Thanks to everyone who responded. Things are going better, using pre-'full
drainage and block feeding' knowledge and techniques, which is to say
expressing just enough for comfort, in order to allow the physiologic
feedback loop to influence supply. Slower, but since this woman's course
was complicated by a nasty case of mastitis, it was really the only viable
option.
I guess I didn't make it clear enough at the outset that this was the first
case I have seen in a long time where full drainage and block feeding as
per the article by Gonneke van Veldhuizen-Staas did not bring speedy and
lasting relief.  I am in contact with at least one woman every week with
oversupply and until now, it has worked in every case for the last 7 or 8
years, can't quite remember when Gonneke first told me about the method. It
was well before her article was published.

The woman I am working with is still *occasionally* experiencing deep
burning pain when her breasts are overfull, and sometimes immediately after
feeding too. But feeds themselves are much more comfortable now that the
baby's tongue tie is fixed, and she has been afebrile since shortly after
starting the antibiotics, which she finished almost a week ago now. She is
able to go for longer periods without her breasts getting overly hard and
uncomfortable, so she is not having to express in addition to feeding the
baby now that the mastitis has passed. While she was ill she was diligent
about removing milk thoroughly and frequently.

This reinforces for me the caveat not to do full drainage/block feeding too
early in lactogenesis, and to prioritize dealing with any suspicion, even a
whisper, of mastitis, before trying to reduce supply by less frequent
draining of breasts.

Jane, I didn't quite understand your post, about how babies suckle with
different degrees of fullness (if that was what you meant?). Perhaps you
could elaborate on it?

And I would dearly love to know what causes the burning, searing,
persistent pain so many women experience in situations like this.

I rarely meet women with organically caused low supply, and the ones I have
met are some of the most persistent, dedicated breastfeeding mothers I
know. They keep going, (usually partially breastfeeding as medications are
unavailable long term) for many months longer than many women who could
feed triplets from day 4. I see far more women who stop breastfeeding long
before they had anticipated doing so, because of oversupply.  Some of them
realize they have too much milk but they get no help dealing with it and
are blown off with 'your problem would be considered a luxury by many
mothers' or they are encouraged to become milk donors. We really
underestimate what a burden it is to have far too much milk. Low supply
does not carry with it an increased risk of mastitis, chronic pain from
engorgement, and breast aversion by a baby who fears drowning.

I find there is little awareness here in Norway that oversupply even
exists, and certainly no awareness that it is distressing to the point of
being a major cause of breast aversion in the baby, and premature weaning.
Any breastfeeding problem here will likely be assumed to be low supply, and
when nothing improves despite doing everything possible to increase (!)
milk production, mothers give up, and the reasons they give for stopping
are 'not enough milk' or 'baby refused to come to breast'. No mystery why
nothing improves, when the diagnosis is as wrong as it can possibly be at
the outset. The ones whose oversupply is unrecognized for the first couple
of months often find that production plummets once the hormonal influence
postpartum subsides, and then they are told 'you can't just lose your
milk'. No, you can't just lose it for no reason, but if you don't know the
signs that baby is actually not feeding effectively in the early weeks,
just passively getting by on leakage, you can bet no one in our health
service is going to figure out what actually happened. And again,
breastfeeding is perceived as unpredictable, unmanageable, and beyond the
reach of many mothers and babies.

Sigh. We are in the midst of a reform/reorganization of the maternity
health service, and I fear for breastfeeding, because care is getting more
fragmented, not less.

Rachel Myr
Kristiansand, Norway

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