>It is my thought that a moms supply drops a bit (or a lot depending on the
>mom) when she is pumping (whether exclusively for a hospitalized baby or
>part time during work) because the pump simply cannot "milk" the breast
>(lactiferous sinuses) the way the baby can, and the pump cannot stimulate
>the breast the same way the baby does.  So while the pump may get the easily
>available say 3oz of milk sitting in the sinuses, the baby can get more than
>that by stimulating the breast and pulling more hind milk down from higher
>up in the breast.

I have to gently dispute this thought Jay. And, to be fair, it is not your
thought alone - there seems to be a common belief that a mom needs to have a
baby at the breast in order to "truly" stimulate the breasts to go on
producing milk and that if this ideal state of affairs cannot be achieved,
then inevitably the supply starts to dwindle and dry up.   While I agree
that *usually* the baby can obtain more milk than the mom can by pumping,
this is not an invariable rule.  Sometimes, for whatever reason, the baby is
not available, or cannot breastfeed, or cannot breastfeed effectively
enough, yet mothers in these challenging circumstances can, and do, produce
sufficient milk to exclusively breastmilk-feed their babies for many months,
and sometimes even years.  Some months ago I asked Lactnetters for stories
and case reports of long-term milk expression or pumping, to provide to
UNICEF in support of the possibility of HIV+ mothers providing their *own*
treated milk (in the long term) for their babies, rather than any of the
"replacement" feeds being bandied about by UNAIDS & Co.  I received the most
overwhelming stories of perseverance and courage in the face of really
difficult challenges.  Women have provided expressed breastmilk for months,
and sometimes for years, and sometimes for several consecutive babies.

It seems that milk production is a function of the frequency of breast
"drainage" (for want of a better word) and efficiency of breast drainage -
whether this is by the baby or by manual expression or by a pump (a plastic
baby).  The milk ejection reflex can be "conditioned" so that milk lets down
for a pump just as well as for a baby, and in some cases, even *more*
efficiently. The principle is the same - whether for a baby or a pump - very
frequent emptying episodes during early lactation, and requiring fewer
emptyings as time goes on.  One of my clients (who could not let down to a
baby) pumped for 10 minutes each session, only 4 times each 24 hours, and
easily obtained 250 ml EBM each time for her 4 1/2 mo baby.

I think this has implications that we can take advantage of when we're
working with moms of premie babies, who are going to have to provide EBM for
a long time.  It could also explain why babies who are not gaining well want
to breastfeed "all the time" (at first, anyway) and what happens during
growth spurts - this is Nature's way of rectifying potential lactation
failure - the breasts need more frequent and more thorough breast drainage
for a time to maintain the milk volume that is required by the baby.  Could
it be that the mother's storage capacity gradually increases over time with
the result that the infrequently breastfeeding older baby or toddler (or
even Laurie's 4 year old) can still obtain the a large volume of milk in
spite of fewer emptying episodes?
Joy, I hope you can persuade Peter Hartmann to do some more work in this
fascinating area - we still need more answers!

Pamela Morrison IBCLC, Zimbabwe
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