Laurie I wish it was all clear cut and we knew exactly what happens - maybe
one day we will - we've got some great researchers and IBCLCs out there
asking questions and getting answers.
The prolactin receptor theory would support early and frequent expressing
to ensure a good ongoing supply.  With this theory it is felt that receptor
sites are laid down on the lactocytes and the number laid down is
influenced by the 'need' for these sites during these very early days.  In
our previous discussion you will recall that as serum prolactin levels drop
to near baseline the ability of prolactin to move into the lumen of the
alveolus to form the substrate of breastmilk (ie milk prolactin) is more
important in controlling milk synthesis than serum levels.  If there are
lots of receptor sites on the lactocytes, then, despite baseline levels of
serum prolactin, it is well and efficiently used by the lactocytes and milk
production is bountiful.
Many IBCLCs will tell you that this is their experience too - poor
stimulation in the early days means poor lactation down the track.  Whether
this is the reason for this result or not though has not been proven -
hence it being called the prolactin receptor 'theory'.  Could it be the
subsequent severe engorgement and cell apoptosis (death) that some women
suffer when their breasts were not adequately 'drained' right from day
1?  Could it be a psychological result - there are several studies that
show that when babies receive formula in hospital their mothers breastfeed
for shorter durations.
That the milk will come in regardless we all know - it's hormone driven,
though your mother does have risk factors for poor initiation of lactation.
However, I also have a study here somewhere on women expressing for preterm
infants.  They found that women who either started pumping early or late
then both continued pumping frequently and efficiently showed no
differences in milk volume in the coming weeks.  However early initiation
and infrequent pumping gave better results than late initiation of pumping
and infrequent pumping (neither, of course, as good as the frequent pumping
groups).
I guess it all comes down to the fact that for every woman there is a
variation to the rule.  Some will react very poorly to poor initiation of
lactation, others will get over it quickly and have no ill effects.  I hope
this is the case for your mother.

IMO - I would express early and efficiently.  I would save the colostrum,
because we know it is not detrimental to this infant.  If the doctor won't
let baby have it yet (where's the evidence for this - see a previous post
of mine titled Do No Harm), then I would keep it for a few days until baby
is 'over' the worst of the drugs he received in utero and give it to him then.

Good luck and I hope your mother recovers quickly and gets on with enjoying
her new baby.

Thanks for the prolactin reference Sara.
Lisa could you refer me to the article on prolactin resistance - now that's
interesting!!

Denise



*************************************************
Denise Fisher MMP, BN, IBCLC
BreastEd Online Lactation Studies
http://www.health-e-learning.com

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