> The idea of "stimulation to let breast know it needs to make the milk" which
> was previous reason for nipple stim and pumping is now outdated?  And this is
> because we have now accepted Hartman's study as "the new truth" and it is
> volume, emptying, etc. that determines production and stimulation is no
> longer "the" issue?

I would really like to give a longer and more considered comment to this
thread on milk production and stimulation however at the moment time does
not permit:-)  - We could spend a semester teaching this stuff. But I just
want to quickly comment that we shouldn't fall into the trap of mistaking "a
new truth" for "the (only and) absolute truth". We do now know that milk
removal stimulates the autocrine response to produce milk production (and
this is not an "all or nothing issue", there are degrees of emptying and
concomitant degrees of increase in milk synthesis. We have learned that
SERUM prolactin is not related to changes in milk production (although milk
prolactin levels do appear to be). Because we know nipple stimulation is
related to prolactin release there has been a "leap of assumption" that
nipple stimulation is not important in the lactation process if milk is not
being removed. I do think its important to work with what we have learnt (ie
milk removal is very important) but equally so - not to make assumptions
about knowledge we have not yet discerned. Clinical experience is important
to our practice when we don¹t have researched "truths" to help us out - and
they provide us with a basis to discover new knowledge. But the entire
picture is a long way off. I think its always important to change our
practice as learn new things and to continue with what seems to work until
we learn otherwise (if this practice always falls within the premise of "do
no harm").

Cathy Fetherston
Perth, Western Australia

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