Hello,
I've been lurking for a couple of months and was finally unable to
resist posting.   I hope that my post is appropriate and helpful.  I'm
an LLLL in San Diego, California, and, possibly more relevantly for
this posting, Frances Andrusiak's daughter-in-law, (Frances was one of
the authors of LLLI's Lactation Consultant Series article on Overactive
Letdown Reflex),
as well as the mother of two breastfed children.   I do not have her
experience and am not pretending to, nor have I mentioned this case to
her, but as I have had mild issues with forceful letdown, I have talked
with her extensively on this subject and most of my opinion on forceful
letdown is gleaned from her paper and discussions with her, as well as
experience with my children.    So I'm going to answer both from a
third party perspective with my understanding of forceful letdown from
Frances and with my own personal experience.
My first thought on this case was that mentioned by many others that if
OAL was the problem, the sidelying position might help, as Frances
stressed this repeatedly with me and it helped both my children, though
at different ages, but as that does not seem to be the case here, I had
a couple of other thoughts:  First, also mentioned by someone else, the
mother might try longer periods on each breast than 2 hours, assuming
she has no supply issues.   My impression was that 2 hours was a rather
moderate length of time and that bad cases often required longer
periods.   Personally it took me at least 3 hour time frames for my
daughter who had more trouble with my forceful letdown than my son.
Another thought was that Frances, at least, never mentioned the
possibility of limiting nursings, only limiting switching breasts.   I
don't know what other mothers/babies have experienced with this
technique, but with my daughter I found that she had the most trouble
when it had been the longest between feeds and did best with more
frequent feeds.  It was also my impression from Frances and her paper
that this could minimize the baby's association of stress with the
breast, by reducing the 'pressure' so to speak at initial nursings.
She advocated, at least to me, more frequent feeds, as per reflux.
With my son this wasn't an issue as he virtually never stopped nursing,
but with my daughter I had to watch and wake her to nurse if I started
to feel full so that she wouldn't choke and be put off.   My other
thought, from personal experience only, is that my daughter did much
better if I didn't nurse her in unusual positions or unusual places.
(ie, she did better staying home than sling nursing in stores, etc)
(This was only in the early months.)   This effect tended to be delayed
by several hours.
I don't know if any of this will be of any help, but I hope so.   Good
luck to you and the dyad!  I'd like to reiterate that this information
is from me alone.

I also wanted to add a bit to the discussion on nursing discreetly in
public as advocacy.   Personally, I'm uncomfortable showing any skin,
but not at all with nursing in public, so I tend to wear nursing
clothes and nurse in the sling and usually no one knows I'm nursing,
though I'm not at all attempting to hide what I'm doing, only my body
parts.   However, I do feel that nursing too discreetly, as I
apparently do, does NOT help people adjust to the idea of nursing in
public because they don't know we're doing it!   (To the point that,
when my grandparents, who know I nursed my son to 32 months, were
visiting recently, I nursed in front of them, but did so as if I were
in public, except usually without the sling, and 2 1/2 days into their
visit( and 5 minutes after my then 8 month old daughter had finished
her most recent nursing) my grandmother stunned me by asking me if I'd
weaned her already.)  So, from an advocacy standpoint, perhaps those
blankets are a good thing.  They announce what's going on, without
showing any 'offensive' skin.

Just my $0.02.
-Rebecca Andrusiak, LLLL and mother of two



>Date:    Tue, 12 Aug 2003 21:24:38 +0000
>From:    laurie wheeler <[log in to unmask]>
>Subject: baby pulls off the breast
>
>Lynn
>Could be oversupply that needs more time and longer interval to manage.
>Since baby is calmer at nite, then maybe it is becoz of less breast fullness
>(seems common in evenings/nites) with less forceful MER. Perhaps mom needs
>to go 4 hrs or more (gradually) per breast.
>Reflux could also be a problem. Have they tried the usual reflux measures
>and even medication for baby.
>What else is different in daytime? Too much distraction? A particular
>vitamin pill mom takes in a.m.? Perhaps another food (if dairy elimination
>did not make a difference) such as caffeine, citrus, soy, wheat, eggs? I'm
>just throwing ideas out now.
>
>Laurie Wheeler, IBCLC, MN, RN
>New Orleans Louisiana, s.e. USA
>
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