I think there are some mothers who hit maximum output and then can't
cope with the baby's increased needs at around three months. I have
seen this with mothers who have had breast surgery.
At ILCA this year Michael Woolridge talked about being careful not to
downgrade supply too vigorously in the early period as it may lose
its capacity to upgrade later. We have had some interesting clinical
discussion around this point and it seemed to ring lots of bells.
When you see a mother with insufficient milk, check whether she had
heaps of milk early on and how it was managed. Many of these mothers
have a history of engorgement. I am now more inclined to encourage
them to express and keep the generous supply up, even if they thow it
away (eg in the shower), rather than to work to downgrade their
supply too soon or too fast.
Ros Escott
Tasmania, Australia