Kate writes of a mother with oversupply.

In our office, we have good success with having the mother continue to
back down slowly, to reduce risk of plugged ducts/mastitis from keeping
the milk in the breast somewhat longer. She may eventually use one breast
for all feedings in 12 hours, and the other for the remaining 12 hours.
Dr. Newman's book contains an anecdote of a mother who on her own,
decided to back the feedings slowly down to one breast one 24 hours, and
the other, the next 24 hours, and found it worked quite well for her. I
guess breasts can't tell time strictly. The whole idea is to use the
built-in feedback inhibitor of lactation factor.

To make the process shorter, Gonneke Van Veldhuisen, an LC in Europe, has
her moms pump as thoroughly as possible on both sides, and resume feeding
one breast for all feedings, slowly extending the feeding intervals to
6-8-10-or maybe 12 hours, whatever she can, till the other side seems
riskily full, I guess. (I hope she's "listening" and clarifies this.)
That way, the baby starts out on "cream" so to speak, which mends the
tummy promptly, and brings peace to the household. I believe I remember
her writing that occasionally, the process needs to be repeated once in
about 48 hours or so, but generally, she finds it an excellent way to
tamp down supply using FIL rather than drugs or herbs.

This mother is probably what we refer to in our office as a milk goddess
- -naturally gifted with a full 20 lobes or so in each breast,each of the
lobes developing many alveoli and lobules from stimulation of regular
menstrual cycles and pregnancies. Fortunately, not every alveolus must be
producing milk at the same rate at the same time, so maybe that helps FIL
work, even if the vigor of the particular baby's suckling and frequency
result in great prolactin levels.

Other mothers may only have 10-15, or far fewer lobes, if genetically,
there were only a few secondary buds sprouting off the primary bud when
they were in utero. Instead of or on top of this, some mothers then also
have years of inadequate hormonal stimulation from menstrual
irregularities, so they develop fewer alveoli and lobules in each lobe.
Perhaps fewer alveoli in which to develop prolactin receptors? More of
the available alveoli may then have to work more of the time to maintain
the best possible supply, even when galactogogues are used.

At least that's how I have come to understand it so far.

Jean
************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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