When a mom pumps "low fat" milk, she's very likely not emptying the 
breast well. The first thing I'd try is checking the pump and pumping 
technique. Make sure the valves are intact, everything is put together 
correctly, the nipple tunnel is wide enough, and she's not setting it 
incorrectly. (Some mothers use high speed for the entirety of pumping, 
which is less effective than just using it for the first few seconds to 
get an MER). For pumps with multiple settings, I like to use high 
speed/low vacuum until a drop of milk is seen at each nipple, then 
switch to medium speed, and raise the vacuum gradually until sprays of 
milk are obtained from each breast.

If all looks right but it's still not working, try a different pump. If 
one metal piston hospital grade pump does not seem to work for a mom, I 
encourage her to try the other brand. Medela and Ameda have slightly 
different suction curves (Ameda's is more sustained at the height, 
Medela's comes down more quickly) and some mothers respond better to one 
than to the other.

Encouraging mom to stop and massage for 5 seconds after the MER subsides 
might get her another one. I usually encourage moms to pump for 3 MER's 
if possible when trying to increase production. It just seems to help.

Is mom willing to supplement at the breast? That can help as well, by 
giving the baby the incentive to work in a more sustained manner.

Catherine Watson Genna, IBCLC  NYC

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