We all know tension inhibits a letdown and it's easy to say "relax!" but
not easy to do.  Karen Pryor in "Nursing your Baby" described conditioning
a letdown by making all sensory input the same each time mom pumps. As a
scenario, mom might pump hourly as a clock strikes, with certain music
playing in the background, sitting in the same chair,  looking at the same
picture (say, of the baby), with the same fragrant cup of her favourite
beverage and snack at hand, and everything she does the same as possible.
The MER is usually conditioned by baby's suckling or the sound or sight of
the hungry baby.  Without those stimuli it can be conditioned by the pump
or other associated stimuli.

Nan Jolly
Port Elizabeth
South Africa

>
>
> Date:    Wed, 6 Jun 2018 19:46:05 -0400
> From:    Brenda Phipps <[log in to unmask]>
> Subject: Delayed MER issues
>
> Hello all, I am hoping you can help me figure out a plan of action for a
> mom I've been working with for a few weeks now....
>
> Mom is currently 9 weeks postpartum (second baby) with a delayed, slow and
> prolonged letdown  mostly on the pump. She has never felt a letdown
> sensation.  Sometimes she doesn’t  see any milk come out after even 20
> minutes of pumping.  When  it does start flowing, it can continue to flow
> for well over an hour!  She feels that her breasts are full, but no milk
> comes out on the pump. She has done pre and post weights with the baby on
> the breast, and the baby will drink 2 ½ oz in 30-45 minutes, but no more
> than this, so she has to use formula.  After  breastfeeding, she can pump
> extra milk out, sometimes getting up to 3 ounces out, but it takes a very
> long time, up to another hour, to get this much.  She is using the Ameda
> Platinum breastpump.
>
> Mother feels that this problem is negatively effecting her milk supply,
> since she is unable to empty the breasts effectively. It is also very
> exhausting to feed and pump for these lengthy periods of time. To
> complicate matters, she will return to work in 2 WEEKS, and is not sure how
> she will handle this situation.
>
> Mom is very dedicated to wanting to make this work. She experienced
> similar problems with her first child and had to wean early. She has
> already tried oxytocin spray she bought off amazon as well as hands on
> pumping, and nothing has worked.  I would appreciate any feedback from the
> group. Thank you!!
>
> Brenda Phipps, BS, IBCLC
>
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