Pam wrote:
<My client has tried many tricks for oversupply. . . . . . . . . . She
has tried cabbage leaves, and
eating altoids. . . . . How much peppermint or sage or B6 would decrease
without wiping out her
supply altogether. . . . . . Mom has been able to get her supply semi
controlled but each time has been very temporary.>
Are those the only "tricks" she has tried? I would be interested in her
nursing pattern, specifically:
Does she use one or both breasts at each feeding?
Does she feed more than one or two feedings in a row on the same breast?
Has she been doing any pumping whatsoever?
<Her baby is tongue tied>
Tongue tie is generally more associated with poor milk transfer, leading
to eventual reduction of the supply. I cannot see how tongue tie could
have anything at all to do with oversupply. I can see how it might make
it difficult for the baby to manage rapid MER/flow that often goes along
with oversupply, however.
<and mom is military patient. It will be 3 more weeks before they will
clip the frenulum.>
I would not expect that clipping the tongue would do anything to help in
the management of oversupply, and the baby may need a while to change the
pattern of any tongue motions due to habit formation during this long
interval. This sudden change in function may not necessarily improve the
way he deals with an OAMER, especially when the tongue muscles and habits
suddenly don't respond the way they used to. Incidentally, does the baby
currently try to control the flow by backing off, and/or clamping down?
Does the mother have any nipple discomfort whatsoever? IME, these are
some of the things more commonly associated with OAMER/oversupply.
<She really has an abundance of milk and her poor little one is so
uncomfortable with feedings.>
So uncomfortable how? Choking and spluttering from OAMER? Gassy? Colicky?
Frequent spit-up? Green tinges to the stool at times? Melissa Vickers and
Diane Wiessinger, among others, have good written information about these
effects.
< We feel confident that much of this will be resolved when he has his
tongue clipped.>
On what basis? I am not aware of any connection of tongue tie as a
contributinh cause of oversupply.
<However this is her second baby and over supply was the reason for her
discontinuing breastfeeding earlier than she wanted with her first baby.>
This leads me to believe that the "problem" stems from the management
pattern of her breastfeeding based on her own unique anatomy and
physiology:
1) I suspect a probable full complement of 15-20 lobes in each
breast, and therefore:
2) A need to manage lactation for a singleton by using natural
feedback inhibition-i.e. using the "finish the first breast first"
philosophy. At this point, there are several physiologic ways to solve it
by changing the management pattern of breastfeeding, before diving into
hormonal, herbal and medication strategies: < She is currently discussing
the possibility of changing her BC pills to one containing estrogen. She
is going to be asking if she can switch for just one week to the estrogen
containing pill, she currently takes a low dose progesterone only pill.>
I have found one way to solve it is through gradually (very gradually)
extending the number of feedings on one breast, with the least amount of
milk removal for comfort, prevention of plugs, etc. as possible on the
unnursed side until eventually she works her way to the point that the
baby is using the same breast for all feedings in one 12-hour period,
then the opposite breast for all feedings in the next 12 hour period. (In
Dr. Newman's book, he gives an example of a mother who on her own
initiative, extended this kind of advice to using one breast for all
feedings in 24 hours, then the other for the next 24 hours, etc.and found
herself quite comfortable.)
An alternate way to manage would be to pump as much as possible off of
both breasts at the same time, then feed the baby on one pumped breast
(mainly hindmilk left), next feeding off the second breast, then next 2
feedings on first breast and following 2 feedings on second breast,
raising the number of feedings on one breast a little more as tolerated
till the all-feedings-in 12 hours on one breast, etc. pattern is
attained.
(It's impossible to tell by external physical assessment precisely how
many functioning lobes a mother has. The pattern for the number of main
ducts [and therefore the number of future lobes] is laid down in her own
embryonic development within her mother by the number of secondary buds
branching off the primary bud on each side. From my reading and clinical
experience, I hypothesize that many mothers have fewer than the commonly
stated 15-20 lobes, perhaps 10 or so, or even fewer, and manage quite
comfortably with commonly used patterns of relieving both breasts
frequently to maintain supply. I believe that using this pattern for a
singleton has the potential to bring on oversupply in a woman with a full
complement of lobes.)
<She really wants to continue nursing for the first year but her supply
is so high that she sprays heavily even when not full. . . . . . .>
A random guess: Does she perhaps have flat or very short nipples? If
there is less connective tissue in a nipple, there is less length of the
galactophores passing through. If the lactiferous sinuses are very
shallow, a nipple with little connective tissue and short galactophores
would offer very little resistance to the MER, or even gravity for that
matter. Of course, my guess may be completely off base. Just musing;-)
<The tongue tie is definitely an issue here but that doesn't seem to be
the entire problem.>
Tongue tie may be evident, but a totally separate issue that is probably
entirely coincidental. I doubt it has any connection whatsoever to the
oversupply. Perhaps it has even reduced the severity from what it might
have been if the baby had a robust tongue action and the same management
pattern were to have been used.
Please keep us posted on her progress. There is much to be learned if a
change in breastfeeding management helps. I will be inerested in what
others have to say.
Jean
**********************
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA
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