This is to offer a UK perspective on Johanna's question about the mother
with apparent low milk supply.

Johanna, there may be aspects of this situation that you have omitted for
the sake of brevity, but some aspects struck a chord with me.

A baby of four weeks or slightly more (not clear from the post how old the
baby was) who takes 45 mins to an hour at a feed is not necessarily doing
anything 'wrong'. The time is only one aspect - if it's 45 mins to an hour
and baby is contented, thriving and satisfied, and gets on to the breast
without a problem, then there is not an issue here, except perhaps related
to mother's own confidence. Giving a finger to suck on risks reducing the
stimulation of the breasts and is no time-saver, either.  The baby's
'non-nutritive sucking'  still stimulates milk production, and may be an
important source of comfort and security for that baby - in any case, there
is not a cut-off point (IMHO) between nutritive and non-nutritive  In the
UK we call NNS comfort sucking, but it has a value to mother, baby and bf.
Comfort is good! ). A baby may suck for food, then for comfort, and go back
to sucking for food again, then for comfort...that's all fine and okay -
yes?  Johanna, you didn't tell us what this baby's weight and general
health were like, or how he fed at the breast, so I may be missing
something here.

Positioning needs to be checked in prolonged feeds if tbey are combined
with fussiness and/or poor weight gain.  I would be very reluctant to
suggest finger-sucking in an attempt to reduce the length of feeds. As
Johanna finds, in this situation the mother may go 'overboard'  in offering
the finger and contribute to a fall off in supply. There may have been an
issue of positioning here, as the mother had had mastitis.

Pumping is not an indication of the breast's capacity to make/store/release
milk - in fact, guaging milk supply this way can be very misleading.  To
take just one aspect - look at the varied amounts the same woman can
express using different pumps and hand-expressing.

In short,  the basic 'rules' of happy bf apply:

1. let the baby suck as often and as long as he wants, as long as he is in
a good and effective position and the mother is perfectly comfortable

2. take the baby's general health, growth,  well-being, contentment and
ease of feeding as the signs of 'success'

3. Help the mother recognise signs of success and grow in confidence

Please - I offer all of this respectfully,  in full knowledge of not having
the whole picture, but I did want to draw a contrast between what we would
be most likely to do here, and the management described.

Heather Welford Neil
NCT bfc Newcastle upon Tyne