>>First baby, now ten days old, milk came in with a vengeance on the first
day. The letdown is so strong the baby won't come near the breast. <<

The milk came in on the first day? Wow!  A thought occurred in the back of my
mind; I remember a write-up in JHL about a mother who had oversupply in
conjunction with a retained placental fragment that resolved with removal of
the fragment. Yes, retained placental tissue is usually associated with
*under* supply or no milk, but in this one, rare case, it was the opposite.
You might screen the mother on her pp bleeding just in case. Also-- consider
a pituitary work-up, as this can also cause oversupply/galactorrhea.

Other than this outside possibility, I would definitely have the mother use
cabbage compresses to bring down the supply, and if that doesn't do it, you
could also consider adding 1-2 cups of sage tea a day. (I know this has been
controversial on lactnet; you need to be judicious). Also, as much as
possible, have her pump/express only to comfort and for baby's need, and not
too far beyond that, so as not to overstimulate her supply. This is a tricky
situation!

If and when baby is ready to try the breast again, I would *definitely* start
with positions that put baby above the breast, especially the one where mom
is laying on her back and baby is up on top. This uses gravity to slow the
flood into baby's mouth, and gives baby more control over the feeding. Baby
needs every edge we can give him!

Good luck--
Lisa Marasco, IBCLC
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