Dear Kim,

First of all, in the situation of post-partum engorgement, I do not recommend pumping only to comfort.  I think that these moms need to nurse/pump/hand express until the breasts are quite soft and comfortable.  Milk production in the early days is driven by hormones, not supply and demand.  I often find that moms do not pump as much as they should for fear of stimulating even more milk production.

When I have a mom overproducing, we are using ice, cabbage, pumping/nursing almost around the clock until the problem resolves. She should be using a good hospital grade pump.  If she is very large, you perhaps might need to use the new larger flanges that Medela makes.  You might want to try to get her some syntocinon nasal spray to help with MER if that is a problem.  Warm compresses on the neck and massage there as well can also help with letdown.  Be aggressive.  The alternative is what you are faced with - the desire to wean.

Of course, there are some unusual women who overproduce no matter what.  In those cases, I would investigate the short-term use of estrogen-containing BCPs to put the brakes on.

Hope this helps.
Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
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