I am presently in contact with a mother who is pumping very large quantities
of milk for her baby who is unable to nurse full time.  The baby is in NICU
at present and nurses when mother can be with him, probably coming home
within a week.  He was born at 33 weeks on 5/19.  This is mother's 3rd baby
she nursed her first two.  The second she had to wean  because she was
"lactose intolerant".  What she described sounded like it was a case of
overactive letdown.
She rented an Ameda Egnell pump with a double collection kit from me on her
3rd day postpartum, before leaving the hospital.  She was already engorged.
 Pumping has gone well, she has pumped q 3 hours during the day, getting from
10-12 oz each time when I talked to her on 5/28.  She was throwing out a lot
of milk, because baby didn't need it all, taking 40cc per feeding.  we
discussed hindmilk and throwing out the first portion pumped.  I think I also
suggested decreasing her pumping amounts and pumping fewer times per day in
hopes of cutting back on her production somewhat.  When I next spoke to her
she had had one episode of a plugged duct in her L breast.  She was still
pumping off 6oz. from that breast and 8-10  oz. from the other.  She didn't
like the feeling of being so full all the time and the baby who was nursing
at this time was doing fairly well but not having to do much work, which she
was concerned about.  We discussed again pumping off less and less
often(which she hadn't tried yet.)
I talked to her again yesterday.  The baby is breastfeeding once or twice a
day when she can get into see him.  Her production is maybe down a little,
but still more than he will ever need.  I discussed different options and she
decided she would try pumping on only one breast each time.  Her R breast
still produces 8-10 oz.  She has a strong let down--she was pumping while we
were talking and turned off the pump and milk continued to spray out for at
least a minute afterward.  She has been pumping for 3 weeks now.
Does anyone have any experience with this kind of situation?  I know she
doesn't want to get too engorged, but does she need to have some engorgement
to cut down on her production?  I suggested that she might hand express
instead, having heard on an ILCA tape that it can decrease the amount
produced.  She did not think she wanted to try that yet.  I also gave her
info on sage tea, but we were both a little leary of trying that.  I realize
that three weeks is not enough time to get lactation fine tuned--are we on
the right track?  I don't want to add to her problems>
TIA
Chris Lundberg, RN, IBCLC
Indianapolis IN