Penny, I apologize for this long post...I've summarized some of what has
already been suggested and added a few new things.
 
Seems to me that there might be THREE seperate issues going on with this
mother.  Three issues that might not be able to be dealt with at the same
time.  
 
It appears that this mother is suffering from:
 
1.)  Extreme pain on MER.
 
2.)  Extreme over active MER.
 
3.)  Biting baby.
 
These *may* or *may not* be related.  It is possible that this mother might
have extremely painful MER regardless of the rate of flow.  And it's
possible that her baby might clamp/bite in spite of her extreme OAMER.
Sure, solving one might solve the other, but we do not know that for
certain.
 
Personally, I think you should tackle one situation first and see if the
others still present.  Tackle the situation that is most distressing to the
dyad.  I personally think that would be the OAMER, because it truly affects
both mother and baby each time.  We well know that MANY mothers can nurse
through extreme pain of all different kinds while baby is completely
oblivious.  So, I don't think that is best one to tackle first.  As for baby
biting...well, if it IS because of the OAMER, tackling that will handle the
problem of biting, and if the biting is NOT because of the OAMER, it will be
revealed once the OAMER is managed better.
 
***Don't forget the latch.  Even with very forceful MER, a baby with a
really good latch can often control the flow.  Dr. Jack Newman states in his
book that often OAMER leads to bad latch because of the constant on and off
and because of the fact that the milk is flowing anyway!
 
***It has already been suggested that mom express some milk before nursing,
and this is important.  She only needs to express from the first side, as
she can simply let the milk flow from the other side during the feed,
effectively removing milk from the second side.
 
***Even if a fabulous deep latch is achieved, if baby pulls off the breast,
mom should give the baby a breather until her milk stops flowing so
forcefully.  She can catch the milk in a cloth diaper or small towel or even
a hand-held pump if she is loathe to "waste" it.
 
***The 'Australian position' really does work; it will be easiest for mother
to control hold baby if baby is tucked, tummy down, right around her chest.
Baby's little feet should be dangling or tucked gently between mom and bed
or couch.
 
***Nursing with baby upright works too.  Sometimes mothers need to use this
position AND recline at about 45*.
 
***Also, side-lying can work in these situations.  This mother might find
that she needs to nurse in one of these three positions all the time, at
least for the next few months.
 
My first instinct on reading the original post was, as has been suggested,
an anti-galactogogue, but I'm not sure that over supply is the issue here.
I wonder if this mother is delaying or avoiding feeds because of the
extremely painful MER and/or biting, which would make it seem like she has
too much milk, via engorgement, etc.  Therefore, once she has been taught to
properly manage b/feeding with the OAMER, she then needs to manage her PAIN.

 
***Medication might be a good option, as might distraction (reading,
watching t.v. or having a conversation while nursing), or even just simple
reasurrance that as she and baby learn to manage b/feeding well, her pain
will likely cease.
 
***I would check to see if she is taking ANYTHING that might be causing
oversupply, which in turn could cause OAMER, or if she has Raynaud's or
vasospasm.
 
***Also, seeing as how she doesn't appear to have traumatized nipples
(though she still should be checked for cracks), she might respond well to
cold compresses applied for a few minutes before latching baby on, unless
she has Raynaud's.
 
***I wonder if baby is biting because he doesn't feel supported.  Proper
position will help with this - making sure she is putting pressure between
his shoulder blades so that he feels secure when on her breast.
 
***He might need some suck training.  If he is biting her DURING a feed, he
is not using his tongue properly.
 
***And, baby needs a thorough oral exam to rule out palate or frenulum
issues.
 
***Finally, it might help the entire situation for mother and baby to relax
together just before an expected feed.  A bath, infant massage, rocking and
singing are all good ways to help both of them feel better about the
situation and feel more in control.
 
Blessings!
 
Karyn-grace Clarke, IBCLC, LLLL
 
 
 
 
 

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