Now some LCs will say 8 pumpings a day is enough and it is for some  
mothers, but my
opinion is that 8 breast emptyings a day is the cusp of lactation, and  
I will explain why
soon enough, but first I want to address the exceptions that some  
people want to believe
create the rule.

There are some women- I will call them "performance outliers" for whom  
8 pumpings a
day is enough.

I would hazzard a guess that not only might these women endowed with a  
little extra
glandular tissue than the average mom, but they are particularly  
fastidious about dividing
their pumping evenly throughout the day and night so as to keep  
themselves just this side
of the permissive hormonal state for lactation.

Other performance outliers on the high end of milk production (moms  
who make a lot of
milk even with poor breastfeeding managment) maybe moms who have  
higher than
average circulating prolactin levels in the non-pregnant and non- 
lactating state.
Sometimes you can identify these moms because their naturally high  
prolactin levels give
them problems getting pregnant in the first place and sometimes they  
have a history of
cysts on their ovaries or other symptoms associated with Polycystic  
ovarian syndrome,
PCOS. (Other moms with PCOS have low prolactin levels and would have  
problems with
low milk supply even with good breastfeeding management...PCOS can be  
accompanied
by either extreme in prolactin levels, too high or too low)

But back to the average mom or the mom who is a performance outlier on  
the lower end
of milk production:

In order to be in the permissive state, hormonally speaking, for  
lactation, estrogen and
progesterone must be low. These hormones become depleted from the  
mother's blood
stream after the birth of the placenta. Once the mother's body has  
metabolized the
placental hormones the receptors on the milk making cells will no  
longer be occupied by
estrogen and progesterone. This means prolactin will be free to bind  
to the receptors and
exert its milk-making effect.

(To simplify the discussion I'm going to leave out discussion of other  
hormones like
insulin)

Prolactin levels increase 10-20 fold during pregnancy and yet milk  
production does not
commence until after the birth of the placenta- this tells me that  
estrogen and
progesterone preferentially bind to the receptors on the milk making  
cells.
That is, they  are "keys" with a better fit into the "lock" of the  
receptors than prolactin.

 From there I extrapolate that it is very very important that estrogen  
and progesterone
levels remain low during the time of exclusive breastfeeding. I know  
we LCs are told that
as lactation progresses mothers become less "prolactin dependent"  
because prolactin
induces the production of its own receptors and as more receptors are  
laid down "a little
prolactin goes a long way."

This makes complete sense to me, but I would argue that while mothers  
may have lower
prolactin levels as lactation progresses they are still dependent on  
prolactin as and if
you do anything to disturb prolactin production, or if you introduce  
estrogen and
progesterone pharmacologically or through poor breastfeeding  
management the mother's
milk supply will go down.

I think one of the reasons researchers believe so strongly that  
prolactin dependency goes
down is that as lactation progress it is more and more likely that  
solids are introduced
which mask the shortfall in the mother's milk production caused by  
slacking off on good
breastfeeding management or the introduction of estrogen and  
progesterone containing
contraceptives. (more about what solids say about a mother's milk  
supply later)

For some reason some people think a mom is still capable of producing  
the same amount
milk nursing under 7 times a day as she was capable of producing  
emptying her breasts
8-12 times a day, but I have never seen this in the real world.

In the real world as lactation progresses pump dependent mothers have  
a harder and
harder time getting the same amount of milk with same number of  
pumpings a day...if
anything it takes them more breast emptyings a day to get the same  
amount of milk they
could get in fewer emptyings a day when the prolactin safety net was  
still in place.(more
about the prolactin safety net later.) I know pumps are not babies but  
the same principal
seems to be operating in the mother with the baby directly at the  
breast.

Often a mother may have to nurse 10-12 times a day to bring the milk  
in, then she can
slack off to 8-10 times a day until the baby is 3-4 months old, but  
some time during 4-6
months postpartum she has actually got to nurse a little bit more than  
she did during
months 2-4 even if it is not as much as in the newborn period.

As lactation consultants we see women who are given progesterone, and  
even estrogen
containing contraceptives but most of the women we see with low milk  
supply have
introduced estrogen and progesterone into their own bodies with poor  
breastfeeding
management. They are not listening to their babies when they ask to  
pick up the pace of
nursing.

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