Pat Bucknell wrote: < it takes probably 5-7 min of post BF pumping before another MER kicks in and then she'll get another one maybe 5 min later. > You are on the right track. Veterinary sources, at least, say that the MER is the single most powerful force in milk transfer. I think part of her situation may be that one can't get the same positive emotions from a pump as from actually feeding the baby. Nor does a pump always give as strong stimulation of the nerves deep under the nipple as a vigorous baby with a good latch. It is not necessary to wait passively for an MER. And pharmaceutical help is probably not needed. Is she making use of Dr. Jack's explanation of breast compression during the feedings? That usually stimulates extra MER's, in addition to direct manual assistance of milk delivery (of the higher calorie milk, at that!) Another of the simplest ways is to deliberately stimulate the nerves passing deep through the nipple-areolar complex. This can be done either by grasping the nipple at the base and very gently twisting and tugging for 20 seconds or so, or by using the Marmet method, which includes overall massage, gravity, and deep fingertip extraction. I imagine you are familiar with the LLL sheet on this. I tell the moms to expect to wait about 3 minutes after stimulation for it to happen, before they start pumping (or feeding, if it's an attempt to save baby from the stress of OALD.) Remember that it is not like a knee-jerk reflex. It is a 2 part reflex, involving not only nerve pathways, but hormone secretion and circulation of that hormone to the target tissues. The nerve stimulus of course travels rapidly. But more time is needed for the pituitary to release stored oxytocin into the blood stream in the brain in sufficient quantities, (especially if stress related hormones are inhibiting the pituitary circulation). If I am describing it correctly, it must then travel through cerebral and neck veins down into the right side of the heart, through the lungs and back into the left side of the heart, out the aorta and into the mammary arteries and from there into the smaller arteries, and then into the tiny arterioles throughout the breast, in order to reach the myoepithelial cells. Only after that sequence occurs does it start to produce compression in the alveoli and shortening and dilatation of the ducts, soon resulting in visible increase of milk exiting more rapidly from the nipple. <Another question related to the pumping. . . . mom said it really wasn't any more comfortable and she thought the nipple being squished with the smaller flange might actually help get the milk out. Can that be?> Who knows but what the mom is perceiving is really a result of a stronger stimulus to those nerves inside and deep beneath the nipple? But another possibility for the use of the larger flange is that it often draws milk sinuses deeper into it to "squish" themselves against the inner opening of the flange. Remember my mantra: "The vacuum acts first on flesh, not on the milk in the breast." Only after the milk leaves the nipple openings does the vacuum act directly on it. I hope she can be reassured that the baby's mouth and vigor will eventually grow so she can experience less work and worry, and more pleasure. Her perseverance is to be commended. Jean ******************** K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html