Hello Ladies,

I am just now catching up after a week that left me too busy to  
respond to the Liz Brooks
post about mothers with low milk supply and a care plan for increasing  
their milk.

Like others, it is with some trepidation that I offer my opinion or  
theories but it is by
taking these risks I think that we advance our field...or at least I  
hope so...

This is my view of how lactation works...I hope it is an accurate  
synthesis of the work of
the great researchers like Peter Hartmann, Miriam Labbok, and Ruth  
Lawrence, and
others and my mentors in La Leche League especially Joanie Randle...
plus a little bit of my own thinking and experience thrown in as  
seasoning...
but the meat and potatoes of this discussion are
definitely not my own....

There are basically two components to milk making

1) the mother must be in the permissive state hormonal speaking...this  
is referred to as
the "neuroendocrine control" of breastfeeding...the brain chemistry  
stuff...

2) there must be effective milk removal from the breast because the  
volume of milk
made is controlled by the breast itself- this is called autocrine  
control, or as LLL puts it,
the breast "obeys the law of supply and demand."

The volume of milk produced is controlled by that whey protein known  
as FIL...feedback
inhibitor of lactation...when FIL sits in its receptors milk synthesis  
slows...when FIL is
removed milk synthesis speeds up, so the emptier the breast the faster  
the rate of milk
synthesis.

So when we see moms with a low milk supply we must determine on which  
of these two
fronts, the hormonal front, or the milk removal front we need to  
attack to solve the problem.
In some cases we will need to attack the problem on both fronts.

Let's address the autocrine control front first because it is the most  
straight forward.
If the mother has been getting nipple stimulation 10 or more times a  
day she is in all
likelihood in a good permissive state hormonally speaking and the  
volume of milk
production is low because the baby has not been able to remove the  
milk effectively.

The cure is pretty straight forward- try to get a deeper latch, and if  
you can't fix the latch
problems immediately with re-positioning, the mother must pump until  
the baby is able to
get a deep latch and withdraw milk effectively.

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