I would have said that the "erratic MER" we hear about with first-time moms
is not so much that they don't let down reliably for the baby, but rather
that they let down for all sorts of odd reasons.  With my first I would let
down in grocery stores, just looking at all that food.  It makes much more
sense to me that a first time mom's MER should be over-enthusiastic and
need to be toned down - much like her milk supply - than that it should be
under-enthusiastic and put her baby at risk before they even get started.

Diane Wiessinger, MS, IBCLC, LLLL  Ithaca, NY