<My impression is that this infant has learned to live the life off mother's MER and then does not pull to work the breast after that.>

Might it help to break that habit by having mom use antigravity position for every nursing for 2 weeks or so till baby is willing to work "uphill" to get milk out?? That would mean at least halfway or more lying on back so nipple is above heart level.

<Husband tends to give the 4oz as he feels that his daughter should not be hungry.> Have you explained to the husband about holding baby more upright and insert pauses to make his feeding sessions less likely to reinforce the baby's bottle feeding type habits? Maybe he is inadvertently adding to the problem.

It's been my experience that mothers get more in 24 hours by 1) Triggering MER with RPS 2)pumping just 5-7 minutes 3){pausing a minute or so to do forward massage from the back of the breast, and then start all over with !) and 2) for a total of no more than 10-15 minutes at a time, but doing this at shorter intervals during waking hours (90-120 minute intervals) for a total of more short milk removals in 24 hours. Milk is made most rapidl7 in the first hour after removal, slower in 2nd, slower yet in 3rd.

Hope this is of some help.

K. Jean Cotterman RNC-E, IBCLC

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