Jessica,

re: "If nipple preference does not exist, then what is going on when mom
introduces a bottle 2,4,6, even 8 weeks postpartum and baby gradually weans
from breast to bottle over the course of the few months that follow?"

IMHO it is not only a phsiological process that you are describing. It can be  more a psychological thought process.  The question arises, how often is that bottle being offered? There is a difference between 1 bottle a day and 4 bottles a day. (of course, the reaction varying from baby to baby). But if a mom is giving a bottle to begin with, that begins a weaning process from the breast. That 1) enables that mom to LEAVE her baby. (by choice) or 2) causes the mom to doubt her ability to bf the baby, as the baby shows less interest in the breast. The more often she leaves her baby or gives a bottle, due to perceived lactation failure or wanting to leave the baby, it is easier for her to give more bottles and easier for the baby to receive them.  It depends alot on her motivation and how she perceives this
OTOH, if the Mom determines that she will give one bottle only and has enough confidence, then maybe the "gradual weaning" would not have taken place. The word "gradual" is of importance here. I have seen more complaints regarding the babies that really refuse to nurse after very limited use of bottles, these arent gradual aversions. "gradual" implies that it is a process, which is most probably a (un)natural  weaning process as opposed to a sudden "confusion" or refusal. We may see less clients with "gradual" weaning because most of our clients obviously do not want to bottle feed , thus they turn up on our doorstep to stop the early weaning process before it is "too late".

sorry this got so long, could probably have said it in much fewer and more coherent words, but it is early in the day, and no time to edit.
Ellen Shein, IBCLC, LLLL Tel Aviv

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