Jay, I have worked with a few moms who didn't have proper MER. Their babies are unable to receive the calorie-rich hindmilk because of the failure of oxytocin release. Two things happen: 1. The baby tends to be hungry frequently, and 2. The baby fails to gain weight sufficiently. If we define "successful breastfeeding" as a relationship which satisfies babies physical and psychlogical needs, without the MER it cannot occur. A mother could use a supplementer at the breast to help the baby receive the calories he is not otherwise receiving. In this way she could breastfeed successfully until she is able to experience oxytocin release. However, there are many moms who experience MER without ever feeling any physical sensations. The only signs are the change in the suck/swallow pattern, and perhaps milk leaking from the other breast. I'll be interested to see the results of your survey. Glenni Lorick, B.S.E., I.B.C.L.C. San Jose, Costa Rica [log in to unmask]