Hi, Lisa,  We met at Boca Raton.
    Re: Lisa's case, the mother with the 5-month-old baby and low supply:
    Have you looked in the infant's mouth, and at the family history?  Some babies with slight or moderate tongue-tie seem to cope just fine at first, and the tongue-tie might not have been identified.  However, if they don't have enough tongue elevation (lift) to "milk" the breast effectively, eventaully this deficit is going to tell.  In some babies I've seen, it doesn't catch up with them till after 2 - 2 1/2 months, and the mothers usually leave it a few more weeks, struggling on valiantly on their own, before seeking IBCLC help.  By that stage, the supply is a mess.
     I'm not saying that this is necessarily the situation with this mother, as there appear to be some other issues, but it is still worth checking out, even if only for the purpose of elimination.  Sometimes puzzling cases seem to be a mix of several factors, none of them big enough to their own to sabotage breastfeeding, but when several factors combine, they can made a difference.  The trouble is to tease out several seemingly minor factors, and identify them.
       Good luck.
                 Virginia 

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