Sara,
Before I say anything else, I do want to point out that, according to the
literature, there is no direct relationship between prolactin levels and
milk production. Thus, I would not assume that hyperprolactinemia is the
problem, at least not unless the levels were tested to verify this.

Having said that, the one-sided nursing plan is probably a wise place to
start. I would also do the sage as you are suggesting; I've also used
peppermint tea with a couple of moms, though I'm not sure if it is as strong
as sage. Definitely start the herbs at the first sign of overproduction.

You asked about pseudoephedrine to also help reduce supply, but research has
not borne out the theory that it reduces milk production. Not long ago I
read about the use of the combo pill (lactnet? elsewhere?) to help bring
down supply. The person who wrote about this said that it was used until
supply was brought down to the normal range, and then discontinued. For
gigantomastiaThough we normally avoid such things, this is certainly
preferable to discontinuing breastfeeding altogether.

Before worrying about antibiotic treatments for mastitis, I would first work
very hard on controlling milk production as outlined above. Chances are that
if the oversupply is brought under control, the mastitis is much less likely
to occur. Mother should definitely discuss this with her OB/midwife before
delivery in order to enlist their help; they are much more likely to be
sensitive to her problems and follow her closely than if she waits until the
problem recurs to bring it to their attention.

Lisa Marasco

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