I posted about 2 weeks ago re a mother with oversupply/OALD.  Her baby is 8 weeks old now and I am pleased to say they are making good progress.  
 
As well as very engorged breasts and a forceful and painful MER, the mother also had sore, pinched nipples as baby tried to protect his airway.  Even when achieving a deep asymmetrical latch, baby would adjust with the MER.  
 
The mother slowly worked on downsizing her supply by first feeding on one breast per feed, then two feeds per breast.  This also had the effect of decreasing the strength of the MER.  She is now using one breast for 6 hours and finally, in the last couple of days, feels her breasts are softer.  She also adopted anti-gravity or neutral-gravity positions so the airway was above the milk, or level with the flow.  Now the mother reports some feeds are "brilliant"and some not so good as she still works on the latch and encouraging baby not to adjust during the feed.  She is also getting out and about more with her baby and I have referred her to a support group.

Other things we did:  briefly tried finger feeding which encouraged baby to bring his tongue forward.  She also used APNO which helped with the inflammation.  (I did not suspect thrush - but wanted to cover all bases.)  She also elicited the MER 5 minutes before a feed, but reported this didn't seem to make a difference.  I also demonstrated Jean Cotterman's RPS procedure, but mother did not feel comfortable doing this so discontinued after a few times.

I found Jean Cotterman's Zone conceptual model very useful for assessing the nipple-areolar complex and am very grateful to her for sharing her valuable insights and lending her support.

PS  I love this time of the year on Lactnet - congratulations to all those who passed the exam!

Jean Ridler  RN  RM  IBCLC  Cape Town  [log in to unmask]

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