Sara Bernard writes:

<< 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  >>

I wonder if all the oversuppy we seem to be hearing about may possibly
have connections to two things:

      * The books say the breast has 15-20 lobes. While there is no way
to tell for sure, it seems logical that mothers with a full complement of
20 lobes in each breast would have a particularly great potential for
oversupply problems under common management rituals.

   *Perhaps this mother is one who might benefit from some of the reverse
of what we tell other mothers who need to build supply in their initial
management, so as never to build up a tremendous oversupply in the first
place.

Not all alveoli are active at the same stage at the same time. But if a
mom were to have more lobes, and therefore, more potential alveoli, the
same amount of prolactin would theoretically be stimulating more
prolactin receptors in more alveoli.

While the chemistry of prolactin and its action is certainly more
complicated than this, my reasoning does not see it's lab level as the
main focus of attention in such a situation.

Perhaps we could think a little more about feedback inhibition, and
building habits, right from the start, that will be helping to make use
of this feature as the changeover period starts to come about.

By this, I mean that maybe some of the concepts underlying the "old"
directions (Q. 4. hours, one breast, etc.) were not 100% wrong in
themselves, for some mothers. I would be particularly wary of any milk
removal by any means other than the baby. Use of a pump can certainly
interfere with balancing supply and demand.

Perhaps if this mother began in the hospital using one breast for any and
all nursing in a 4 hour period, then reversing for the next 4 hour
period, for at least a few days, it might help.

Perhap she might need to go down to 2-3 hours on one breast for any and
all feedings during engorgement, or even alternating opposite breasts at
each feeding for comfort, but only using one breast for whatever she
considers a feeding, might help.

When engorgement is waning, she could go back to one breast (as often as
the baby wanted) in a 4 hour period and vice versa. Gradually, to avoid
mastitis, perhaps by 2 weeks she might begin each day or two, extending
the "non-nursing period" of one breast at a time to 5, then 6, 7 and all
the way eventually up to 12 hours or more. I still have not looked up the
reference someone gave me that Dr. Newman actually said one breast per 24
hours works for some mothers.

Coach, does any of this make sense to you?

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

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