Dear Joy,

About the first case....
I don't understand why this mom is still anemic.  Is she not being treated for the B12 deficiency at this time?  Does she have some other chronic condition which causes macrocytic anemia?

Has she tried sage to cut down on production:  The tea can be made by infusing 1 TBSP of dried herb in 1 cup of hot water - steep for 10-15 minutes.  Drink 1 cup, 3 - 6 times per day.  You could use a tincture instead:  30-60 drops of tincture, 3-6 times a day.  In really bad cases, a short course of an estrogen containing birth control pill can often bring overproduction under control.  One-sided nursing, for up to several nursings in a row, is often a good technique for overproducers, but I'm not sure it is so relevent in these cases of massive overproduction, at least at the beginning, but could be helpful as the overproduction begins to abate.

MER could be involved, so a trial use of oxytocin couldn't hurt.  Try putting those hot compresses on the back of moms neck and adding some massage - often good for encouraging let-down.  Rescue remedy also could be helpful, and certainly will cause no harm.

Would do most of my hand-expressing just before nursing the baby so that there is a chance he might get some hindmilk.  Then apply ice packs and/or cabbage - cabbage could be worn virtually around the clock.  Use the hot compresses briefly just before expression/nursing if they are needed for MER - heat is not normally recommended in these cases, but I have found moms who really do rely on the warm compresses to get the milk flowing.  But most often I have found that a lot of cold/cabbage will actually free up milk flow much better than heat.  This mom seems to have been using a lot of heat and only a little bit of cold - needs to reverse the percentages.

Good luck.  These moms are so uncomfortable, I hope she finds some relief this time around.


Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
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