Diana,
Are you sure this is mom's problem and not baby's?  Have you seen the
mom's milk ejection, is the milk spraying from more than the usual 3-4
nipple pores at once?  When I see a mom who is spraying milk across the
room from 8 nipple pores at once, it's obvious her MER is too strong.
Usually doing simple things like changing the positioning so that baby
is feeding "uphill" and ratcheting down the supply like you have has
dramatic results, within just a few days.

On the other hand, some babies have difficulty with even a normal flow.
  I recently saw a baby who behaved very much like the baby you
describe.  We did everything possible to reduce mom's flow, and the baby
was still miserable. He sucked in long bursts (up to 70 or so sucks)
without taking a breathing break, and was very unhappy afterward.  He
had a very slightly tight lingual frenulum.  It was far back from the
tongue tip, and far back from the gum ridge, and his palate shape was
normal, so I initially didn't think it was an issue.  In desperation, I
referred mom to a very knowlegable doc to evaluate it, and doc thought
it was marginal too.  Mom decided to wait another weekend to see if the
baby would improve with all the flow control measures, and he didn't, so
she brought him in for a frenotomy.  The results were dramatic - within
24 hours he stopped gulping, resumed a normal sucking burst length and
respiratory pause pattern, and was a happy child.  There has been no
recurrence of the misery, and he is doing very well.

I am convinced that if we do everything we know to do for the condition
we think we are treating, and nothing works, we should re-examine our
hypotheses as to what is causing the problem.
Catherine Watson Genna, IBCLC

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