Debi,  I was so excited to read about the baby who drinks well with the SNS,
but transfers "next to nothing" from the breast, and whose mom could pump
"ounces and ounces" after.  I have been working with a mom/baby couple from
birth with circumstances so similar, and have also been stumped!  My
observations of nursing have shown almost nil milk transfer, yet mother can
now pump sufficient for her now four-month-old in only three pumping
sessions per day, 20 minutes each time, to provide him with exclusive
breastmilk-feeding.  Mom is lovely, highly motivated to do "the best" for
her baby, has a lovely relationship with her 4 year old (also exclusively
breastmilk-fed in the same manner for about 3 months) but she has a great
sadness in her past.  She was a teenage, unmarried mother, decided to give
her baby up for adoption, changed her mind, and the baby subsequently died
due to a congenital heart defect.  She has been treated for depression for
many years, and was advised not to become pregnant with this baby because of
unresolved issues.

Mother's success with pumping is proof that her milk ejection reflex is
functioning, not only well, but unusually well.  However, the let-down is
visibly inhibited when baby is at the breast (there is no evidence of
swallowing and baby either becomes impatient, or resorts to fluttering, as
you describe, no matter how long the nursing).  After much investigative
work, such as you have done (positioning, latch, breast compression,
ensuring adequate feeding frequency/duration, no drug issues, etc. etc. no
stone unturned) I suggested pumping after feeding to maintain mom's milk
supply and provide EBM for the baby, hoping that the "tincture of time"
would programme the milk ejection reflex to work eventually in response to
the baby, but it hasn't.  I have finally and reluctantly come to the
conclusion that this mother may have some unresolved emotional difficulty
(possibly connected with the first baby?) which inhibits her milk ejection
reflex when *this baby* (and baby #2) is actually *at* the breast.  I have
seen this before, but with very short duration and never in such a
*committed* mom.  This is so unusual that I have reported my observations to
mom's doctor, who is also so impressed by this that she said she will write
to mom's psychiatrist to see if he wants to work on resolving whatever might
be "blocking" milk-flow.  I wonder if we see this kind of situation so
rarely because there are not that many moms out there quite so dedicated to
ensuring that their babies will have "the best".

Pamela Morrison IBCLC, Zimbabwe