Jan, my "hunch" coincides with yours.  Regarding attempts to increase milk
output later in lactation you wrote, "It seems as though regardless of what
you do, supply won't go up.  I think that at that point, if the prolactin
receptors aren't there (laid down) in the beginning, then the fenugreek,
reglan, blessed thistle, etc. won't work.  If they were laid down initially,
and mom bf frequently to start with, but then tapered off, you have those
receptors, and using something that stimulates prolactin will increase milk
supply.  But that's just a hunch, not based on anything specific.  It
certainly does point to the importance of breastfeeding early and often in the
first few weeks, however.  Also pumping a lot for those moms that can't
breastfeed."

Could it also partly be keeping all the milk-producing alveoli intact? -
draining very well as the milk comes in, and maintaining the breasts in as
soft and comfortable a state as possible so that nothing becomes damaged,
and they all just keep on producing milk - more and more efficiently - which
brings in your prolactin receptor theory.  I'm wondering if, during later
lactation, when the prolactin levels are much lower, if the increase in the
prolactin receptors has the effect of making the breasts equally responsive,
but to lower and lower levels of prolactin.

Now, just to put a spanner in the works, what about the receptor theory
during induced lactation and re-lactation?  I had a client about a year ago
who re-lactated for her 8 month old baby, having weaned him at 2 months. She
achieved an amount of 360ml EBM per day after about 3 months.  She used
sulpiride, which increases prolactin levels. Would this lay down prolactin
receptors in the breast too?

Pamela Morrison IBCLC, Zimbabwe
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