can't release to the pump, or in circumstances where using the 
pump may present as many hygiene problems as using a bottle.

It dawned on me that I have lots of data in my charts, not as systematically collected as I would do 
for research, on a wide variety of women from those with almost no supply to copious suppliers 
that would show that pumps are often more efficient than the baby.  But one has to realize that 
efficiency in draining the breast is not everything.  The BENEFITS of feeding at the breast are 
multiple and in looking at the whole picture among a population for whom breastfeeding is going 
well, I'm sure that the baby at the breast wins for physiologic response and for all over well being 
of the mother infant dyad.  

What I am talking about is how to look at this for a specific population for whom the milk supply is 
low from iatrogenically induced low supply - i.e. all those things that happen to mess up mom and 
baby draining milk from the breast.

Best regards, Susan

Maybe Karleen and I could do an exchange some year, although I'm sure if we did, I'd have the 
better end of the deal.  

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