<<One question though -- if milk must be removed to increase supply, how is
it
that a prospective adoptive mother builds up a milk supply from zero by
pumping?>>

The adopting mom who pumps in anticipation of receiving the baby is trying to
do with pumping what pregnancy usually does. It takes a long time and is
usually only partly successful, because placental lactogen is the primary
hormone responsible for developing the secretory cell structures with
prolactin playing a secondary role. Prolactin and estrogen are the primary
hormones responsible for setting up the metabolic systems that make the milk.
Pumping will increase prolactin, but not necessarily do much for the other
hormones needed. This is not the "usual" situation, and my hunch is that
secondary systems are at work during induced lactation.  In most other
mammals induced lactation is rare or impossible without a pregnancy. I don't
think anyone has even begun to study the mechanisms involved, given that even
normal ongoing lactation is still not completely understood at the metabolic
level.

The point I was trying to make is that "breast stimulation without milk
removal" is not the answer. Removal of milk drives the system that maintains
milk supply in Lactogenesis Stages 2 and 3 (onset of copius milk supply, and
maintenance of milk supply). Stimulation as a substitute for pregnancy
(Lactogenesis Stage 1) is a different aspect of the issue.

Regarding what I do with moms - after 2 days of pumping and cupfeeding while
continuing attempts at-breast, the mom has more milk and the baby has been
fed and is less frantic and more alert. This gives us some breathing space to
decide what needs to happen next. Some dyads just got behind the power curve
because of birth medications, too many visitors, too many pacifiers, etc -
and after two days of concentrated efforts baby is nursing quite well at
breast.  More often, I find a lousy suck which needs more attention.

Linda Smith, private practice in Dayton OH where fall is gloriously beginning
with cool nights, sunny crisp days, and the grass has finally stopped growing
for the season.