My protocol is similar to Linda Pohl's.

I recommend 1/4 tsp of ground sage 3 X a day until supply is decreased
sufficiently.  Mother can put the sage into capsules if she has access to
them or she can make a "tiny" sandwich on a corner of bread with something
sticky to hold it on. She has a comparably tiny top to the sandwich.  The
idea is to have a piece that she can swallow without tasting it.  She
swallows, then drinks water or juice.  It works very well. I find sage to
be the most potent antigalactagogue.

She can use peppermint drops or such and parsley as an added
antigalactogogue.  Most of my clients just use the sage. THey are always
afraid that their supplies will get too low, but I work with them daily and
assure them that they have to concern themselves more with preventing a
recurrence of over-supply instead of losing their milk.

I also suggest that they limit the amount pumped at most feedings instead
of time pumped.  But once or twice a day (as needed--breasts are tight) the
mother drains both breasts well.  The rest of the time she leaves milk in
the breasts to facilitate reduction.  After I read about this pumped
drainage once or twice a day , alternating with well-filled breasts, my
clients have had no problems with blocked ducts or mastitis. I urge the
mother to use her judgement and to not have painful breasts. I let her know
that this is not an regimented protocol and that we will work with her body
to reduce the supply as it comfortably can.

At those times of full emptying (or "almost") she feeds the baby afterwards
to help baby to see that she can feed without drowning. Mother finds that
at the next feeding after the emptying, baby feeds well and drains the
breast. She can make a high-fat feeding from the pumped milk by putting the
milk in the refrigerator, allowing the cream to rise to the top, skimming
it off, mixing it with "regular" milk,  and giving it to baby with
alternative feeding method of her choice.

Baby feeds on the same breast for any feedings under 3,4, hours depending
on where we are in the process.  I begin at the lower interval and move to
the higher as needed. If there is one breast that can be regulated more
easily I may suggest that baby feed on that side only and the other side is
pumped well, alternating with leaving fullness and relief pumping.

I find that the alternative well-emptying and well-filling along with the
sage has good outcomes.

Patricia Gima, IBCLC
Milwaukee, Wisconsin

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