Anne, My $.02 on your questions --


       3) Do first time mothers have more problems with MER  . . .

 I think the answer to this question  is "yes and no."  Moms who have breast fed before can develop problems related just to the current dyad -- due to a different type of delivery, different life situations, and also hormonal or physical changes -- for instance a growth or hypertrophy of the pituitary.  But usually, if moms have demonstrated the ability to make milk before, they should be able to do so again.    The problem with first timers with problems, that makes it seem like more first timers have problems, is that they don't usually go on to try a second time if they   couldn't make milk the first time.  Unfortunately, many times the first time wasn't because they COULDN'T make milk, it was because of either poor latching or other problems that weren't caught, and therefore mom DIDN'T make enough milk and quit.

My experience with moms who said they had to stop due to low milk supply last time, is that barring actual breast problems due to surgeries or pathologic processes in mom, if they are willing to try again this time, they actually do make milk, and enough of it.

For instance, moms who said their milk dried up at four weeks, when educated to growth spurts and changing distractibility patterns in infants, found their milk supply lasted longer with a subsequent baby.

Moms whose babies never latched properly the first time, find that with a different baby, or different nursing staff to help, this time the latch is successful, and so is the milk supply.

A mom I worked with a few months ago, whose first baby was BF only every other feeding during the day, and not at all at night, and mom pumped only three or four times a day, "ran out of milk" at four weeks (I wonder how she kept it THAT long).  Educated to BF more often, if not exclusively, and pump when feedings were skipped, she found she had much more milk, and at 8 weeks was still going strong.  Her question -- "why didn't anyone teach me this the first time?"


       2) If same mom says she doesn't feel MER  . . . 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?

First, I have to ask, how many days into breastfeeding is she saying this.  If it is day one, it is way too early to say there is any problem at all.  If it is day three, and baby has been losing weight beyond acceptable parameters, you have to look at everything, simultaneously, because it is time to FEED THE BABY. 

 I spend a lot of time in the room with mom, if she is still in hospital, watching the nursing, checking where the tongue actually is, seeing how much "nutritive sucking" the baby is doing, as opposed to how much sleeping or recreational sucking.  I check the baby's suck on my finger to make sure that the baby has his end of it together.  And after the feeding I have mom pump.  I warn her not to expect milk, after all she just fed.  But we collect every precious drop, and get it into the baby.  After several feeds, I also suggest pumping once before a feeding to see how much is there.  It reassures mom when there is something. ( Another method to assure that milk supply is there, and increasing, is weigh the baby before and after the feed, on a scale that measures weight changes in grams.)

        Meantime, I have been reviewing mom's history prior and during pregnancy, to see what "redlights" might flash -- for instance no tissue changes during pregnancy, or hx of surgeries, etc.  And I review the labor and delivery history to see what might be causing problems now, if anything.  Especially potential for retained placental fragments, or extreme blood loss and concommitant changes in Hgb levels before and after labor.  
        With the latter I start talking about dietary assistance with iron rich foods, and possibly telling her about the herbal galactogogues -- though I have to be careful about discussing these in the hospital situation.  I mention the use of herbals, and refer them to the BAB and Nursing Mothers' Companion for the how to use, as it is beyond my "scope of practice" to prescribe.  On the outside, I do give information more directly, citing my references, including LACTNET.

The point of all of this is that there may be more than one cause, and the older the baby is, the less luxury one has to take one thing at a time.  You check everything out as simultaneously as you can.
Regarding feeling the MER, by the way, many moms don't recognize a feeling of "let-down," until several weeks, to months have passed.  Some of them never "feel it."  The proof of it is in the baby who is gaining weight and pooping and peeing in sufficient quantities.  Or in seeing the milk dripping or pouring when not feeding, or while pumping.


       1) If a mom gets little result when pumping . . . how likely is it that pumping would do anything to boost her supply?

Is this what she gets after feeding her baby? and the baby is gaining weight?  She IS making more milk.  If this is what she is getting only pumping, then I would start investigating other stimulants to boost her supply
(as above, diet and galactogogues); and other causes for the lack of milk.

A lot of information here, and I hope it reads as straightforwardly as it spills across my screen.  

To sum it all up, there are no easy answers to the question of supply, and even the general answers have lots of caveats.

Sincerely, Chanita