Christine, These cases are a mystery. I suspect that she did not have "lots of milk with her first" 7 yrs ago, but had short-term breast fullness (she did not bf) which she interpreted as plenty of milk. Because she was not removing the milk by expressing, nor bf, she felt very full for a day or so. I have seen this many times, where the mother reports "her milk is in" but in fact it is a short-lived event, and even with expressing and bf, the milk supply remains very low. With her second child, who she did initiate bf, she "had no milk come in." There is so much to learn as far as the effects on lactation of premature birth, delays in effective bf, or effective milk removal by expressing, hormonal milieu, insulin resistance, increased body mass index or obesity, etc. Several of these things could be affecting this mother, even in a small way, but having an additive effect. To counsel this mother, as you know, you will have to determine her goals (milk volumes to bottle feed, feeding at breast, how many months, etc). If she is mainly interested in providing ebm to the fullest, then you could talk to her about rental pumps and nutrition and galactagogues. If she is mainly interested in feeding at the breast, you could offer one of several lactation aid devices. In my vast experience, when a mother with a very low milk production attempts to breastfeed without a lactation aid and supplement by bottle, the baby will soon reject the breast and become completely bottlefed. On the other hand, a mother who tries to bf, pump after each feeding, bottlefeed the supplement will soon become exhausted and unhappy. So I see the most practical choices are 1. feed at breast with lact aid, 2. feed expressed milk and supplement by bottle. Of course it is the mother's choice, even to do something other than these 2. Laurie Wheeler RN MN IBCLC MISSISSIPPI USA *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome