Rachel, I have worked with breastfeeding moms for close to 45 years. 
Until about 20 years ago, most of my mothers had insufficient milk, sore 
nipples or wouldn't latch. They were mostly doctor managed, hospital 
deliveries, babes in nursery at night, close to 100% given pacifiers and 
supplemented with formula / bottle, (earlier sugar water), given 
inconsistent information, all given formula "gift" packs at discharge (3 
days if a vag delivery and 5 days if a CS), received formula coupons by 
mail and poor follow-up in the community. I rarely saw a mother with too 
much milk.

For the last 20 years, likely 90 %% of my clients have too much milk. I 
see about 600 women a year and rarely have  women who can't make enough 
milk (only 1 or 2 a year). My clients are a special population. They are 
almost 100% midwifery clients and very motivated. Midwives may not know 
how to manage lactation problems but they certainly know how to get moms 
off to a good start (although education was needed in this area). 
Unfortunately, only about 5% of the deliveries in B.C. are midwifery ones.

  I am 71 and need to retire one of these days but keep working because 
I keep getting calls from women begging to be seen. Very few 
professionals know how to help women with big supplies. Many tell me 
there is no such thing or that this wouldn't happen if the mother let 
the baby "choose" which breast to use or that it is only because mothers 
are pumping too much (which may happen but not the norm in my area 
because most women get a years mat leave). Others tell me block feeding 
causes poor weight gain (which is true if not used properly).

Moms present, (usually between 4 - 6 weeks), with babe gaining well, 
(often) green, explosive stools, fussy, wanting to feed very frequently 
(or this is how mom interprets the fussiness), and often projectile 
vomiting. I ensure the latch is good, (these babies may have just 
"caught" the milk previously) and start block feeding at 1 breast for 3 
or 4 hours. I increase the time of the block every 3 days (if 
necessary), to give the breasts a chance to adapt. I call this "going up 
the ladder". I also recommend "gently" taking off not more than a couple 
of teaspoons of milk if feeling uncomfortable (some women say they are 
taking off a little but when you ask further they are often taking off 
an ounce or more), letting the opposite side drip when feeding and no 
pumping. Mothers are asked to have their babies weighed weekly.

  I usually only do 1 home visit and then follow up by phone. I don't 
charge for phone calls as I consider that my volunteer part of the job. 
This can be time consuming (and not very lucrative) but I have learned a 
lot by following them.

  I also teach all my clients (prenatally and postnatally) to do a daily 
check of their "empty" breast and discuss how to manage plugged ducts. I 
used to see mastitis and abscesses but that is rare today. I also 
discuss that there is someone out "there" who doesn't want them to 
breastfeed (they often say my mother?) and we talk about what happens 
when they sign up for "gifts" in maternity and baby stores. Very few of 
my clients give out their name and address today. Women who do receive 
"free" samples and coupons are encouraged to send them back C.O.D. to 
the company.

History of a recent client: baby (7 weeks old) feeding for 5 minutes, 
gulping and choking at the breast, coming off / throwing-up all over 
mom, the chesterfield and the carpet, (gaining above the 100%), green 
stools etc. Mom had so much milk we "climbed the ladder" until she was 
using 1 breast for 12 hours. Finally her breasts settled down. If they 
hadn't, I would have introduced a cabbage leaf to the alternate breast 
for 1 hour time slots.

Have also had clients (occasionally) with too much milk and twins. 
Feeding was managed and milk supply regulated by block feeding both 
babies on the same breast.

  It is also my experience, that if a mom had an over-supply with the 
first it will be even bigger with a second child so we discuss this once 
the problems with the first are resolved.

  I believe it is nature's way to make more of something than not enough 
and I believe that as breastfeeding gets off to a better start, (and the 
marketing is controlled) others will also see these big supplies. We can 
only dream that then, most of the questions on Lactnet will be how to 
"fine tune" over-supply.

  Renee (in Vancouver, Canada)

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