6/13/96 From: Anna Utter, BS, IBCLC [log in to unmask] To: Becky Sharkey Dear Becky, Having helped more than 150 mothers with oversupply in the past 7 years, I have not found cabbage leaves helpful for the actively breastfeeding mother with oversupply. I have found the following helpful 1. One-sided breastfeeding--use of one breast only per feed. Given your description of mother's condition, I would suggest using the same breast for all feeds within any given 3 to 6 hour period of time (you will have to judge from mother's response how long of a period of time to suggest). This approach allows for the action of suppressor peptide to bring about reduction of milk supply in the contralateral breast. Use the contralateral breast after specified period of time for a given 3 to 6 hour period before switching back to use of breast used for first period of time. 2. Expression of enough milk from unused contralateral breast to achieve comfort for the mom but not so much expression as to encourage increased production. 3. Since breast shells encourage leaking they can indeed be contributing to oversupply 4. Baby's sucking function needs to be assessed so referral to IBCLC may be in order since babies will compensate for oversupply and accompanying rapid, forceful milk ejection. Some babies cope by backing off areola to nipple-feed, others clamp their jaws causing compression of nipple, and others still cope by weakly sucking and essentially waiting for mother to let-down milk 5. One-sided feeding also helps ensure that baby begins to receive higher fat content milk and will hopefully allow for longer periods of time between feeds. 6. Special positioins that have mother lying supine or semi-supine while infant feeds in prone position across mother's chest or laterally alongside her are helpful in assisting baby to cope with rapid, forceful MER 7. It is essential that appropriate positioning and latch-on be taught and used so that baby learns effective breast drainage skills and that nipple pain is avoided or resolved. Keep in mind though that even though baby may initially latch-on well, he/she is likely to back off areola to nipple-feed at MER. 8. Careful follow-up is needed to monitor baby's calorie intake and sucking function and mother for plugged ducts, mastitis, and recurrent engorgement. 9. It is likely this problem will take some time to completely resolve but mother should begin to see improvement in a short time. It is important that she be patient with baby during this time of stabilizing milk production. Baby may want to nurse often for comfort, may have a lot of gas, and be fussy. This is another reason why using same breast for a 4 to 6 hr period of time has been helpful for many of the mothers I have helped. 10. Some mothers find it necessary to remove a little milk before latch-on so as to facilitate appropriate latch. If so, minimize the number of days such intervention is taken since it will only prolong appropriate reduction of oversupply. 11. Mother should be informed that it is quite likely baby will be satisfied with milk from one breast only for many weeks to come--possibley throughout breastfeeding experience. Caution her against return to use of both breasts at each feed too soon but at same time educate her to follow her baby's cues. 12. With oversupply, the baby often sends unclear signals. For example, the baby may come off the breast spontaneously after brief time and give mother the impression he/she is "finished" with that breast when in fact there is still copious quantities of milk available. This milk stasis can be demonstrated by hand expression of breast. Another example is the frequent hunger cues exhibited by baby. Baby may indeed be hungry often due to low-fat intake and rapid gastric motility but not all apparent hunger cues are true hunger. Some fussiness, rooting, putting hands in mouth is indicator that baby needs some comfort sucking but if put to breast again becomes overwhelmed with milk. In this case, allowing baby to suck on parent's clean finger or judicious use of pacifier can be helpful. 13. Calming techniques such as massage, walking, colic hold/dance, change of scenery, white noise, frequent burping, etc. are also important. 14. Mother should anticipate similar problems with future infants and make sure baby truly finishes first breast before offering second right from the start. 15. It is helpful to inform mother that this problem is rarely covered to any degree in the breastfeeding literature. I am presently writing a manuscript describing 140 cases of premature breast switching in the presence of ample milk production all of which resulted in oversupply and other problems. Hope you find these suggestions helpful and don't hesitate to ask over LactNet for someone in your community or close by who is more experienced with this problem to assist you and/or mother. Anna