Dear Lacnetters,

I'm looking for some wisdom for a pregnant lady who has had no end of
problems with bf her other 5 children. The two problems (or one depending on
how you look at it) is that by each baby she has had an enormous oversupply
problem plus "never ending" mastitis (her own words). Her milk supply is
huge within hours of the birth (so much so that she can easily express 200ml
from each breast on the first day). With the last child she was feeding him
and also expressing 1000ml per day for her sisters baby within a few days
after birth.
Coupled with the oversupply she had 5 episodes of mastitis (41oC
temperature, very quick onset) for which she received 5 antibiotic
treatments of only 5 days each. She is not able to rember which antibiotics
but received two different types. After a few weeks with each child she
stopped breastfeeding (with help from contraception pill) because her
breasts were just two much to bare. She was never able to reduce the
engorgement to a confortable level (she tried cabbage leaves, cold and warm
compresses, warm baths, showers, massage etc). Expressing milk never helped
as her milk prodution was just too fast. She told me she would have to
constantly express milk to get relief. Also never had problems with sore
nipples or thrush.

Despite this she is detemined to feed her sixth child and is thus looking
for help. My questions are for her:
1. The method described frequently on Lacnet is nursing from one breast for
long period (say 6 hours) to reduce the milk production in the other breast.
This seems to me a great option for this mother, but I'm worried that
because of her history this might only increase her likelyhood of mastitis
even if precautions are taken to make sure the engorgement does not lead to
block ducts etc?
2. We are thinking about using sage to reduce milkproduction, beginning on
the first day after the birth of this child. Would it be effective to use
pseudoephedrine to bring her milk balance into line with her babies needs.
Can this be used from the beginning straight after the birth or would it be
better to wait until the oversupply became a problem (I know, not very
optimistic)? If so, then would it be best to begin with a small dose several
times a day and increase if necessary?
I read in the J Hum Lact. how 30mg, 3-4 times a day has helped at least one
women with oversupply.
3. I'm wondering about a pathological problem with her prolactin production.
She has never had milk production in between pregnancies. Or is she just on
the right hand side of the prolactin  production curve?
4. The mastitis, is it possible to use antibiotics as  prohylasis
(spelling)?
5. I've been thinking about the yeast situation where you treat mother and
child - would this also be an idea with infectious mastitis?

Next to this we have discussed getting enough rest (also before the baby
comes) and eating healthy and paying particular good attention to frequent
feeding and good latch. Plus visiting her doctor with more information
before the brith to talk about eventual medicine use (i.e. antiobiotics or
pseudoephedrine).

Anyway, along with a new IBCLC I'm going to jump into the literature but was
thinking that a few extra words of wisdom wouldn't go amiss for this mother.

yours

Sara Bernard
The Netherlands

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