Lee writes

<Lee now writing:  Jan, I will be very honest, I have more questions than
answers.  One reason for the overproduction may be that the edematous moms
get off to a very bad start with breastfeeding and go on to pump a lot
before they seek LC help, especially if the baby is guzzling down 3 or 4 oz
at a time from the bottle.  OTOH, and this is purely anecdotal, in my area
it SEEMS to be related to edema (caused by lots of pitocin, IVs,
epidurals?).  Maybe in the future, we will have studies/research regarding
if overhydration can lead to a superabundant milk supply; I know that at the
present many believe that the opposite is true.  Do you have any thoughts on
that?  Do any other Lactnetters?  I only have questions and suppositions!
BTW, oversupply in my area is something that I have noticed more of in the
past few years only.  I don't know why that change is the present
situation.>

Lee,

I questioned your original post when I read it too. I would certainly not
want to get a rumor started that extra IV fluids in labor may create more
milk!!!


I take the view that they tend to complicate the initiation of
breastfeeding, by distorting the nipple-areolar complex to complicate
latching and even pumping, as well as hand expression. That factor alone
keeps lots of moms from having the kind of initial experience they would
like. On top of that, it often seems to delay the onset of lactogenesis II
for some mothers.


I have read quite a lot about edema formation in my quest to shed some light
on edema superimposed on engorgement. The concentration (of various
substances in the blood) is one factor in



   1. the speed at which those substances move out through membranes of
   the arterial capillaries, and therefore
   2. how rapidly they move into the interstitial fluid in order to be
   transferred toward the walls of the milk making cells. I deduce that
   dilution probably even effects
   3. how rapidly that raw materials (hormones, electrolytes, etc.)
   actually cross the basement membranes to enter into the alveoli themselves.



So to sum it up, I believe the overhydration actually dilutes the
concentration of raw materials destined to go to the milk making cells, both
in the circulatory vessels, and thereafter in the interstitial fluid, and
could conceivably be a contributor to delayed lactogenesis II.



So, as you suggested, rather than the fluids themselves, if the pumping
attempting to solve the initial problems is overdone, oversupply might
conceivably result. You say you have noticed this "just over the last few
years".  IV's in labor, (in varying amounts for different mothers according
to their true complications or interventions or anesthetic, etc.) have been
around for decades now, so if there has been any actual change, the cause
must lie elsewhere.


The following is simply the vision in my own head from what I have read:


It's my perception that "normal" mothers must vary in the number
of secondary buds that they were gifted with as an embryo. From my reading I
gather that each of the secondary buds which canalizes becomes a future main
duct, each of which will form a lobe at thelarche (the initial breast
changes occurring several years before actual menarche).


I visualize that this would mean that some women must have a full complement
of lobes (which means not only development of more total alveoli, but more
storage capacity) while others might have a few less, etc., but still have
an entirely  adequate amount of glandular tissue to produce milk with
appropriate frequency of nursing. Simply put, it may be that oversupply is
easier to induce in the mothers who have a full complement of lobes.



(I imagine this as the reason some women made such good wet nurses, or why
some women can more easily produce all the milk needed for multiples.) I
think this is most likely the reason that breast dissections of individual
mothers over the decades has led to differing reports on breast anatomy,
reporting the often quoted number of 15 to 20 lobes, whereas some report
lesser numbers of lobes. I am not aware that radiological testing is yet
able to detect the exact number of lobes a breast contains. I hope someone
corrects me if they have references to the contrary.



Therefore, I would wonder what are the management protocol changes that the
local hospitals or physicians groups, (or LLLL's, or WIC classes, prenatal
classes, etc.) may have made in the last several years.  This is in addition
to what mothers might be told by their grandmothers, aunts, mothers,
sisters, cousins, etc. who were told to "religiously" use both breasts at
every feeding.


This is one of the first things I ask mothers about when they call WIC to
report the birth of their babies, and answers are extremely variable as to
what they  "were (or were not) told" by various hospitals or individual
personnel, or come up with on their own. I try to help them cope day to
daywith initial swelling and prepare them to eventually move on to a "finish
the first breast first" mentality. Then, on follow up calls as to their
progress, if needed, I eventually give them insights to help balance supply
with demand if there are problems.



Unfortunately, the good news is that we now have so many WIC mothers
breastfeeding in our area that we cannot make all the follow-up calls we
would like;-) So there is work to do among our peer counselors and area
breastfeeding coalition about what mothers are instructed to do as far as
"one breast, or two, or first-breast-first etc.".

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

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