Well, I'm reading this right now as I study for the exam.  I thoroughly agree
with those who reserve judgement.  IMO, it makes no sense to say that nipple
stim. is not necessary.  Karleen, thanks for posting your personal story, it
was interesting that you were able to analyze the situation enough to realize
a minimum amount of nipple stim. that was necessary for your milk production.

It is my understanding that nipple stimulation is necessary to prevent the
inhibitory hypothalamus pathway.  The lower level of  dopamines/inhibitory
substances is what allows prolactin release and thus the production of milk.

So, does it follow that this glandular secretion (bmilk) being "on" is the
physiological "normal" state while the inhibitory control mechanism is what
has taken place in mammalian evolution so we don't make milk all the time?  A
fascinating adaptation of a glandular strutcture.  But, then I am preaching
to the chorus.

Let's also not forget oxytocin release as a result of nipple stim.  If
nothing else, the MER seems helpful if the goal is breast emptying.

Karen Seroussi LLLL, B.S., IBCLC 2002 candidate

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