Since I was responsible for getting a link to Gonneke's article from
International Breastfeeding Journal onto the BF org website in Norway I've
been getting all the flak from mother to mother counselors here who simply
will not try to understand it.  The mother Isabella posts about would be a
prime candidate to do complete drainage followed by block feeding as
described in the article, which is freely accessible at
http://www.internationalbreastfeedingjournal.com/content/2/1/11  I think
it's a 'must read' article for anyone working with mothers in the first
month postpartum.

What Linda describes is a lot like what Gonneke describes, with some
important differences, and they are the very differences, IMO, that cause
'full drainage' etc to work swiftly and effectively in most cases, while the
more complicated measures described in Linda's post may be necessary for
weeks on end.   Linda describes a lot of the things I used to recommend
before I learned about full drainage followed by block feeding.   The very
short version, and please please read the whole article before you tell
anyone to do it, is that both breasts are drained as completely as possible,
first by expressing as much as mother can manage, and then by the baby who
is let loose at both breasts for as long as baby wants, right afterwards.
Mothers worry that the baby won't find anything in the breast after they
have expressed so much but they always do, and they feed more relaxedly when
not trying to drink from a fire hose.  Starting with two empty breasts makes
it possible to leave one side alone for the next several hours, while baby
feeds ad lib from the 'on duty' side.

To date I have not encountered any mothers whose oversupply or powerful milk
ejection reflex got worse after using the method, nor any who developed
plugged ducts or mastitis from the long intervals with no milk removal.
Obviously you don't start the process in the middle of treatment for
mastitis either.  Most of the mothers notice a dramatic improvement
immediately and for many of them, the problem is solved once and for all
after the first attempt.  If they have been piddling along for weeks with
it, (with constantly tense, tender breasts, expressing before every feed to
soften them so the baby can grasp it more easily - all the things that will
ensure the oversupply lasts much longer), they seem to need to go through
the regimen at least twice to really get rid of the problem, with a few days
between each new round.  The first time works well enough to convince them,
but breasts conditioned to produce tons of milk need some time to get used
to the new production level and in the course of a day or two they are
feeling engorged and seeing signs that baby is struggling again.  I have had
to reassure them over and over again before they try it, because they have
had the Fear of Pumping put into them, as if one good emptying will increase
their milk supply permanently, ten fold.  If only it were that easy :-)   I
usually can convince them to try it when I point out that things are
untenable as they are, and can hardly get any worse, so what have they got
to lose?  And I promise they can call back and say 'I told you so' if it
doesn't help.  So far every single mother who has carried out the method at
my suggestion, has called back to say it helped.  It's especially convincing
when they have had the problem with previous babies and not gotten help;
they can really tell the difference.

The most recent request I had for help dealing with oversupply was from a
mother whose first child had ended up on enzymes for lactose intolerance
while she had been instructed to do all in her power to *increase* her
supply.  The 'proof' of her low supply was an unhappy baby who regurgitated
a lot of milk but wasn't gaining as expected.  Needless to say, increasing
supply didn't make the baby happier.  This time she has been more savvy and
through reading up on oversupply had diagnosed her own problem AND knew
where to go for help.   The advice given her by her public health nurse at
the well child clinic was to feed the baby (then just 4 weeks old) less
frequently, for example, no oftener than every three or four hours.  This
was to allow the baby's stomach to 'rest' or something, she wasn't sure.  I
asked what advice she'd been given about how to respond to the baby when it
seemed to want the breast but it 'wasn't time yet'.  She didn't recall any
advice for that eventuality, and on further questioning she said she'd found
the advice difficult, if not impossible, to use, because she couldn't tell
when it was OK to feed her and when she should delay.  So it was clear she
needed a change of strategy.  She got in touch because after a 24 hour
interlude following the full drainage, in which the baby for the first time
seemed to enjoy feeding, her breasts were threatening to get uncomfortably
full again and she was very eager to hear whether she could start at the
beginning again.  (She could!)

About emptying the breasts once a day in addition to breastfeeding a child
ad lib: in my experience this keeps the oversupply alive and well, and may
even exacerbate it.  If you try Gonneke's method as the first treatment, you
will find it is rarely necessary for mother to express milk for comfort or
for ease of attachment by baby.   But one of the unluckiest women I have
heard from, had been told to carry out a complete emptying of both breasts
*daily* and then block feeding for the rest of the day.  I don't even know
if she had oversupply before she started in on the method, someone else had
been counseling her, but boy did she have it after two weeks of this
routine!  She was producing about two and a half times what her baby needed
and was desperate.  Even that case was surprisingly easily dealt with by
simply practicing the technique as described by Gonneke.

It's so different from what we've been used to recommending that it's hard
to take on board.  What convinced me was trying it, and seeing how well it
worked, knowing how distressing oversupply can be for mothers, especially
when they are told it's a luxury problem.  OK, way too much milk is not as
bad as way too little milk.  But it's so unnecessary and it predisposes to
mastitis, and to premature weaning, because babies don't experience the
breast as a relaxing place to be and they spend as little time as possible
there.  The mothers lose out on experiencing all the other aspects of
breastfeeding and their first weeks or months with their babies are a lot
less enjoyable.

Onward and upward  - and do read the article.
cheers
Rachel Myr, feeling like a broken record (remember LPs and diamond
styluses??) about oversupply in Kristiansand, Norway

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome