I guess, like Jean says, we will never stop learning about lactation.... I
have been working with a mum , third baby, never had problems breastfeeding
other babies, other than nasty mastitis with #1 for which she needed to pump
for a bit as it was too sore to bf.

This baby, physiological birth, no analgesia, baby seemed to latch and feed
ok at birth, but damaged nipples and unsatisfied frantic baby days 2-4. She
opted to pump and use some formula with finger tube/SNS as baby  lost 10% 
and, understandably, was jaundiced. She didn't have any real fullness or MER
sensationat that time.
 We worked on correcting the latch (her technique, tho, was always pretty
good) and she started fenugreek and then domperidone, as supply was limited.
Baby went back to breast at about day 8-10 when supply was getting better.
We treated thrush. Now, at 4 weeks, baby is 1.2kg above birth weight - wow!
but when she stopped the domperidone her baby got very antsy and went back
to wanting to feed hourly. Her supply is huge now - she needs to pump to
relieve fullness sometimes - but has tried to reduce and /stop domperidone
again with same result. 
Why is her supply compromised this time? This is her biggest baby, (3.8kg)
and there have been no questions around retained placental fragments etc.
I guess we will never have the answers - every time. This baby's dad is a
doctor and has learnt quite a lot about bf during the time!

Fiona Hermann
midwife, IBCLC, 
NZ

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