I am having a hard time supporting a mom with a very resistant
oversupply, so I will be happy if you help me - as always! - to see what
I am missing.
It is a first time mom, baby 4 months old. In the hospital mom got the
usual information - nurse on one breast and then pump *both* breasts
until they are completely soft (don't start me on this... I feel ashamed
even to mention it, but that's common advice in our hospitals - pump
both breasts after feeds or your milk will stop).
So mom follows this advice and pumps dilligently both breasts after
every feed despite using only one breast per feeding. Needles to say
that results in an oversupply and exhausts her completely.
First case of mastitis follows at 2 months, resolved with antibiotics and
more pumping. Strong OAMER, baby gags - she pumps 50 ml before
feeding to make feedins more comfortable for baby and then about 50
to 100 ml to make the breast soft after baby has fed. Mom feeds on
one breast only, baby's weight gain is WNL, not too much - about 700-
900 gr per month.
Some weeks ago a friend mentions to her that maybe she has an
oversupply, mom digs out information about block feedings on the
internet, stops pumping cold turkey in order to try it - and gets another
mastitis. She begins taking antibiotics again, gets an awful diarrhia
from them and stops them per doctor's advice after 6 days. Mom is
getting plugs continuously ever since, even when she restarted
pumping. No mastitis - just plugs, low grade fever, swollen hot areas in
the breasts which require more pumping to clear...
Breasts fill very rapidly - she cannot stay even 3 hours without
pumping for comfort and in order to achieve comfort without draining
she pumps about 50 ml... Nights are a nightmare - she pumps for relief
every 2 hours or they get rockhard with lumps and it takes her more
than 24 hours with complete draining of the breast to resolve the
blockages. This mom has not slept more than an hour straight for 2
weeks now...
2 weeks ago she started cabage leaves and sage tea, first 1 cup per
24 hours. After a week of this there is some improvement during the
day (she only needs to pump 20-50 ml from the unused breast to
achieve comfort), but nights are the same nightmare. Sage tea to 2
cups, one during the day and one at night, for 5 days running - not
much difference for her.
She got a very painful blockage in one breast yesterday and she will be
seen today for it. I am very concerned with this blockage as she only
got 6 days of antibiotics for her mastitis because of the diarrhia. I have
no doubt she will get the advice to pump more to clear it if it is only a
plug...
So - what else we could try? Would staying on 2 cups of sage tea be
safe for so long - it will diminish her supply further, but it does not help
the blockages she gets. Lecithin is not an option - mom's diarrhia has
not been resolved and mom says lecithin aggravates it. She didn't see
improvement with lecithin even prior to this though.
Mom is reluctant to drop pumpings because of the blockages she gets
when she tries to go even 3-4 hours without pumping.
We talked about visiting an endocrinologist - she had no trouble
getting pregnant or with the pregnancy itself, but she had some minor
issues in the past (very painful breasts before period with sometimes
drops leaking - before getting pregnant! and mild hirsutism too), but all
her hormones came out normal when she was tested.
I know this could change after a pregnancy and I am aware that
normal hormone levels in the past does not mean they are normal
now. So she will go to the endocrinologist and hopefully she will get
her normones tested. But in the meantime - what could we do to make
things more comfortable for her?
She got a prescription for a low dose of bromocryptin after the first
bout of mastitis, but her prolactin levels were not tested and she didn't
want to use it for fear she could risk not only lowering but losing her
milk.
I feel now as desperate as she is. I don't know if it is normal for
leveling out the milk supply to go so slowly. In fact, after writing it all
out I can see the progress mom has made in the past 2 weeks but it
has never taken so long for any mom I have worked with. And I am still
very concerned about why she gets plugs even when milk supply has
gone relatively down - maybe it needs more down regulation to
resolve?
I will be very grateful for any suggestions.
Christina in Bulgaria,
BF Peer Councellor
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