Hi all-
I haven't found inhibited MER in a mom in years. If the milk isn't letting
down, it's usually because supply is low.  She can't let it down if it isn't
there in the first place. And that's nearly always because milk is not being
removed from the breast by baby or pump. And THAT's usually either because
(1) the mom won't allow access to her breasts (by baby or pump) often enough
to remove the suppressing stuff in milk, or (2) the baby has a bad suck and
isn't removing milk, or (3) the baby is getting so many bottles or pacifiers
that at-breast time is severely limited (same as #1). The physical removal of
milk is the (or a) primary mechanism for galactopoiesis (milk supply
maintenance), and more evidence to this keeps accumulating in my files.

IMHO, stress isn't the issue unless sudden and severe, and then it's only
temporary. Such as a mom whose husband was killed in a car crash had slow MER
for about a half day. The baby's negative oral pressure (suck) and tongue
peristalsis are responsible for the vast majority of milk removal, I think.
The MER just gives the milk a little extra push to the front of the breast.
Any experts on fluid dynamics wish to discuss this further? This is what I
think is happening, based on 25 years helping moms and studying what goes
wrong in real life, and why.

Linda Smith, BSE, FACCE, IBCLC
Private Practice, Dayton OH