Re:MER (let-down reflex), my understanding is that MER is extemely unlikely
to 'fail'. It may be very *slow*, particularly if supply is low and/or mum
is tense for any reason, eg in pain, embarrassed, uptight. Psychological
factors can inhibit it, but can't actually stop it happening eventually.

>Here are the questions I was asked by a mom today:
>       1) If a mom gets little result when pumping -- <1 ounce total with
>top grade best kind of pump (same result with Q3 pumping for 1 week) and
>says she doesn't feel any MER with pump how likely is it that pumping would
>do anything to boost her supply?

Was she waiting long enough before giving up each session? Probably most
mothers don't let-down easily for a pump. In my own experience, I tried to
express a whole feed, just for an experiment once, using a hand-operated
pump (this is about 10 years ago!) and I recall that it took 20 minutes
before I let down my milk. But with my baby, it took seconds - sometimes I
had let down even before she was attached! Amazing the power of the
subconscious mind!

I have found that often mothers using pumps for the first time need lots of
suggestions to help them relax, perhaps use nipple stimulation, massage,
warmth on their breasts, etc to help get the MER working a bit faster. Once
they get used to the pump, they usually let down faster.

>       2) If same mom says she doesn't feel MER with baby or see the rythmic
>swallowing/sucking/pausing pattern indicative of MER and good milk flow how
>likely is it that she is producing much milk or will ever? Is this HER
>problem or a suck problem with baby, both? neither? how do you tell?

My guess, without knowing a lot more detail of the situation, is that she
has low supply. This could have resulted from *either* a maternal problem
*or* a suck problem (ie transfer problem) which meant the breast wasn't
drained efficiently and the autocrine control kicked in to suppress supply.
A thorough history would be needed to work out what is the most likely
reason.

>       3) Do first time mothers have more problems with MER and milk
>production/supply issues than moms with mulitple kidlets and more lactation
>experience?

There is no evidence that I know of to suspect this, except that mums who
had breastfed before would perhaps pick up earlier signs of a problem and
get help or take steps to fix the problem sooner. Perhaps first-time mums
are more tense as they are learning so much new stuff, and this may
contribute to slowing of the MER.

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Joy Anderson B.Sc. Dip.Ed. Grad.Dip.Med.Tech. IBCLC
Nursing Mothers' Association of Australia Breastfeeding Counsellor
Perth, Western Australia.   mailto:[log in to unmask]
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