I faxed the posts from the past few days to Kittie Frantz earlier today and
received the following.  I will type it verbatim.  Any comments, complaint or
criticisms sent via e-mail, I will be glad to pass along.  If you wish to
send her a personal reply and by-pass me, fax her at 213-257-7209.

Sent Monday, 5 Feb 1996
Subject:  Multiple letdowns
I agree with Maureen Minchin that women do experience multiple let-downs
during one feed.  I have noticed infants start a feed with a rapid
non-nutritive suckle and then change to a slow deliberate one-per-second
suckleswallow when the let-down occurs.  the infant seems to take in that
milk at the steady one per second pace until the milk flow slows and then the
infant returns to the more rapid suckle without much swallowing.  Then all of
a sudden the infant's eyes open and he is back to a one per second suckle
pattern with a swallow with each suckle.  The infant seems "caught by a
let-down."  McNeilly , AS; Robinson, IC; Houston, J, Howie PW: "Release of
Oxytocin and Prolactin in respnse to Suckling" BR MED J (Clin Res) 1983  Jan
22; 286(6361)257-9 found a pulsatile release of oxytocin during the feed.
 Their study was unique to others attempting to study amounts of oxytocin as
McNeilly measured the blood continuously and previous researchers measure the
bliid occasionally in the feed. (The skin pricks alone would have altered the
amount in those previous studies wouldn't you think?)  McNeilly's group used
a butterfly they inserted well before the feed and left in in -sans no pain
to interfere with the oxytocin levels (Newton N; Newton M.  "The let down
reflex in human lactation: J PEDIATR 1948;22:1179-88.)  McNeilly's groups was
looking mostly as to when the first let down occurred and in seven out of ten
samples the first let down occurred when the baby cried, got restless, or
mother prepaed for the feed.  Prolactin did not kick in until after the baby
began the feed.  If you look at McNeilly's charts in the study, you will see
that the samples indicate that there are 4-5 spikes of oxytocin and prolactin
in the first 15 minutes after the baby starts sucking.  It would seem that
this "baby driven" phenomena indicates that the baby drives the manufacture
of the milk and its release according to his own need during the feed itself.
 This again proves the continuousf feed idea of Klaus and Kennell and belies
the old advice that we have fought for years that "milk is stored up in the
breast over four hous and released all at once in five minutes to the baby."


For the last 6-7 years I have discussed this in class at the UCLA Lactation
Educator course and have done a little fun survey of each class of 35
students.  I ask how many felt let-downs.  All but 2-3 hands will go up.  The
I ask how many felt more that one let-down per feed with any child they
nursed.  About 3/4 of the hands would to up.  Then I ask, how many let downs
do you feel?  Most students will answer 2-3 but one woman said ten and
several have said eight.  The students then volunteer that it is different
with each child that they have  nursed.  The "slow feeders" don't create the
sensation of let-down as much as the fast efficient suckers.  Then Is uggest
that the students watch and count the let-downs of the mother-baby dyad they
are supposed to follow for the first weeks of breastfeeding (without mother
knowing what she is doing).  See how many you can count is my challenge.
In the early 1980s I has mused during lectures taht I thought there were
multiple let-downs during a feed by my observation of patients.  I think
McNeilly proved this in 1986 and many experienced lactation professionals
have observed this, let alone the millions of women who have nursed babies
and been tuned into their babies and bodies enought to have noted it as well.
 When will we give up the "rules" we give to new mothers about timing feeds
and when to switch breasts and encourage them to tune into their babies and
listen for the wonderful swallowing and cadence of let-downs? We might have
more confident, empowered mothers and much happier babies!