After reading why people are exasperated over block feeding, all I can say
is 'well, doh'.
If you don't have the right diagnosis, then the right treatment is going to
be awfully hard to find, and if the right diagnosis is the exact opposite
of the one you have mistakenly made, the treatment is really going to be
bad. That is what I see many times every week, but here it is oversupply
being misdiagnosed as undersupply.  Fascinating!

Here, most people advising women are suffering from the collective fear
typical of all health personnel and many women, that there is not enough
milk for the baby unless the mother is compulsively feeding and/or
expressing around the clock (slight exaggeration but only slight). A baby
who never settles happily at the breast, is very unhappy shortly after
feeding, and who starts declining offers to feed will be considered
'hungry' even if she is choking and spluttering through the feeds she can
be convinced to take. The idea that oversupply is even possible, not to
mention a real pain for mother and baby, just hasn't gotten here yet. Thus,
mothers of such babies will be advised either to give both breasts at each
feed, or even to express after feeding and feed the expressed milk, and to
wake the baby at night to feed, or if the baby can't be coerced into
feeding then, to pump in the night. This advice is often given in the
absence of any sign whatsoever that the baby is not getting enough food,
and in the presence of every single sign of oversupply listed in Gonneke's
article about full drainage and block feeding.  Block feeding has never
been on the radar of health professionals and there seems to be less talk
of babies 'not getting the good, nutritious hindmilk' than there was a few
years ago, now that I think of it.
On the other hand, mothers of slow-gaining babies are advised routinely to
feed LESS frequently, to 'make sure the baby is really good and hungry so
he'll feed properly'. It all makes me want to scream.
My daughter has been taking calls as a volunteer peer counsellor since
April and 95% of the mothers she has been in touch with are suffering (and
I mean SUFFERING) from oversupply due to misdiagnosis. (She is getting to
be really expert in advising mothers and I am proud to the bursting point
that she is *my* daughter.)  As in my own experience, they uniformly
improve, usually dramatically, after one round of drainage. And, as Pat
writes, once the supply is in line with the baby's appetite, they can just
get on with breastfeeding.

This week we have dealt with the mother of a seven week old baby who was
put on medication for reflux before 6 weeks, which is practically unheard
of here. The baby's symptoms were absolutely classic for oversupply and the
parents had not seen any improvement after starting medication a couple of
weeks prior. The hardest part was convincing the mother to try feeding from
a floppy, un-tense, newly expressed breast. Guess what?  The baby fed
happily for longer than he'd ever done before, and settled down to sleep
for the first time since her milk came in. He continued to do so.

I guess we should be on guard because mothers communicate amongst
themselves and we might start seeing block feeding being used
inappropriately, but so far it really isn't a problem, while oversupply
seems to be on the rise. I do shudder to think what might happen if the
PHNs start recommending it to everyone whose baby expresses displeasure for
any reason. Yikes.

Rachel Myr
Kristiansand, Norway

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