When I see post on Oversupply Syndrome , like the recent ones about  
bloody stools, I am convinced that very few people got the message  
(points) I was trying to make in  my lecture on the subject at ILCA  
in July.   It is unfortunate that 2 of us were scheduled to speak on  
the same topic, on the same day. ( I had a small break out group and  
the other speaker had the house.)

First  Can we please stop calling it "block feeding?"    "Block  
feeding" isn't physiologically sound beyond a certain point; roughly  
3-4 hours. I think Hartmann's research will prove that out. When we  
as LC's make recommendations for alterations in natural feeding  
patterns, those recommendations must have some basis in physiology.

Are you aware of what moms are ACTUALLY doing out there? My own  
practice is primarily internet based these days.  Some of the cases  
that make their way to me are beyond belief.  What do I know for  
people, in general, is true "if a little is good--more is better,"   
The number of hours these moms go using only one breast  is beyond  
ridiculous. Going 6, 10  or even 18 hours on a single side boggles  
the mind (believe it or not, mothers are out there doing just that).  
They are feeding the baby in positions that are painful, and may lead  
to plugged ducts and mastitis; fretting over when it becomes hind  
milk; figuring (albeit wrongly) it's a easier to pump and bottle feed  
if the "letdown" is the problem; or they pump off ounces and ounces  
before a feeding to get to the hind milk for their babies; only to  
have the breast continue to oversupply. etc, etc.....

Moms read something on the internet and do what ever treatments sound  
"reasonable" to them without any supervision and with very poor (If  
not dangerous) results and unfortunately in many cases they tell me  
they've "already seen a LC."  I don't know if I should be angry or cry.

You aren't going to get a "hyperactive letdown" to calm down until  
there is a more natural resting state in the lactating breast.   
Frankly,  I have never witnessed anything as forceful as the first  
letdown in any mom (in the 20 plus years I've been doing this). If we  
are going to "blame" problems on a letdown reflex that is too strong,  
then we as a profession, must "study" to see if all letdowns in a  
feeding are equally as forceful and that really is where the problem  
lies. It may be that we find that  in most women the first letdown is  
the only one of concern. Then we can take appropriate steps to help  
take some of the force out of the initial letdown.

Oversupply syndrome affects both mom and baby. So while we are busy  
giving mom all sorts of things to do, what have we done,  treatment  
wise, to help the baby? Or have we focused our "treatment" entirely  
on the maternal side  blaming mom (yet again) for having a problem  
making correct milk .

The baby is having bloody stools because the digestive system is so  
irritated. The infant gut is hyperactive because of a lactose  
overload. The swollen belly we see post feeds is from a massive  
accumulation of gas. I compare what's going on in the baby to the  
diarrhea phase of someone with irritable bowel syndrome. (When my IBS  
acts up after hours of diarrhea I have some blood in my stools), my  
stomach (belly) distends to 8-9 month pregnancy size and I am pretty  
uncomfortable. For me eating is not going to fix the problem it will  
only worsen it. For a baby on the other hand, because they react to  
any sensation between their chest and pubic bone as if it is hunger,  
They want to suck. Sucking brings comfort but because of the supply,  
it results in more pain down the line. Look for ways to treat the  
baby's symptoms too.

If I go on, I will be for pages (probably my whole lecture) and I  
will be preaching to the choir.
But please take a look at these mom's diets and not for allergens (I  
don't believe that so many babies could be truly allergic). Look for  
the presence of too much simple carbohydrate and too little fat.  
Women with a diet high in simple carbohydrate have been shown to have  
a high lactose load in their milk, where lactose goes water goes.   
Increase the available fat in the diet (through supplementation if  
need be), tell moms to avoid a simple carbohydrates and junk food and  
not to skip meals. I've been supplementing mom's diets with EFA's for  
the past 7 years and along with a few additional treatment measures,  
it works
  I recommend as a supplement : Flax seed (800 mg): Take 2 capsules  
three times a day and Evening Primrose oil (500 mg): Take 2 capsules  
three times a day. (Total dose is 1600 mg flax and 1000 mg evening  
primrose each time.)(I don't use fish oil)

As for "it gets worse before it gets better."  I had to chuckle,  
here's a notation from my parent instructions on Oversupply Syndrome  
that warns about this phenomenon: "The first 24 hours normally goes  
very well. Hours 25 through 48 are rougher, baby tends to get fussy  
again, but don't be tempted to stop the plan.  (I haven’t discovered  
why this happens but many mother’s report that this occurs)  Baby’s  
stools should change after 48 hours of treatment.  A change in the  
stool is the first sign that the treatment plan is working.  If  
symptoms worsen, AFTER 48 hours contact the lactation clinic. There  
may be another cause for the symptoms.  A noticeable improvement in  
the majority of symptoms should occur after 72 hours of treatment."

One last plea
I am firmly convinced that as long as we, as a profession, don't call  
this group of symptoms the same thing, research cannot begin. My vote  
is on Over Supply Syndrome (OSS) because the condition manifests in a  
definite group of characteristic symptoms that effect both mother and  
baby.


  ***I have more references these are the ones I had at hand
Abakada AO, Hartmann PE: "Maternal Dietary Intake and Human Milk  
Composition." Breastfeeding Review 13: 43-45, 1988
Del Prado Martha et al  Contribution of dietary and newly formed  
arachidonic acid to human milk lipids in women eating a low-fat diet   
Am J Clin Nutr 2001;74:242–7.
Hatherly,Patricia A  THE MANIPULATION OF MATERNAL DIET AND ITS EFFECT  
ON THE INFANT WITH PARTICULAR REFERENCE TO GASTROINTESTINAL  
DISTURBANCE… A SERIES OF CASE STUDIES Journal of Australasian College  
of Nutritional & Environmentl Medicine Vol. 13 No. 2; December 1994:  
pp. 5-12
Prentice AM, Roberts SB, Prentice A, et al.: "Dietary supplementation  
of lactation in Gambian women. Effect on breast milk volume and  
quality". Hum Nutr Clin Nutr 37C: 53-64, 1983
Siber H, Hachey D, Schanler R, et al.: ‘Manipulation of maternal diet  
to alter fatty acid composition of human milk intended for premature  
infants." Am J Clin Nutr 47: 810-814, 1989

Sorry for the rant
Marie Davis RN IBCLC
www.lactationconsultant.info

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