My name is Denice Goodheart and I am an NICU
RN for the past 18 years. I will be sitting for the IBCLC exam this July. I
had chronic overproduction with my 2 children and am successfully nursing my
14 month old now. I tried everything in the literature with my first child
and nothing seemed to help (ie. positioning upside down, nursing one side,
small frequent feeds...). The thing that finally worked for me was nursing
one side for 12-24 hours. My milk supply didn't normalise for several
months. My situation was also comprimised by an over active let down. Does
she have that as well? Of course you have to be very careful to watch for
mastitis, especially since she has had it before. I believe I avoided
mastitis by not wearing underwire bras, having the ability to leak very
well, and some gentle expression of the engorged breast at the twelve hour
mark. I would nurse the breast that seemed to have the overall bigger supply
at night, say from 8 pm to 8 am. Then I would nurse my left side from 8am to
8pm. My baby slept with me and I would nurse sidelying very frequently at
night because when she was more wakeful during the day she would have
difficulty with the let down and supply. These nursing couples need lots of
support and since weight gain or lack of, can be an issue, you must get the
calories where you can (ie. at night). Another tendency in these cases is
milk blisters. Often they can be your first sign of a problem. They
masquerade as a plugged duct and you pump and massage and warm pack all to
no avail. If you get a sudden onset of nipple pain and a hard painful streak
without redness(usually), get a magnifying glass and check for a small
whitehead and pop it with a sterile needle. The milk will flow, nurse right
away on that side and pump if necessary. And speaking of pumping, it is
definitely something to avoid with an abundant supply as it only exacerbates
the problem. A couple of additional things to be aware of is an overactive
let down is due to an abundance of oxytocin. This extra supply of oxytocin
can wreak havoc with brain seratonin levels and so it is a good idea to
check with these moms regarding their emotional health. A huge milk supply
is related to too much prolactin and in some cases it can be a sign of a
pituitary adenoma. This is a benign tumor pressing on the pituitary and
apparantly is somewhat common but underdiagnosed. Often you will see moms
who continue to leak long after weaning and a host of other symptoms. Of
course, an MRI is needed. I realise I have been somewhat verbose but I hope
this can be helpful. I am also available to this mom by e-mail or by phone.
Feel free to let me know if you have any further questions.
Denice----------
> From: Susan Keith-Hergert[SMTP:[log in to unmask]]
> Sent: Thursday, April 01, 1999 7:17 PM
> Subject: chronic overproducer
>
> I need some advice about a mom I am now working with. She has a history
> of overproduction. It was so bad that she only survived a couple of
> months with her second child and then weaned after a bout of mastitis.
>
> She now tells me, at four days postpartum, that she is feeding baby
> every two-three hours, is severly engorged, pumps off about two ounces
> after each feed with a manual pump, and twenty minutes later she is
> "full again."
>
> She seems to know what she is talking about...I mean this is not just
> your normal overfullnes related to milk coming in.
>
> Any suggestions? I'm going out to do a home visit on her tomorrow.
>
> Susan Keith-Hergert
>
>
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