Hi Randi,
I follow a 2 pronged approach to oversupply: increase the baby's ability
to handle milk flow while reducing excessive production.  To help baby
with flow we try adopting prone feeding for baby, or football/clutch
hold with mom leaning back so baby is nursing uphill, allowing milk to
pool in the front of the mouth if baby can't keep up.  I teach mom not
to try to hold baby's head to the breast.  Sometimes moms misinterpret
their baby's distress with fast flow as impatience with not enough
flow.  This can lead to her using counterproductive measures.  Another
factor to look at is tongue-tie, as a baby who has restricted
longitudinal grooving of the tongue will be less able to handle a bolus
of milk.  Referring for evaluation and treatment if appropriate can
increase baby's comfort with milk flow.
Simultaneously, we work on reducing both milk production speed, and the
speed of milk ejection, by short, frequent nursings, using one breast
several times in a row before switching to the other.  This way neither
breast is "emptied", and speed of production is slowed.  As milk
production slows, the MER generally calms down as well.  Tricks like
nursing while standing or walking around also help slow MER.
        The most extreme case of this I have seen was a mom of a 4 mo old baby,
who would spray from 8 or more nipple pores simultaneously.  Baby was
displaying all kinds of aversive behaviors at the breast.  It took 3
weeks of the above to calm things down enough that this baby could nurse
without letting go, arching, and screaming several times per feeding.
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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