Marcia in MN,
I notice that your client has a son this time. You mentioned that when she couldn't let down for her son, she could do so for her daughter. I wonder if gender is the underlying issue?  I had a client once who had supply issues for the first six months with her firstborn, which couldn't be explained by anatomy and other physiological reasons, nor by her having, in the early weeks, had mastitis, stopped breastfeeding, and then relactated. Everything should have been fine after that, and her motivation was strong, but there was something I couldn't put my finger on. Eventually, at 6 months, she gave me a very big clue. She told me she could at last genuinely love her baby, without pretending - all because he was the wrong gender. We didn't explore past experiences from her early life, as she wasn't ready and she'd worked it through for herself. Her next baby was a girl and supply was never a problem.
I know that her little boy had lots of cuddles, eye contact, and that his emotional needs were met. A lovely mother.
Another thought for you, Marcia, is that your client may assist her MER by using her baby's hands to do so. A little hand placed on her breast, and gently pressed in. Since I realised in the early/mid-1990s that this is what babies naturally do to spur a letdown, this is a tool I've shared with many mothers across 18-20 years. Years ago I saw a mother whose baby was head butting her breast whenever the flow slowed down and she asked me why. With experience of calves and goat kids, I knew that this is what they do to stimulate a MER.  So I started to observe what human babies usually do, and then to apply this.
Here are some further tips for encourage the MER without making it too "big deal". Applying warmth to the breast may help, as may playing a very funny DVD or audio tape, the sort that triggers laughing out loud. (Reading a chapter in a very funny book worked a treat for me, years ago, when my MER needed help. Lactnetters of a certain age will remember the chapter in Auntie Mame where Mame, who can't ride a horse, claims she can - and then gets stuck in a side saddle!)
Cheers,
Virginia
in Brisbane, Queensland, Australia

Date:    Thu, 24 Jan 2013 20:08:21 GMT
From:    "[log in to unmask]" <>
Subject: Re: mom with fluctuating ability to let down (MER)

Marcia in MN wrote:
I recently received a call from a mother who said she was suddenly unable to let down for her baby.
She nursed her 2-year-old daughter through this pregnancy.
Had a son, no problems with delivery reported, did have IV.
Baby nursing well, gaining weight. On day 9 at 2 a.m. she reports suddenly not being able to let down for her son, who became very frustrated after about a half-hour latched.
When I spoke to her 12 hours later, she'd managed to let down for her daughter and for the pump once, and after more (in her view) unsuccessful latching gave in and gave pumped milk in the bottle.
She said this had happened to her once before (with first baby) due to a 'very traumatic' event but since her daughter was on solids at the time she was less concerned then and it resolved after a couple of days.
Everyone she talked to tried to tell her she just wasn't feeling the letdown, but she says she knows the difference, and she can see that the baby's not doing suck/swallows.
She generally has a very quick, forceful letdown and abundant supply, with baby sometimes having to work to keep up....


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