I have worked with moms with history of overproduction (we're talking 40 ounces above baby's needs, donating to two other babies!)  With second baby we followed the directions for baby-led, mother-directed attachment, mother reclined at 15-30 degrees and comfortable, moving baby from breast to breast whenever falling asleep or latch changed. Wonderful results with adequate supply but not excessive supply. No mastitis.  When mothers have a high supply and especially high storage capacity, the unused breast continues to make milk. When baby goes to that side, there is a reaction to the forcefulness of let-down (more milk stored, heavier the let-down).  It's equivalent to a bellows shoving the milk at the baby with let-down.  My sister has cows.  If she wants the cow to make just enough for the family and not too much, she puts the calf on from the start and doesn't start milking for a few days. If she wants more milk, she starts milking earlier and milks once a day. If she wants even more milk, she milks twice a day plus let's the calf on.  It's supply and demand even with cows!  The higher producing breeds have more issues with mastitis.  And guess what!  Cows get nipple damage and sore nipples and wish they had a nipple shield! JK ;-)

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of nandan fogelman
Sent: Wednesday, October 26, 2011 6:27 AM
Subject: Re: OMER and huge weight gain update

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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