HI Chris,
You point out some very interesting thoughts and I agree with most of them
but one I question.
If a mother never establishes an adequate milk supply, she is more likely to
wean quicker than the mother who first establishes her supply and then starts
adding supplemental bottles.
I theorize this in two ways.  The first, which Linda Smith knows extensively
on this subject, is that the alveoli need the stimulation and message early
in the lactation period to know how much milk to produce.  So early in the
postpartum period the mother is actually producing slightly more than her
newborn needs and then the two match up.  Once these cells in the alveoli
have been stimulated and programmed to make the amount the baby needs, even
if the mother temporarily weans, these cells can be restimulated to come back
up to the level of production to meet the baby's need.
Another observation I have on early introduction of supplements is that the
mother never trusts her own body and watches the baby suck down bottles after
breastfeeding and therefore assumes that she is starving her baby.  Instead
of watching the baby for cues and swallowing patterns at the breast these
mothers go by the number of ounces the baby drank and slowly increase the
number of ounces of supplements and decrease time at the breast leading to
weaning.
I do encourage mothers to do any amount of breastfeeding in combination of
formula over not breastfeeding at all, but I do let them know that the milk
supply may never get up to the full amount the baby needs if they start out
this way.  I try to encourage them to start out with exclusive breastfeeding
and then later introduce formula so if the baby does not tolerate this it is
easy for the mother to bring back up her supply.

I know there are some mothers who are exceptions to this theory and can make
more than enough milk any time but they are far and usually unknown and I
wouldn't want to chance which ones could do this in the early days
postpartum.

Ann Perry RN, IBCLC
 Boston, MA

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