Jaye Simpson, IBCLC <[log in to unmask]> wrote:

> So my client who was producing literally up to 96 ounces of milk per day
> while pumping ONLY 4 times in 24 hours finally got her prolactin levels done
[....]
> Help?  I'm outta my league on this one but so seem to be her Dr's.  What say
> you my esteemed colleagues?  What other information do you need to help this
> mom figure out what is up?  Could this still be a pituitary tumor
> possibility?  Why would she be producing this much milk with such a low
> level?  

I missed the first post, sorry - is there anything medically wrong with
this woman otherwise? Is she well? Why is she expressing? Is she
inadvertently taking any galactogogues?

If all is well otherwise, is it possible that she is producing that much
milk simply because she is continuing to remove that much milk?  If she
has a huge natural oversupply, a terrific storage capacity, and great
pump response, and she keeps pumping 4 times a day to emptiness,
removing enough to feed triplets... she might just keep on making that
much milk. At four months postpartum she'd be well and truly at her peak
production.

I'm guessing you've gone over the simple ways to reduce supply
(appropriate herbs, etc). If I was overproducing this much, I'd cut back
on the expressing very gradually - keep the pump vacuum down if she's
pumping with an electric pump, and instead of expressing 24 ounces, stop
at 22, then at 20, and so on, until she is closer to a her appropriate
production level. She might, when it is comfortable to do so, try
alternate-breast expression, just as a feeding-from-the-tap mum might
try feeding just off one breast for 4 or 6 or 8 hours to manage
oversupply.

Lara Hopkins
GP in Western Australia and experienced EPer 

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