Itching breasts on the inside: I have found this can sometimes be helped by a slight positioning change. Usually the baby has a good latch in terms of plenty of breast tissue and no nipple/areola friction to cause discomfort but is slightly off centre. Eg if in the cradle hold the baby might be a little to far towards the mother's upper arm or a little too close to the centre line so the nipple is being tugged slightly on one side. This is very difficult to describe in text form! Often its easiest to do a total position change eg from cradle to clutch to get it feeling Okay.
I had two mothers in a month a coule of years ago with varying degrees of nipple dimpling and in the absence of the dimple ring the BAB suggested we went with using  a drier on no heat setting (ie cool) to air dry after the feed and a light glaze of a product with as similar properties as possible to Lansinoh (also not available in NZ at that time). The theorising behind that was to act as a protectant against milk gathering in the crevice between feeds. Both mothers found considerable relief quite quickly from those measures. And once the trauma had healed which did take a while longer (cant remember exactly as they were quite relaxed once the pain was gone) they just naturally stopped as  it was comfortable.
In NZ low supply at four months tends to be attributed to cultural reasons rather than a poor start. In particular the mother's diet and activity levels. In recent years i have often started asking if she has joined a gym recently. Also around three to four months mothers can become more frustrated with the frequent feeding of the breastfed baby. equally it is not uncommon for a mother to wonder if she is losing her milk because her baby isn't so interested or is spending less time at the breast when all that is happening is the baby isn't always hungry (needs other mothering) and/or has just become super efficent at "milking" the breast. As for fenugreek, blessed thistle, oatmeal etc I remember reading many years ago in the Stanaways "Breast is Best" about some reasearch that had shown just really wanting to breastfeed increased your milk supply by a significant percentage. Personally I'm uncomfortable with galactogoges (sp) A well positioned baby with unrestricted frequent access to the breast used to do the job of increasing supply fifteen years ago. Different "favorites" for increasing milk supply come and go but usually in association with a recomendation for that feeding pattern. Too often I get counselling calls where a HCP has recommended a galactogogue (or expressing after feeds) to a mother without discussing whether a genuine problem exists (eg low urinary output) or suggesting more frequent feedings. Yes there are a small number of women who seem to struggle to keeping up a supply, just like there is a small number of women who struggle with consistent oversupply. But it seems to me the key is believing in our bodies ability to meet our infants needs. BTW the mother of the four month old with the slow let down hasn't been using teething gel before feeds by any chance? The numbing effect could possibly delay let down. There are also some good resources on encouraging let down on the LLLI site in the "Making it work" articles.
Sonja ( who has just had one of those calls from a mother where you would like to make a formal complaint of incompetance about her so called health professional!)

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