I am always grateful when people share the "what happened next..." part of cases they have shared on line. Here is an update on the story of the grand multip I was working with. To briefly re-cap for newcommers, she was G8P7 (one miscarriage between baby # 4 and 5.) Fully breastfed all her first 5 children for about 1 yr each. She experienced ftt w/ baby #6, and went early to formula when nothing she did brought her milk in beyond a low supply. She had her 7th baby home birth as usual, no meds, no excessive blood loss, everyone healthy, no appar. sucking or swallowing prob. with either infant or past baby now 24 mo. (whom I saw in office and assessed speech and oral-motor as best I can; both seemed normal and well-functioning.) We used super-positioning, good feed management, freq. feeds, SNS with formula to get baby over growth faltering and back to strength, post-feed pumping, deep breast massage, diet and rest were always decent, mother had some stress, but nothing really out of the ordinary. She had thyroid levels read (including TSH) and all are border-line low but WNL. Endocrinologist says nothing significant there. I spoke to mom last week to see how things are going (baby is approx 3 mo old). She never felt any increase in supply, has stopped pumping, and basically pacifies at breast and feeds formula by bottle. Baby is well, seems to like nursing more than Baby #6 who would not nurse once he had bottles. She is grateful this baby likes to be at breast. But we are no closer to understanding why a proven producer would stop being capable of producing enough milk to sustain her infant. I did come across one old piece of reseach from Scand. lit (at office, sorry) which talks about greater risk of maternal mortality in grand multips. No specific mention of physical stress creating non-fatal (to mother) risks such as depletion of energy or physical stores which might affect lactation. So anyway, we end no smarter than we began. That's the way it sometimes goes. Barbara Wilson-Clay, BSE, IBCLC priv. pract. Austin, Tx