Hi all, Coach Smith here again.

I just got back from Toledo after giving a lecture on "what drives milk
supply." To prepare, I dug into literally every reference book I have on my
shelves, read my notes from every lecture I've ever attended on the topic,
and listened to every tape that I have on the topic. We all know about supply
and demand.  The question is "what ABOUT demand drives supply?"

Here is what I found, in a nutshell:  (1) chemicals/compounds in the retained
milk block synthesis of new milk, AND (2) pressure of retained milk disrupts
the shape of the cells, which stops synthesis of new milk.  Probably in that
order.  Stimulus of the breast alone - without removal of milk - doesn't do a
thing.  I was convinced that if the baby has a poor suck, he can stimulate
the breast all day long, but  the mom's supply will quickly go downhill
because the milk isn't being removed.  I was right.

I was astounded to discover that Neville and Niefert's book (1983) has the
most useful information currently in print; and other major texts have either
undocumented theory, lots of detail on purely academic issues, or  virtually
nothing to say on ongoing maintenance of milk supply except the unexplained
phrase "supply and demand!"  I found no reference in any book to the role of
baby's suck.

Bottom line: supply and demand still applies. Only make sure the baby at
breast is actually eating, not just listening to the music in the restaurant!

The most common scenario I see in my private practice is a 7- 10 day old
baby, skinny, dry, not pooping, either very shutdown or screaming - and mom
with low/no milk saying "but he nurses all the time!!" Why? Baby can't suck
worth a fig.  Remedy: pump and cupfeed, keep trying at breast, and see them
back in 48 hours. Pumping starts rescuing the milk supply, while the calories
help organize the baby and nourish the oral muscles.

Linda Smith, private practice in Dayton OH feeling glad that I've spent all
that money on books and tapes over the years.