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Subject:
From:
"Kermaline J. Cotterman" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 10 Jan 2004 11:11:14 -0500
Content-Type:
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Coach Smith's point about jumping to conclusions about overactive letdown
being a sign of oversupply is well taken:

<When we're working with a mother-baby pair where the baby can't handle
the
flow of mom's milk, it's tempting to blame the rate of flow on
"oversupply"
or "overactive letdown." Before trying to reduce mom's milk supply, make
sure the baby is totally able to coordinate suck, swallow and breathe
smoothly.>

Much depends on the age of the baby we're observing. If the baby is
thriving, especially if there are further signs of overfeeding and/or
relative lactose overload, we have a much different situation from a very
 young baby who is recovering from birth, especially any form of
traumatic birth, including rapid labor with no intervention whatsoever,
has not yet begun to gain well, attained sufficient maturity, etc.

Rule # 1 of course, is "Feed the baby". If we think about it more
carefully, I propose that Rule #1A. is "The baby must breathe, adequately
and all the time, right from the beginning, no matter what other
conditions exist.", and then Rule # 1B. is "Feed the baby"

So, even if the baby does have difficulty in coordinating suck swallow
and breathing from some physiological problem or some type of traumatic
birth, I want to point out that consistent use of anti-gravity or neutral
gravity (lying side by side at the same level) positions is a first step
that does nothing at all to tamp down the mother's supply, but it does
recalculate the force of gravity in the equation, and favor the baby's
air space.

It does this both by slowing down the force of the milk leaving the
breast, and by putting the infant's nasopharyngeal passages above, (or at
a similar level of) whatever ability the MER has to propel milk, versus
being physically down underneath the flow of milk. (For moms, I use the
phrase "so the milk comes up at the baby like a drinking fountain,
instead of down, like being under Niagra Falls.")

If the baby is even slightly below the level of the largest part of the
breast tissue, which is in the upper half of the breast, especially the
upper outer quadrant, gravity alone would tend to attract milk leaving
the breast at any speed, downward toward the nasopharyngeal area that
needs to be partially reserved for air space, even in the baby with the
most well coordinated suck and swallow. Try lying down, even on your side
and then drink through a straw coming from above your mouth, to see what
I mean.

So, I would modify my previous post with such a caveat, in light of
Coach's cautioning post. And BTW, I had a detailed dream about her last
night. I was giving her a big hug to show my gratitude for the
terrifically documented debate she is leading with some of our local
health authorities (who apparently have blinders on and earplugs in)
about modifying a yet to be released brochure that nixes all co-sleeping
as dangerous. They haven't heard the last of this yet, by a long way,
I'll bet. She's truly like a "Rottweiler with a bone", like I told her at
the beginning. Go, Linda!

Jean
************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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