Hi Linda,
Several years ago worked with a mother with a very similar history. 
It was a memorable case because it was so extreme.  It seemed like 
any change we tried, the results were completely unpredictable.  She 
swung back and forth between seeming-oversupply and 
seeming-undersupply.  The baby was unhappy, had odd stools and fussy 
behavior, and food sensitivities were a big question mark the whole 
time.  We just could not pin down what was going on.

The mother I worked with was committed to a certain strict scheduling 
regimen from a popular book and that certainly complicated things. 
Some of my suggestions she would not even consider trying.

I helped her as best I could -- we had many long conversations about 
the physiology of breastfeeding and she used that information to 
chart a course she was comfortable with.  The problems persisted for 
many months however.

In hindsight, I came to believe that almost everything about the 
situation could be explained by the mother and baby being out of 
sync.  They started off on the wrong foot with scheduled feeds and 
too much pumping, and everything else that happened just sent them 
see-sawing between extremes.

I would suggest doing what "my" mother wasn't comfortable with: 
Skin-to-skin, babywearing, and cosleeping 24/7 or as close to it as 
can be managed.  Basically, go back to the beginning and start over. 
Hopefully the mother's supply and baby's needs (including frequency 
and pacing of feeds as well as amounts!) can be reconciled and 
recalibrated this way.

If the baby developed breast avoidance or defensive nursing patterns 
during the time of rampant oversupply, s/he may need a lot of 
comfortable, no pressure, easy access time at/near the breast to 
overcome that.  In the meantime, those frequent long feedings are 
much easier for the mother to deal with if she wears the baby in a 
sling.  Slings are also great for reflux if the baby is snuggled in 
an upright position between the mother's breasts.

Margaret
LLLL, IBCLC
Longmont, CO


>Hi All,
>
>      I have a client who has a tremendously fluctuating milk supply.  I told
>her I would post here today for possble insights.  This is one of those
>whose supply is "all over the place".  You'll understand that by the end of
>this posting. 
>
>G1 P1, vag delivery, uncomlicated, 6#15oz.
>sleepy baby, not gaining well.
>mom starts fenugreek/blessed thistle and rents scale to do pre and post
>feedings. (advice from someone else)
>Mom calls me when baby is 5 wks old and very fussy.  Gaining well.  But
>eating 5-6 oz every 3-4 hours!  (now 9#) Mom pumps off 15 oz(!) after am
>feeding.
>* obviously oversupply!  AND reflux, as baby refluxed several times in my
>clinic whenever placed semi reclining. Note to doctor, baby started on
>zantac.
>* discuss ways to decrease supply, block feeding, reverse compression
>technique or pumping off fast flowing milk prior to latching, stopping
>fenugreek/blessed thistle.
>daily phone calls see am. pumping steadily decreasing. 
>5 days after our visit, she now pumps 7oz after am feeding, but it takes
>about an hour of eating the rest of the day for baby to get 2 1/2 - 3 oz and
>mom reports breasts feeling flacid.
>* so, we change block feeding to meeting needs of baby.  If no longer eating
>at breast, and breast feels soft, switch to other breast.
>mom also working on positioning, keeping baby upright, buys tucker sling,
>tries colic calm, doctor adds prevacid....
>supply still decreasing, breasts soft in am., doesnt pump, taking long time
>to get 2-3  out for baby, started back on fenugreek/blessed thistle 1:1 TID
>supply seems to even out, mom happy to pump off extra 5-6 oz after am
>feeding, so can offer a bottle now and then. mom starts weaning off fen/bles
>this. very gradually.
>a week goes by, she calls wondering if her milk is "spoiled". 
>start "scalding" milk after pumping.
>another week goes by, baby now seems sick, not eating much, and supply seems
>to have dwindled, as she is only eating about 2 oz, takes a long time, and
>cant pump any extra out.
>she is taking fenugreek/blessed thistle again x 2 days. 
>so far, it hasnt come back up yet.
>
>
>So - baby has appt today with doc, but probably just a tummy virus.  She
>described some "diarrhea" diapers.  Baby also has GI appt for reflux next
>week.  Her supply seems sooooo
>sensitive to everything!  Its "all over the place".  I have never dealt with
>anything like this and suggested the mom have her thyroid checked.
>
>What else???
>
>Linda Hill RN, IBCLC
>Austin TX
>

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