Have you investigated overactive MER as the cause? Very often an overactive letdown can be quite uncomfortable. Does the baby do a lot of gulping and sputtering on the breast? Does s/he have green stools or frequent tummy aches? Does mom's milk spray or eject forcefully? Does she leak a lot and suffer frequent plugged ducts? These are all symptoms of Overactive ejection reflex. I wrote an article on the subject in 96 or 97 for Leaven and it is available on the LLL website. Usually what I do is put the mom on a 3-4 hour on one breast cycle, baby can have the breast as often as s/he wants, but the same br is used for the 3-4 hour period. A small amount can be expressed form the other side if the mother becomes engorged. At the end of the 3-4 hour time, mom starts using the OTHER breast FIRST removing the baby during the first letdown of each nursing session. The milk is directed into a cloth diaper and the mom reattaches the baby after the letdown. This is continued for as long as the symptom presents itself. This technique may "tame" the mother's ejection and balance the hind milk and foremilk. The baby should still be having the requisite no. of wet and poopy diapers. If the baby's output decreases, go to one breast per feeding and nurse VERY frequently. If the mother goes too long between feedings her ejection will be even more painful. Warm compresses, before and after nursing and an anti- inflammatory or narcotic analgesic is often used until mom is more comfortable. Mary Jozwiak IBCLC Private Practice, LLLL, AAPL *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html