Lyla says,

> in light of the discussion about early and often to reduce engorgement (and
> i have not seen any answers to someone's question re: *why* that would help
> given that Lactogenesis II occurs regardless of stimulation (endocrine
> control), is there a consensus about whether we should expect that a mom of
> a sleepy, ineffectively nursing baby might have a sluggish supply from
> moment one of lact. II, or are we more likely to see obvious signs of
> ineffective milk removal, such as engorgement, discomfort, and leaking,
> followed later by suppressed supply due to feedback inhibitor/cell
> apoptosis, etc?
>
>

I've been hesitating as to whether or not I should share my own personal
experience -- which is subsequently the reason I became an LC -- but we've
never gotten any good answers as to what happened to me....Bear in mind that
this was 18 years ago, and said reason for my being an LC is happily
ensconsed in the college of his choice...

Brief history:  two girls born 4 years apart, milk supply adequate -- never
stellar.  Of course, what I knew about breastfeeding on demand 28 years ago
would fill a "Baby(un)wise book" with ample materials.  I could have passed
for the Exxo poster-mom.  However, other than a severely sore nipple w/ baby
number one, and a severe mastitis (L breast) which resolved w/ penicillin w/
baby number two, there were no incidences of note.

Fast forward -- 1984 -- and the WWM is born (at home -- no drugs, no nothing.
 Great story for another time & place).  He doesn't latch.  Nope -- no
interest.  This lasts for at least 5 days.  By day two I'm on a hospital
grade electric pump (Medela classic).  I pump LOTS.  I'm thrilled when on day
4 I'm actually able to pump an entire ounce.  Tim still not latching.  His
weight is down, he's jaundiced (17), and I'm feeding him via tube and syringe
(hadn't seen anything like this at this point -- just made it up).  This is
before the SNS is invented, though the Lactaid is, and I'm reluctant to use
it (don't know why -- just am).  Finally latches -- he's a wimpy sucker
(hence the WWM appelation), but we are getting there.

NO evidence of lactogenesis II, no engorgement, no fullness, no nothing.
Milk (such as there is) gradually changes from yellowish to white --
ultimately I am able to pump a grand total of 3 ounces from the right, 3 ml
from the left when I go back to work at 7 weeks, using the hospital grade
pump.  Tim is on the breast for 1 hour every 1.5 hours.  I have 30 minutes to
do something/anything before he's ready to breastfeed again.  Knowing what I
know now, I would realize he's simply not getting enough, and would have used
the SNS (or a reasonable facsimile thereof).  The most I'm ever able to get
from the left breast is 3 ml -- generally not more than drops.  We finally
settle on breastfeeding plus supplementing after every other feeding in order
to get him enough to eat.  At that he moves to breastfeeding about every two
hours for an hour -- I have a whole hour to do something, and I hardly know
what to do.  (We actually watched game shows in the am, and read books in the
pm).  We finally quit trying on the left breast at 7 months, bf only on one
side for the remaining 5 months before we gave it up w/o a whimper on his
part, or any subsequent "engorgement" on mine.  Never did experience ANY
fullness, anything that would even faintly resemble fullness or change in the
breast.  And yes, I had normal breast changes during pregnancy.  The only
thing that may have been a factor was the mastitis w/ baby 2 over 6 years
before, my age (38), and/or his wimpy nursing (which I augmented w/ a pump.

So I'm not convinced that lactogenesis II occurs "regardless."  But then, I'm
an "n" of one, and what it did was push me into lactation consulting for
better or for worse.

And of course, the sheer fact of having Timothy made me NOT go into
midwifery.

Hmmmm.....
Jan Barger, RN, MA, IBCLC -- Wheaton IL
Lactation Education Consultants
www.lactationeducationconsultants.com

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