Thanks so much, Karleen, for your reply.
The whole discussion of how milk supply is 'set' in the first few weeks makes me really uneasy.  I hate to get into an argument because I know I have both less clinical experience and less scientific knowledge than many people on this list.  What I am good at is collecting lots of bits of information and coming up with my own (cock-eyed?) theories.  So I'd just like to throw a couple of arguments out there.  Please note I'm not talking about mothers with endocrine problems or insufficient glandular tissue, etc.
First, if we see a lot of women who can't increase production even with pumping 8 times a day, I'd suspect it's as likely that (a) the pump doesn't work with this mom for whatever reason or (b) 8 times a day isn't enough to increase supply - a cluster-feeding baby will go way over 8 times a day, right? - as that it's (c) that her body can't produce more milk.  I could also add (d) maybe some moms need the skin-to-skin or suckling to stimulate production.
I found this report on relactation to be very encouraging:
http://www.who.int/child-adolescent-health/New_Publications/NUTRITION/WHO_CHS_CAH_98_14.pdf 
RELACTATION<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
A review of experience and recommendations for practice
DEPARTMENT OF CHILD AND ADOLESCENT HEALTH AND DEVELOPMENT
© World Health Organization 1998
 
To quote from the report:  
"Some clear and important conclusions can be drawn:
_ Relactation is possible and practical for almost any woman if she is adequately
motivated and supported. Age, parity, previous breastfeeding experience, and
lactation gap, are less important factors."
 
Read that twice ;)
 
Many of the studies that showed the highest success rates of relactating/inducing lactation - including one with women who had never been pregnan where 11 of 12 women succeeded - were under conditions where breast pumps were not used.  It seems to be all about the baby suckling often at the breast.
I'm afraid that if we buy into the idea that irreversible changes happen that preclude increasing production at any point we're doing mothers a disservice.  At the least I'd rather explain that milk production is driven by the baby spending enough time at the breast, with proper latch/technique.  Maybe her baby is not able to or interested in suckling enough, maybe her lifestyle or family circumstances don't permit enough nursing time, but it's more likely that is the case than that her body is incapable of making more milk.  Yes, there are women who physically can't, but the vast majority of women I see do not have a physical but instead a breastfeeding management problem.
Sorry if I'm sounding grouchy - I'm just so tired lately of hearing 'I didn't have enough milk'   If women really believe their bodies aren't capable then of course supplementation with AIM is the logical remedy.
Please go ahead and tell me where my reasoning or my knowledge is wrong - I really want to know if I'm off-base in my opinions here.
 
TIA,
Marcia McCoy, IBCLC
Minnesota
>Date:    Fri, 1 Feb 2008 08:04:38 +1100
>From:    Karleen Gribble <[log in to unmask]>
>Subject: Re: Progesterone filling prolactin receptor cells
>
>If you search for information on the "prolactin receptor theory" you will 
>find information.
>However, sometimes the information that we have about prolactin receptors is 
>interpreted to mean that if a mother doesn't get off to a good start that 
>she is doomed and will never produce sufficient milk. This simply does not 
f>it in with what we know about relactation and induced lactation where 
>prolactin alone does the job of building the structures in the breast 
>necessary for milk production. It is simply never too late.
>Karleen Gribble
>Australia


 

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