Boy this sounds like a real tough one to figure out!! I had a couple of thoughts as I read your post for Robin, Lisa, but none are extraordinarily insightful - please don't be offended by the simplicity herein. If the baby seems to be overly sleepy at the breast, can the mother: gently waken the baby with an *air* bath while breastfeeding, gently employ the valsalve maneuver to waken baby prior to breastfeeding, use a cool washcloth on baby's tummy, legs and feet prior to or during the feeding, wear baby in a sling sitting upright between breastfeedings, get some fresh air in baby prior to a feeding (sorry, if mother is in a cold climate and this is inappropriate), have some rock'n'roll music playing as mother begins to breastfeed. If this situation appears more like a nursing strike type of infant response, possibly some quiet, protracted skin-to-skin time in the mother's bed, or a long soak in a warm bath with baby positioned at the breast, a few candles for dim lighting, and a hummed lullabye... If you or Robin suspect that the mother's MER is delayed and the baby is responding to this by sucking three times and quiting (as opposed to the mother responding to the lack of sucking stimulation with a delayed MER) then the last two suggestions as well as possibly refering the mother to someone trained in maternal-infant massage therapy might be a consideration. Again, I realize just how very basic this *stuff* is, I felt a need to review the obvious before I ventured into the next part. Two more concerns hit me as I read and re-read your post, Lisa. The first is the kidney stones - though I have no knowledge of a conncection between these and a delayed MER as such. I have had personal experience with kidney stones that passed - I'm struggling with the idea that one can eliminate these from one's body without any discomfort. The residual pain, irritation, general discomfort might be hampering her ability to concentrate of breastfeeding her new baby. What alerted this woman that she may be currently trying to pass stones - what prompted the ultrasound one week postpartum? pain?, discomfort?, routine examination? Does the mother find any of this distracting to the process of postpartum recovery? Is she being encouraged to drink excessive fluid in her attempt to pass the stones?Any other diet/life style changes suggested for the kidney stones? My second thought was when you mentioned that the mother has, "...an anorexic personality, is already back to prepg wt." Is the mother a naturally slender woman?, possibly with a high basal metabolic rate?, one of those few women who gain just so much during pregnancy and lose the very same poundage the day they deliver? (I do believe there are a rare few like this in the world - unfortunately I am not one of these, though I dream...). Or is she a woman who when faced with circumstances beyond her control turns to her diet as SOMETHING in her life to gain control over?, does this mother interpret the baby's falling asleep at the breast as a rejection of her mothering efforts, as well as her milk? From your post, I gather that the mother has an unpredictable MER response to the breast pump as well as to the baby, am I right? Possibly experimenting with conscious relaxing techniques while pumping might act as biofeedback, letting the mother learn how and when she respondes with a MER? Lisa, you also don't mention the two year old's response to the new baby. Was this positive or negative? Did the two year old ask to nurse? How does the mother feel about "dividing' herself between the new baby and her old baby? Also, has the new baby's total weight gain from day 10 to day 15 postpartum continued to increase? by how much? The frustration of these kinds of challenges to breastfeeding are enough to make a committed breastfeeding advocate crazy, aren't they!! Good Luck!! Jeanine Klaus, MS, IBCLC Oakville, Ontario