Chris,

<Oh Wise Ones:  I need some assistance with a patient.  I think I've
exhausted all the obvious things and now I need to 'pick your brains' for
other ideas.>

Just a few shots in the dark here. I'm not certain if these are among
your "obvious things".

Of course, it wouldn't hurt to check the prolactin level in case there's
a pituitary problem, but at 5 months, since the breasts normally function
with a much lower level at this time, even if it were still above a
non-pregnant level, could we say with any certainty that it is the cause
of overfunction?

Seems like a vicious cycle and a question of "Which came first, the
chicken or the egg?" The oversupply is causing the leaking and the
leaking is encouraging oversupply!

Could we somehow (perhaps by reducing the # of MER's), eventually retain
more of the milk inside the alveolus in contact with the membrane, and
thereby use the milk itself for feedback inhibition? (In other words,
reverse the physiology by deliberately and studiously doing what makes so
many mother mysteriously "dry up"?)

This is an alternative that at least one mother I talked to found
helpful. I explained milk production to her, and the possibility of
nursing off the same breast for, say, all feedings in a 3-4 hour period,
or even a 4-6 hour period before switching breasts.

I also told her that I had heard that some primitive agricultural tribes
used to sling the baby on the non-dominant side all day to use the
dominant hand in the fields, then, round the campfire and all night,
nursed on the opposite breast.

She took in the info, and decided on her own to very gradually change to
the12 hour pattern for all nursings on one breast and vice versa the
opposite 12 hours.

I had warned her to take just a little out of the opposite side as needed
for comfort, anti-gravity positions etc. and trigger MER before
latchings, to spare the baby the coping stress if need be.

Till the baby could handle it comfortably, I suggested she let "the
surge" flow for a moment before latch, on that one side only, and
gradually add control of leaking on the unnursed breast with manual
pressure with the heel of the hand for a few minutes.

By doing it gradually and observing carefully to avoid signs of plugs
etc., she successfully navigated the rapids to the "just one side in each
12 hour pattern" and found she and the baby were very comfortable with
the end result, and no leaking.

Just my $.02.

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

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