In my clinical experience, autocrine control kicks in very quickly.  I get
nervous as a cat if I see a mother with prolonged, unrelieved engorgement in
the first week postpartum, because I know the mop-up is going to involve
trying to recover a full milk supply.  I manage early postpartum mothers
with non-nursing babies much more assertively than I used to years ago. I
tell the mothers that I want there to be a milk supply available once the
baby recovers from whatever transient condition is interfering with
breastfeeding. I explain there is a calibration phase of lactation that
begins with onset of copious production (kicked in by the endocrine control)
and that from then on, autocrine (frequency of emptying) is the driving
force.  If the baby is tiny, ill, ineffective, sleepy or whatever, we want
to empty the breasts frequently via some other method to protect the
potential for full production.  Baby receives the expressed milk in lieu of
formula, and it buys time to fix the presenting problem.  If you fudge this
early management, many moms are stuck with what Mike Woolridge calls an
"acquired low milk supply" (ie, an iatrogenic condition that in some mothers
defies remediation).  This is when some people start tossing around the
phrase "nipple confusion" to explain why baby won't breastfeed.  That's not
the real reason, in my opinion.  Typically the milk supply is too low to
compete well with any form of alternative feeding, and baby is saying so by
refusing.  If you have a full, flowing breast, it is generally pretty easy
to transition babies back no matter how they've been fed.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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