Jennifer writes: " She's also pumping a
pretty large volume of  milk, 6 oz every 3 hours, averaging 45-48 oz in 24
hours."

She definitely has oversupply by any measures, but she will be needing to
pump for a long time so I would keep her at a relatively high supply--at least
30 oz. per day. These moms often have a dip in supply down the line and a
high supply provides a cushion. I would have her first stretch pumping  interval
to 3.5 hr. and when she is comfortable with that to 4 hr. At this point  she
can take off 5.5 oz. instead of 6. She will need to keep an eye out for
plugged ducts and may have a difficult time bringing supply down. If these  measures
don't work, I would suggest 30 mg sudafed twice a day.  Although this baby
will be out of the hospital before he ever takes 30 oz. per  day, keeping supply
high for a premie makes breastfeeding easier. Flow is faster  and baby
doesn't need to work as hard. Also a small nipple shield can be quite  helpful in
stabilizing the nipple in the baby's mouth and in facilitating milk  transfer.
When she first puts baby to breast it should be on a relatively empty  breast.
If he does well with that she can gradually transition him to a fuller
breast. The moms of premies I've worked with with high supply generally have the
most success with breastfeeding. Test weights will be very helpful when he
begins nutritive sucking at the breast. And, yes, it is very frustrating that  the
nurses have allowed her to be in pain. I would try the 30 mm flange. Also
check her for thrush. Moms with oversupply are at greater risk.

Kathy Boggs, RN, IBCLC

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