(Gee, Sar, I don't know why I can't get your message posted from here to
Lactnet, but...)  Oops, oh hello folks!  Just having some technical
difficulties here.  Please excuse the round about way I had to go to finally
get the following earnestly written message from Sarah posted.   Whew!
--Harry
-------- Original Message --------

From: [log in to unmask] (Harry Chaikin)
Date: Sat,  4 Mar 95 18:42:28 EST
To: [log in to unmask]
Cc: [log in to unmask]
Message-Id: <[log in to unmask]>
Subject: oversupply



Hello,
   Some of you may know me from the days of LLL of Prodigy.  My name is
Sarah Chaikin.  I am a League Leader and an AAPL with La Leche League of New
Jersey and an IBCLC.
   I have recently come across a perplexing breastfeeding situation and I
would welcome any bright ideas anyone might have as to how to help this
mother.
   Mother is in her late 20s.  This is her first baby.  The mother has an
oversupply of milk like I have never before seen.  With the exception of one
day since the baby's birth she has nursed the baby on one side only per
breastfeeding session.  The infant is satisfied and does not take the other
side when offered.  The infant (a girl) nurses approximately every three
hours for *no more than 10 minutes*.  She has frequent wet diapers and bowel
movements.  She is described as a "good baby" but is quite gassy.  The bowel
movements tend to be copious and rather explosive.  The baby is gaining
rapidly.
   The mother has had large breasts since puberty and they developed
significantly during pregnancy.  Her periods have always been very regular.
During pregnancy the mother had bouts of tachycardia which were initially
thought to be "panic attacks".  Eventually she was referred to a
cardiologist who did a 24 hr. Holter monitor and found that these occurred
periodically throughout the day and night.  The mother reported to me that
an adrenal scan was eventually done in an attempt to explain the
tachycardia, but this did not yield any useful information.  The mother
experienced premature contractions during her last trimester and was
eventually put on a small dose of Brethine (the cardiologist restricted her
dose due to her prior experience with tachycardia).  The pregnancy went to
term.  Labor and delviery were quite rapid and no medications were used.
   At eight weeks postpartum the mother continues to experience painful
engorgement.  Her breasts are very enlarged, hard and very painful.  She
does not use a breastpump except on rare occasion.  She experiences frequent
let-down reflexes throughout the day.  When breastfeeding a let-down will be
stimulated within 10-15 seconds.  The baby struggles at the breast and will
let go when the let-down occurs.  Breastmilk spurts forcefully for 12-18
inches from the nipple and the mother reports that she frquently soaks a
hand towel before the milk flow slows down.  When the infant returns to the
breast she gulps and struggles to coordinate sucking and breathing.  The
infant terminates the breastfeeding after about 10 minutes.  After burping
she does not usually wish to return to nursing.  On those occasions when she
does she usually spits up a large amount of milk.  The infant frequently
sucks her hands.
   In addition to breastfeeding on only one side per nursing session, for
the last 3 days the mother has been applying ice packs to the breasts after
nursing.  This has improved her comfort level somewhat but has not
appeared to reduce the milk production.  We used cool cabbage compresses for
part of one day.  Fresh, chilled cabbage leaves were applied for
approximately 20 minutes (until wilted) after nursing.  She repeated the
procedure 4 times during the late morning through afternoon.  Paradoxically,
that night she experienced engorgement and pain more extreme than ever
before which was not relieved by nursing the baby.  The infant vomited a
large amount of breastmilk after nursing and wanted to be fed again.  The
mother fed her a second time then used her pump to relieve the pressure.
She was able to pump an additional 4 ounces.  After this pumping she
reported feeling "normal" for the first time in many days, with soft
non-painful breasts.  The next nursing was easier and the mother reported
that this was her first time in memory that the baby seemed to be able to
nurse for comfort longer than 10 minutes.  The next day brought the same
level of engorgement and leaking that she has been experiencing.  She is
reluctant to try the cabbabe again due to the middle-of-the night
engorgement she experienced and described as "rebound".
   The mother is feeling frustrated and I am about out of ideas.  Any new
ones would be appreciated.
                                Sarah Chaikin