Nina,

Respectfully, this is not a new discussion. There are quite a few posts on
this very issue in the archives.
I see your point exactly, though, and I do believe there is merit to
informing and supporting mothers to breastfeed many, many times a day
to ensure both adequate production and adequate intake. Certainly, where
there has been restriction of feeds, in any way, this will
not drive the demand/supply system appropriately.

Now that I've had 25 yrs of working with breastfeeding mothers, I would have
to say that it is not rare for mothers to have insufficient supply.
I can often predict which ones, based on their body type and breast shape.
Since we have a followup clinic in 1-2 days post hospital
discharge, I don't say anything to the mother, but often it bears out. I
have seen enough cases of PCOS (because we have an OB doc on staff
who sort of specializes in this, and infertility), that I believe it is
definitely associated with lowered milk production. Certainly, lowered
production
is often multifactorial, and so when a mom has PCOS, diabetes, conceived
with fertility drugs, twin premies, we will be very worried about her
supply.

On the other hand, sometimes it's the baby (we have alot of premies and
near-term infants) who is just not driving the system. In that case,
a good hospital grade pump, used frequently, will drive the system. I also
believe that many mothers don't give it enough time, and after a week, or
even two weeks of doing supply-enhancing interventions, they stop bf
altogether because they expected better results.

I know a mother who had her 5th baby, and had breastfed all others
long-term, attachment parenting style. For some reason, she had a serious
problem
with milk supply and had the help of 2 excellent IBCLC's at another
hospital. (I was consulted by the 2 LCs by phone) She had help with the
latching,
and all that, took herbs, domperidone, and secretly (from the doctors) used
donor milk because formula use was so distasteful to her. It was so
devastating
to her, that I do believe it contributed to her hospitalization for major
depressive episode. It was soon after Hurricane Katrina and that certainly
added to the
severe stress she was under. What I am saying, is that no matter how often
the baby nursed, the mother was not making enough milk to sustain the baby.

I definitely believe we need to examine this issue, what we say to mothers,
how we support them etc.
So I do welcome any discussion on this, as the last discussion was very
enlightening.

Laurie Wheeler, RN, MN, IBCLC
Mississippi USA

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