In regards to early milk removal affecting long-term production, there are cultures where it has been customary for mothers to feed substitute foods (various teas, mashes, etc) for the first few days, at least until the milk surge has begun and the colostrum is transitioning to more mature milk (ie, colostrum is bad). In my understanding, at that point the moms begin nursing pretty much ad lib and usually have no problem with supply.  Also, in my experience, if I have a very engorged mom pump out her breasts, there is usually no rebound effect - it does not trigger the production of even more milk, in fact, it generally leads to a pretty immediate relief as long as mom then nurses frequently thereafter.  So I see a "grace" period, so to speak, before the autocrine system really begins to kick in.  However, I think that there is probably great variability in each mom and even in each breast to respond to various insults that may occur during the first week or two, including severe engorgement or lack of stimulation/milk removal. For that reason, I think that is it helpful for the majority of moms to nurse early and often, thus sidestepping any potential problems.  As research continues, it may help us to fine-tune our recommendations and also to better help those moms who do find themselves in the various predicaments that we run into so often in our practices.
Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
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