Wow!  I just finished reading Gonneke's article on complete drainage
followed by block feeding  - and am awed by such brilliant creative thought
and am so glad to have this tool to use for such a difficult situation.  I
admit, that when mother's call me describing what sounds like over
production, I generally don't want to take the case - I do of course - but
these are some of the hardest with the babies being so miserable.
I have a question though, how early in the game can we determine that
someone is going to over produce.  For instance, case number 4, the baby is
only 4  days old.  How could we determine at 4 days that the mother is an
over producer and not just temporarily over producing as so many women in
the first week or so  postpartum do.  I have heard of and recommended a
complete drainage for women with engorgement during this time period (with
excellent results) but would be weary of starting block feeding so early and
perhaps tamping down a milk supply that hasn't been fully established.  I
would love to hear your opinions on this.
Thank you so much,
Chayn IBCLC in Israel, catching up after a short hiatus

On Fri, Oct 21, 2011 at 12:16 AM, Rachel Myr <[log in to unmask]> wrote:

> Since I was responsible for getting a link to Gonneke's article from
> International Breastfeeding Journal onto the BF org website in Norway I've
> been getting all the flak from mother to mother counselors here who simply
> will not try to understand it.  The mother Isabella posts about would be a
> prime candidate to do complete drainage followed by block feeding as
> described in the article, which is freely accessible at
> http://www.internationalbreastfeedingjournal.com/content/2/1/11  I think
> it's a 'must read' article for anyone working with mothers in the first
> month postpartum.
>
> What Linda describes is a lot like what Gonneke describes, with some
> important differences, and they are the very differences, IMO, that cause
> 'full drainage' etc to work swiftly and effectively in most cases, while
> the
> more complicated measures described in Linda's post may be necessary for
> weeks on end.   Linda describes a lot of the things I used to recommend
> before I learned about full drainage followed by block feeding.   The very
> short version, and please please read the whole article before you tell
> anyone to do it, is that both breasts are drained as completely as
> possible,
> first by expressing as much as mother can manage, and then by the baby who
> is let loose at both breasts for as long as baby wants, right afterwards.
> Mothers worry that the baby won't find anything in the breast after they
> have expressed so much but they always do, and they feed more relaxedly
> when
> not trying to drink from a fire hose.  Starting with two empty breasts
> makes
> it possible to leave one side alone for the next several hours, while baby
> feeds ad lib from the 'on duty' side.
>
> To date I have not encountered any mothers whose oversupply or powerful
> milk
> ejection reflex got worse after using the method, nor any who developed
> plugged ducts or mastitis from the long intervals with no milk removal.
> Obviously you don't start the process in the middle of treatment for
> mastitis either.  Most of the mothers notice a dramatic improvement
> immediately and for many of them, the problem is solved once and for all
> after the first attempt.  If they have been piddling along for weeks with
> it, (with constantly tense, tender breasts, expressing before every feed to
> soften them so the baby can grasp it more easily - all the things that will
> ensure the oversupply lasts much longer), they seem to need to go through
> the regimen at least twice to really get rid of the problem, with a few
> days
> between each new round.  The first time works well enough to convince them,
> but breasts conditioned to produce tons of milk need some time to get used
> to the new production level and in the course of a day or two they are
> feeling engorged and seeing signs that baby is struggling again.  I have
> had
> to reassure them over and over again before they try it, because they have
> had the Fear of Pumping put into them, as if one good emptying will
> increase
> their milk supply permanently, ten fold.  If only it were that easy :-)   I
> usually can convince them to try it when I point out that things are
> untenable as they are, and can hardly get any worse, so what have they got
> to lose?  And I promise they can call back and say 'I told you so' if it
> doesn't help.  So far every single mother who has carried out the method at
> my suggestion, has called back to say it helped.  It's especially
> convincing
> when they have had the problem with previous babies and not gotten help;
> they can really tell the difference.
>
> The most recent request I had for help dealing with oversupply was from a
> mother whose first child had ended up on enzymes for lactose intolerance
> while she had been instructed to do all in her power to *increase* her
> supply.  The 'proof' of her low supply was an unhappy baby who regurgitated
> a lot of milk but wasn't gaining as expected.  Needless to say, increasing
> supply didn't make the baby happier.  This time she has been more savvy and
> through reading up on oversupply had diagnosed her own problem AND knew
> where to go for help.   The advice given her by her public health nurse at
> the well child clinic was to feed the baby (then just 4 weeks old) less
> frequently, for example, no oftener than every three or four hours.  This
> was to allow the baby's stomach to 'rest' or something, she wasn't sure.  I
> asked what advice she'd been given about how to respond to the baby when it
> seemed to want the breast but it 'wasn't time yet'.  She didn't recall any
> advice for that eventuality, and on further questioning she said she'd
> found
> the advice difficult, if not impossible, to use, because she couldn't tell
> when it was OK to feed her and when she should delay.  So it was clear she
> needed a change of strategy.  She got in touch because after a 24 hour
> interlude following the full drainage, in which the baby for the first time
> seemed to enjoy feeding, her breasts were threatening to get uncomfortably
> full again and she was very eager to hear whether she could start at the
> beginning again.  (She could!)
>
> About emptying the breasts once a day in addition to breastfeeding a child
> ad lib: in my experience this keeps the oversupply alive and well, and may
> even exacerbate it.  If you try Gonneke's method as the first treatment,
> you
> will find it is rarely necessary for mother to express milk for comfort or
> for ease of attachment by baby.   But one of the unluckiest women I have
> heard from, had been told to carry out a complete emptying of both breasts
> *daily* and then block feeding for the rest of the day.  I don't even know
> if she had oversupply before she started in on the method, someone else had
> been counseling her, but boy did she have it after two weeks of this
> routine!  She was producing about two and a half times what her baby needed
> and was desperate.  Even that case was surprisingly easily dealt with by
> simply practicing the technique as described by Gonneke.
>
> It's so different from what we've been used to recommending that it's hard
> to take on board.  What convinced me was trying it, and seeing how well it
> worked, knowing how distressing oversupply can be for mothers, especially
> when they are told it's a luxury problem.  OK, way too much milk is not as
> bad as way too little milk.  But it's so unnecessary and it predisposes to
> mastitis, and to premature weaning, because babies don't experience the
> breast as a relaxing place to be and they spend as little time as possible
> there.  The mothers lose out on experiencing all the other aspects of
> breastfeeding and their first weeks or months with their babies are a lot
> less enjoyable.
>
> Onward and upward  - and do read the article.
> cheers
> Rachel Myr, feeling like a broken record (remember LPs and diamond
> styluses??) about oversupply in Kristiansand, Norway
>
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