I wouldn't be looking at the engorgement and thinking oversupply (in the
case of the small baby who is not back to birthweight whose moms breasts are
over-full and uncomfortable.)  I would be thinking "incompetent feeder who
is not draining the breasts and is only consuming foremilk."  This would be
a more likely explanation for the very loose (but still dark) stools and the
poor weight gain. Babies with moms with too much milk typically grow very
rapidly in the early postpartum.  They often post gains of a pound a week
until, weeks down the line, their over-feeding, GI discomfort, and
impatience with the forceful milk ejection sometimes starts putting them off
breastfeeding.

 I wouldn't want to manage this situation for over-supply (i.e. weaning down
the milk with cold therapy and minimal pumping.)  The first two-three weeks
are the calibration time period for establishing a robust milk supply.  The
breasts should be emptied a minimum of 8 times each 24 hrs.  If the baby can
only coast on the first letdown and then fatigues to the point where the
breasts are left with a lot of residual milk, then the management should
focus on finishing the job of breast emptying with a good pump.  The hind
milk can be delivered to this small, weak baby via some alternate feeding
method.  When the baby "perks up" as Cathy Genna says, then you can back off
of the interventions (pumping and the alternative feeding.)  Monitor weight
gain carefully.  Babies should recover birth weight by Day 7-10 (see
Heinig's research) and gain approx. 1 oz a day thereafter for several months
(plenty of ref. data for this.)

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com
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