The first thing that comes to mind is perhaps mom has a case of an over active letdown that is causing baby to spit up after nursing. This is a common side effect of this problem. I would like to see if baby chokes or gulps very rapidly at the breast and do a test weigh on a good scale (such as a Baby Weigh Scale or equivalent) to see how much baby takes in at one time and how fast. I would test weigh before nursing, and at five minutes into it, and at the end of nursing. I would want to see baby's body language while nursing also (lots of body twisting, arm flailing, biting or sliding to the nipple tip, and fussing are clues to a too fast flow). A woman with an abundant milk supply would also be more likely to have no problem maintaining her milk supply while using a PIS for exclusive pumping. She might let down very quickly and be able to drain her breasts on the pump in 5-10 minutes. 

Information can be found in the Lactnet archives, in The Breastfeeding Answer Book, and Dr. Newman has reprintable articles on this topic. I believe the one addressing over active let down is called "Colic in BF Babies." 

Best wishes, Kathy Eng, BSW, IBCLC

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