Pat Bucknell wrote:

< it takes probably 5-7 min of post BF pumping
before another MER kicks in and then she'll get another one maybe 5 min
later. >

You are on the  right track. Veterinary sources, at least, say that the
MER is the single most powerful force in milk transfer.

I think part of her situation may be that one can't get the same positive
emotions from a pump as from actually feeding the baby.

Nor does a pump always give as strong stimulation of the nerves deep
under the nipple as a vigorous baby with a good latch.

It is not necessary to wait passively for an MER.
And pharmaceutical help is probably not needed.

Is she making use of Dr. Jack's explanation of breast compression during
the feedings? That usually stimulates extra MER's, in addition to direct
manual assistance of milk delivery (of the higher calorie milk, at that!)

Another of the simplest ways is to deliberately stimulate the nerves
passing deep through the nipple-areolar complex. This can be done either
by grasping the nipple at the base and very gently twisting and tugging
for 20 seconds or so, or by using the Marmet method, which includes
overall massage, gravity, and deep fingertip extraction. I imagine you
are familiar with the LLL sheet on this.

I tell the moms to expect to wait about 3 minutes after stimulation for
it to happen, before they start pumping (or feeding, if it's an attempt
to save baby from the stress of OALD.)

Remember that it is not like a knee-jerk reflex. It is a 2 part reflex,
involving not only nerve pathways, but hormone secretion and circulation
of that hormone to the target tissues.

The nerve stimulus of course travels rapidly. But more time is needed for
the pituitary to release stored oxytocin into the blood stream in the
brain in sufficient quantities, (especially if stress related hormones
are inhibiting the pituitary circulation).

If I am describing it correctly, it must then travel through cerebral and
neck veins down into the right side of the heart, through the lungs and
back into the left side of the heart, out the aorta and into the mammary
arteries and from there into the smaller arteries, and then into the tiny
arterioles throughout the breast, in order to reach the myoepithelial
cells.

Only after that sequence occurs does it start to produce compression in
the alveoli and shortening and dilatation of the ducts, soon resulting in
visible increase of milk exiting more rapidly from the nipple.

<Another question related to the pumping. . . .  mom said it really
wasn't any more comfortable and she thought the nipple being squished
with the smaller flange might actually help get the milk out.  Can that
be?>

Who knows but what the mom is perceiving is really a result of a stronger
stimulus to those nerves inside and deep beneath the nipple?

But another possibility for the use of the larger flange is that it often
draws milk sinuses deeper into it to "squish" themselves against the
inner opening of the flange.

Remember my mantra: "The vacuum acts first on flesh, not on the milk in
the breast." Only after the milk leaves the nipple openings does the
vacuum act directly on it.

I hope she can be reassured that the baby's mouth and vigor will
eventually grow so she can experience less work and worry, and more
pleasure. Her perseverance is to be commended.

Jean
********************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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