Has she tried nursing in more upright positions to help lessen the MER and help slow the flow?
You can also position baby above the breast and have them "nurse on top" of mom.  A bit more challenging to do with a newborn baby than one who is a few months older but it can be done.

An exaggerated football/clutch type hold where baby is sitting up facing mom with his or her head level with the breast may help.

--
M. Green
Breastfeeding Counselor

-------------- Original message --------------
From: Penny Lane <[log in to unmask]>

> Permission to Post --
>
> I am working with a mother that has both classic oversupply and over-reactive
> let-down; however, this is by far the worst case or most aggressive let-down I
> have ever witnessed. Baby is now three weeks old and although is coping well,
> mom is experiencing extreme pain while breastfeeding and fears initiating each
> feeding.
>
> We have attempted, I think, most all the usual tricks to compensate for the
> aggressive let-down and to down regulate her supply... feeding on only one
> breast for several sessions at a time, pumping through initial let-downs, nipple
> shield for decreasing the force of the let-down and the intensity of his bite,
> varied positions placing him in more control of his airway, numerous comfort
> measures and even narcotics.
>
> Her let-down does not lessen after a few minutes of feeding. She literally
> lets-down consistently and forcefully throughout the entire feeding, squirting
> clear through the living room into the kitchen. Her three-week old does very
> well overall, but is gasping and gulping throughout the entire feeding and then
> is just completely exhausted. He is also experiencing the classic green, runny,
> mucousy stools, but is gaining very, very well. He is coping and does enjoy his
> breastfeeding experience, but of course is protecting his airway at every cost -
> most unfortunately through biting mom.
>
> My question is how can I assist her further with the intense nipple pain due
> to his biting through her let-downs? The little guy is such a trooper and of
> course, needs to protect his airway! However, mom is completely breaking down
> emotionally (absolutely no nipple damage what-so-ever). This mother has an
> overwhelming desire to successfully breastfeed after having had two previous
> heartbreaking experiences. She is just devastated that she has thoughts of
> quitting, but she fears feeding him or even burping him because she knows she'll
> have to relatch him again and he'll bite down on her.
>
> At this point, I have "ordered" her to take a forty-eight hour break, pump,
> and feed him via any method she feels comfortable and that he will accept (my
> order allowed her, I think, to not blame herself, lessens her guilt, and
> prevents her from quitting). We discussed the options and she is well equipped.
> We discussed "wearing" him between feedings and potentially Dad feeding
> skin-to-skin. She is heart-broken, but also relieved at not having to
> experience continued pain and/or quit.
>
> Am I missing anything? He really is a happy baby. I expect of course for her
> breasts to eventually regulate themselves, both in production and let-down
> intensity, but patience through the next three to six weeks will be trying for
> her. Any suggestions and of course, I am sure I am leaving out many details
> allowing you to gain a complete picture. Ask away.
>
> Note: previous breastfeeding experiences lasted not much longer than voicing
> an intent. She never left the hospital nursing due to lack of support. Mom and
> baby are healthy in every way that her pediatrician and I are aware. Weights
> before and after revealed an intake of nearly two ounces in less than seven
> minutes and no he hasn't aspirated!!
>
> Very Respectfully,
> Penny Lane
>
>
> Penny Lane RN, IBCLC
> Maternal & Child Health: Lactation Consulting
> Believe - Birth & Breastfeeding Resources
>
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