I wrote Pam:

<nursing from one side for 2 feedings in a row then the other side for 2
feedings and she has done this several times, over 4 feedings each day
for a few days and then took a few days off then did it again. >

I think this inconsistency may explain it. The idea is to increase
(gradually) the time that the milk stays in the breast in order to take
advantage of "feedback inhibition". Using the same breast for 2 feedings
in a row is just the beginning. After a day or so of that, the next step
is to use the same breast for 3 feedings in a row, or however many
feedings occur in, say a 6 hour period. The other side needs to have the
milk stay in it to get the effect of feedback inhibition. Of course, it's
important that she not get plugged ducts, etc., so if there is genuine
discomfort, just the least amount necessary for comfort should be taken
off the unnursed breast, but if more is taken off, she is just probably
continuing to stimulate, rather than allow inhibition to take place.

After she is comfortable using the same breast for all feedings in a 6
hour period, she needs to progress to all feedings within an 8 hour
period, etc. etc., and perhaps a day later, if there still seems to be
too much for the baby, proceed to all feedings within a 10-12 hour period
etc., and keep that pattern. So this might mean the baby is taking in the
vicinity of 6 feedings from one breast while the other breast has no (or
very little) milk removal, so the feedback from the milk protein can be
accomplishing the inhibition of production down to the desired level,
then the next 12 hours, reverse the situation.


<over 4 feedings each day > just isn't enough to "cut it" for some of
these women, and <she has done this several times . . . . and then took a
few days off then did it again> completely negates the time needed
consistently for the milk in the unnursed breast to give feedback
inhibition. The nursing pattern needs to stay consistent at one level
till it can be done without need to remove milk for comfort from the
other breast, and then the time interval needs an increase and to be
sustained. Stopping and starting every few days is just sending "mixed
messages" to the milk making cells. Some women get by with consistent
periods of say 4, or 6, or 8 hours using just one breast and letting the
other breast get the inhibition message. Other women absolutely seem to
find that they must work their way all the way to 12 hours of leaving
milk undisturbed (except for MER, of course) in one breast while using
the other for all feedings. 


On the matter of MER, if she is in fact leaking, either at, or between
MER's, that is all the same to the breast as feeding it to a baby, in
regard to stimulation. If the milk is leaving the breast, it is not in
there to offer feedback inhibition. If there were any way she could cut
the leaking way down, such as pressing the nipple with the heel of her
hand for a few minutes when she knows she is about to let down, that
might eventually help normalize it. I don't know if the product called
"Blis" would have any luck in stopping the leakage or not.

It is a little complicated to get some mothers to understand that the
desired reduction in supply depends on actual factors in the milk and
their being left inside the breast to do the job of consistenly slowing
down the rate of production to a level that matches the baby's actual
physiological need. It has a good success rate IME, if you can get that
idea across, that nature provides the milk itself with its own built-in
"medicine" for reducing the milk supply, to get them to step back, try it
consistently for a week, and stop the clamor for some magic pill to do
the job.  

This reminds me that I must go back and re-read the Hartmann article on
feedback inhibition. I don't want to be dreaming any of this up whole
cloth out of my head. I just know what we've had that worked with some
"blessed" with overabundant milk supply.

Jean
**********************
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA

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