6/13/96
From:  Anna Utter, BS, IBCLC
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To:  Becky Sharkey

Dear Becky,

Having helped more than 150 mothers with oversupply in the past 7 years, I
have not found cabbage leaves helpful for the actively breastfeeding mother
with oversupply.  I have found the following helpful

1. One-sided breastfeeding--use of one breast only per feed.  Given your
description of mother's condition, I would suggest using the same breast for
all feeds within any given 3 to 6 hour period of time (you will have to judge
from mother's response how long of a period of time to suggest).  This
approach allows for the action of suppressor peptide to bring about reduction
of milk supply in the contralateral breast.  Use the contralateral breast
after specified period of time for a given 3 to 6 hour period before
switching back to use of breast used for first period of time.

2.  Expression of enough milk from unused contralateral breast to achieve
comfort for the mom but not so much expression as to encourage increased
production.

3.  Since breast shells encourage leaking they can indeed be contributing to
oversupply

4.  Baby's sucking function needs to be assessed so referral to IBCLC may be
in order since babies will compensate for oversupply and accompanying rapid,
forceful milk ejection.  Some babies cope by backing off areola to
nipple-feed, others clamp their jaws causing compression of nipple, and
others still cope by weakly sucking and essentially waiting for mother to
let-down milk

5.  One-sided feeding also helps ensure that baby begins to receive higher
fat content milk and will hopefully allow for longer periods of time between
feeds.

6.  Special positioins that have mother lying supine or semi-supine while
infant feeds in prone position across mother's chest or laterally alongside
her are helpful in assisting baby to cope with rapid, forceful MER

7.  It is essential that appropriate positioning and latch-on be taught and
used so that baby learns effective breast drainage skills and that nipple
pain is avoided or resolved.  Keep in mind though that even though baby may
initially latch-on well, he/she is likely to back off areola to nipple-feed
at MER.

8.  Careful follow-up is needed to monitor baby's calorie intake and sucking
function and mother for plugged ducts, mastitis, and recurrent engorgement.

9.  It is likely this problem will take some time to completely resolve but
mother should begin to see improvement in a short time.  It is important that
she be patient with baby during this time of stabilizing milk production.
 Baby may want to nurse often for comfort, may have a lot of gas, and be
fussy.  This is another reason why using same breast for a 4 to 6 hr period
of time has been helpful for many of the mothers I have helped.

10.  Some mothers find it necessary to remove a little milk before latch-on
so as to facilitate appropriate latch.  If so, minimize the number of days
such intervention is taken since it will only prolong appropriate reduction
of oversupply.

11.  Mother should be informed that it is quite likely baby will be satisfied
with milk from one breast only for many weeks to come--possibley throughout
breastfeeding experience.  Caution her against return to use of both breasts
at each feed too soon but at same time educate her to follow her baby's cues.

12.  With oversupply, the baby often sends unclear signals.  For example, the
baby may come off the breast spontaneously after brief time and give mother
the impression he/she is "finished" with that breast when in fact there is
still copious quantities of milk available.  This milk stasis can be
demonstrated by hand expression of breast.  Another example is the frequent
hunger cues exhibited by baby.  Baby may indeed be hungry often due to
low-fat intake and rapid gastric motility but not all apparent hunger cues
are true hunger.  Some fussiness, rooting, putting hands in mouth is
indicator that baby needs some comfort sucking but if put to breast again
becomes overwhelmed with milk.  In this case, allowing baby to suck on
parent's clean finger or judicious use of pacifier can be helpful.

13.  Calming techniques such as massage, walking, colic hold/dance, change of
scenery, white noise, frequent burping, etc. are also important.

14.  Mother should anticipate similar problems with future infants and make
sure baby truly finishes first breast before offering second right from the
start.

15.  It is helpful to inform mother that this problem is rarely covered to
any degree in the breastfeeding literature.  I am presently writing a
manuscript describing 140 cases of premature breast switching in the presence
of ample milk production all of which resulted in oversupply and other
problems.

Hope you find these suggestions helpful and don't hesitate to ask over
LactNet for someone in your community or close by who is more experienced
with this problem to assist you and/or mother.

Anna