Sometimes a baby with a tongue-tie can cause an erratic milk release.  He can do it when everything's just right, but needs a very specific mouth/breast position to hit the "sweet spot" reliably, where most babies can take any reasonable breast offering and make it work. Some of the tongue-tie babies may cause no pain or nipple distortion, they just can't access the milk reliably. 
Maybe not likely with this baby, but worth a look!
Diane Wiessinger, Ithaca, NY
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Date:    Thu, 24 Jan 2013 20:08:21 GMT
From:    "[log in to unmask]" <[log in to unmask]>
Subject: Re: mom with fluctuating ability to let down (MER)

I recently received a call from a mother who said she was suddenly unable to let down for her baby.

Baby nursing well, gaining weight. On day 9 at 2 a.m. she reports suddenly not being able to let down for her son, who became very frustrated after about a half-hour latched.

She generally has a very quick, forceful letdown and abundant supply, with baby sometimes having to work to keep up.

I saw her in person 24 hours after our first conversation, and the situation had pretty much resolved. I observed a nursing and everything looked good - a textbook feeding :) No pain with latch, tongue-tie or other obvious physical issue.

She already is using Bach Rescue Remedy, takes Vitamin D (4000 IU daily) and fish oil as well as a multivitamin. 

Her mother is there helping her with chores and the 2-year-old.

Now, a week later, she says it's happening again, but thanks to the Stanford videos on hand expression/breast compression, she's able to use breast compression so baby gets enough even without a letdown. 

The suggestions I had included using the sister or pump to stimulate letdown, trying reverse pressure softening. I even mentioned that someone on LACTNET suggested stretching out the nipples to elicit a letdown.

We're talking through her expectations/understanding of how letdowns and milk removal work and talking about her anxiety (which is unusually high in my assessment). I demonstrated using laid-back positioning to get completely relaxed. She's extremely worried about having something go wrong where she loses her supply. I'm guessing it's her anxiety which is the key to the issue.

I'm just wondering if there's something else that could be a contributing factor? I haven't run across a mom with this issue before where it wasn't low supply or a baby clamping due to oversupply, and where things went well until day 9.
Also, any other tips for eliciting a letdown?
TIA,
Marcia in MN

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