Diane Wiessinger would be ideal to address this, but she is out of town.

I am also dealing with a mom with oversupply and great sensitivity to
the pain of being overly full. She is not as severe as the mom you
describe, but it's severe enough for her and tends to peak in the middle
of the night. On top of the chronic engorgement issue we have sore
nipples that are in part due to baby latching to a full breast, and in
part to an atypical frenulum that I suspect is causing baby to suck
differently despite his ability to extend tongue well beyond gumline,
etc. (engorgement is not related to suck-- he can chug 3-4 ounces in
5-10 minutes!)

We've already tried peppermint-- tea and altoids-- before bed, but it
hasn't made much of a dent; she was still miserable. This was concurrent
with trying to keep baby to one side for 3-4 hours at a time to allow
FIL (feedback inhibitor of lactation) to build up and kick in. When my
client does pump herself all the way down, her breasts take about 8
hours to get to the "out of control" point again.

After conferring with Diane, we have devised an adjustment that we are
trying. Since mom cannot tolerate the pain of overfullness, we are
having her start off with pumping both sides all the way down, then
nursing only on one side for 6 hours. At the end of the 6 hours she will
pump that breast the rest of the way down to rock bottom and starting
nursing on the other breast for the next 6 hours. She is "allowed" to
express the unused breast to comfort if it becomes intolerable, and she
takes ibuprofen as needed as well.

On top of this, because baby gives her a lot of mixed signals about
wanting to breastfeed but then is fussy and indecisive at breast, she
will try a pacifier (which I almost never otherwise recommend!) to help
him settle as he seems to need to suck without always getting milk. This
may also have the advantage of reducing unwanted nipple [and prolactin]
stimulation.

If necessary, we may add sage tincture or sudafed to help control
supply, with birth control pills as our last choice. However, we are
going to try and let the natural system re-calibrate if at all possible.

We just started this yesterday, and while it will take several days to
see if this is the right path, mom did tell me this morning that she had
a better night last night. Time will tell. I was actually going to
recommend cabbage also, but forgot it in the midst of our discussions.
Some of these cases can only be solved by trial-and-error.

~Lisa Marasco

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