Just a few comments on milk production in mothers of preterm infants:

I remember when a 34 week gestation infant was on the cutting edge of
lactation management! Over the years we have moved this age to 23 weeks, the
cutting edge of viability. Our research has not kept up with managing a milk
supply for a mother who has completed only about half of the gestational
period. An early study which gave preterm mothers syntocinon before every
pumping session from day one through five showed a remarkable increase in
milk production. This is a simple intervention which can have a large effect
on priming and boosting an early milk supply. The research was not carried
out further than the first week because the effect was so dramatic between
the experimental and control groups, that the research was no longer blinded
and it was felt unethical to withhold the syntocinon from the control group.

Acupuncture is another underused therapy for faltering milk production. I
have had many mothers use acupuncture to preserve lactation in long term
pumping situations. (Clavey S: The use of acupuncture for the treatment of
insufficient lactation. American Journal of Acupuncture 1996; 24:35-46)

Human growth hormone is now being used to improve milk production in preterm
mothers. (Gunn AJ et al: Growth hormone increases breast milk volumes in
mothers of preterm infants. Pediatrics 1996; 98:279-282)

These types of interventions hold some promise in helping us help these
mothers. Many of the preterm mothers I work with simply do not pump enough
times each 24 hours nor do they drain each breast well at each pumping. I
have mothers pump at least 8 times each 24 hours, massaging and compressing
each breast while pumping to drain it as much as possible. If the degree of
emptying influences quantity of milk produced as Peter Hartmann has
suggested, then we need to help mothers take advantage of these types of data
as they relate to long term pumping. Some mothers are advised to pump only as
much as the baby needs early on and find that their milk production gradually
declines because it was never optimized to begin with.

While different pumps may have some bearing on milk production, I think there
is much more to it than that. So much revolves around the early days and
weeks. Michael Woolridge calls these times the initiation and calibration
phases where the breasts must figure out how much milk they should be making.
Some pumping guidelines and some mothers limit themselves because they fail
to calibrate milk production at a high enough level.