>Diane, could you elaborate?  What do you mean by "What finally worked
>was mom spending 6 hours on a side"?

This is roughly what I tell mothers.  Do others want to add/change/comment?

Babies tend to be more settled when they're allowed to "finish the first
breast first" - that is, to soften one breast completely before starting on
another full breast.  That way, they get what some people think of as a
gradually-transitioning three course meal - relatively lowfat soup, a higher
fat main course, and cheesecake at the end where there's very little
swallowing but the fat content is at its highest.

Although they usually can grow fine without the cheesecake, they may be more
likely to have intestinal distress without it.  For most of us, finishing
the first breast first is a simple matter of not taking the baby off one
side specifically to make sure that he takes the second side, but letting
him soften one side completely with no particular expectation that he'll
need to nurse on the other side as well.  (If he's still cruising for food
after he's pretty much stopped swallowing, you offer it; if he's in a
drunken stupor you let it go).

But if we have a significant, ongoing over-supply, the baby may nurse to
satiety on one side and *still* not have gotten very far into the higher fat
part of the feed.  One way to reduce an oversupply is to let the baby nurse
as often as he wants, but to use just one breast for a couple hours, then
let him nurse as often as he wants on the other breast for a couple hours.
Those several feedings on one side let him work through the accumulated
milk, and allow the other breast to stay somewhat over-full, which cuts back
on production.  Two hours per side is pretty standard.  The mother with a
more significant oversupply problem may need to spend 3 or 4 or even 6 hours
on one side, relieving the other side only enough to keep it comfortable and
avoid plugs.  I've heard of one woman who spent 12 hours on each side and
still took a while to bring her supply down; the longest anyone I've worked
with has needed to go is 6 hours.  Usually the baby is less fussy - *if*
this was the problem - within a few days.

Some signs that this *is* the problem are a gassy, fussy baby; a baby who
gulps and chokes and splutters at breast; lots of poopy diapers, some of
which may be greenish; and a mother who answers the question "Do you make a
point of using both sides each time?" by responding, "Well, I *try* to."
The word "try" makes me think she's interrupting an actively nursing baby in
order to make a switch that he wasn't keen on making.  It's not working well
for them, but she thinks she's supposed to do it.

LLLI's Lactation Consultant Series has a unit on this - #13, Effects of an
Overactive Let-down Reflex.  It costs about $3 and is one of my most
frequently used references.  Mothers who are skeptical read the article's
description of the problem with *great* interest, and often report back,
"How did the authors know?  It's as if they live in our house!"

Diane Wiessinger, MS, IBCLC  Ithaca, NY
www.wiessinger.baka.com

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