I think on this list we have alot of theories about overproduction and mine
is obviously one of many.  Part of the problem with this discussion for me is
that I have a different vocabulary than everyone else--my problem not yours.
So I am hoping that I can explain myself better this time around.

My understanding of the regulation of a milk supply during stage III
lactogenesis is that it is primarily dependent on infant demand.  I think
most would agree with this...I hope.  If this is so, then it is hard for me
comprehend oversupply.  It would seem that a true oversupply would be a rare
occurence and that this problem would not be corrected by changing infant
nursing patterns Yet my impression from various posts on Lactnet is that
oversupply is not a rare problem in lactation.

Lactogenosis I and II are hormonally driven, right?  Thus, we have mothers
who may bring in an amazing amount of milk 24-48 hours after birth (or even
later)--many suffer from engorgement during this time period.  I often hear
mothers being told that it's as if nature thinks you are having twins.  As
the milk producing tissue become dependent on infant demand, the system which
was primed by hormones is now driven by infant demand.  This system is pretty
amazing and it would seem to me that oversupply could only be related to an
imbalance in the system--meaning the mother and infant are not in sync with
with each other.  It could be the infant is the problem--ineffective suck,
weak suck.  Or it could be the mother--erractic nursing, mother determining
length of feed, lifestyle so busy mother does not take time to nurse.  Yes
and then it could be something all together different--that rare problem.

If the early days are mismanaged, then the problem of getting production in
line with infant demand might take longer than normal--possibly weeks or
months--particularly when mothers assume that full and leaking milk between
feeds are a good sign.  The early days in lactation and weaning  have this
common problem--a milk supply out of sync with the infant. Mastitis and
weaning are events that are often intricately intertwined.  Mothers start the
process of weaning or skipping feeds and develope mastitis.  The milk cells
become full of milk.  When milk is not released the cell junctures that were
tight become "leaky." Cell junctures are also leaky during the early days of
lactation.  Higher levels of sodium and lactoferrin are found in women with
mastitis and during rapid weaning.  Do full breasts create some leaky
junctures or is it just the breast undergoing weaning or the breast with
mastitis? Is this a system to protect the breast (although mastitis shows
that somehow the sytem of protection failed) or to protect the infant or
both? Lots of questions in my mind..

Cathy Fetherston was right in correcting my reference.  It is definitely
Peggy Neville's research that I was thinking of although I believe that Semba
was referring to her research.  I still think that what we are seeing in
women with full and leaking breasts is more than likely not a true oversupply
but a management problem of lactation.     In the early weeks mothers maybe
skipping feedings because they have enough milk for 2 babies and there is no
problem with supply.  I would call it a kind of weaning--weaning down a milk
supply.  Mastitis, too, can be caused by skipping feeds or erractic nursing
patterns.  Weaning is about skipping feeds--usually replaced by other foods
or drinks but could include pacifiers.  Thus skipping feeds is the thread
that binds all these problems.  So that is why I said that it is not
surprising that women who have oversupply problems have high levels of sIgA
and lactoferrin.  If oversupply is about skipped feedings and a milk supply
trying to readjust to a lower level, then it is entirely possible in my mind
to imagine that the alveoli cells are swollen, the junctures opening up and
allowing more immunoglobulins to be released into the milk.  Yes, speculation
on my part and quite possible that my understanding is wrong.

My concern is this.  How are we defining oversupply?  Ann you mention some
common observations of oversupply.  Yet how can we narrow those observations
down.  For example, is leaking from the other side during a feeding a
distinquishing feature of oversupply?  I think that it is normal for most
breastfeeding mothers to leak from the unnursed side.  I am not sure about
the observation of a breast filling quickly after feeds--I think that is a
very subjective observation. Many of the observations you mention, I have
seen in some breastfeeding couples and yet I don't think they had an
oversupply problem. How can we distinquish overproduction from some other
problem or no problem?

You all may be seeing oversupply cases that are not caused by mismanagement
of lactation but I find that pretty remarkable because it means that the
normal working of the system based on infant demand has gone haywire.  How
common can that be?  Valerie W. McClain, IBCLC




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