Chris, <Oh Wise Ones: I need some assistance with a patient. I think I've exhausted all the obvious things and now I need to 'pick your brains' for other ideas.> Just a few shots in the dark here. I'm not certain if these are among your "obvious things". Of course, it wouldn't hurt to check the prolactin level in case there's a pituitary problem, but at 5 months, since the breasts normally function with a much lower level at this time, even if it were still above a non-pregnant level, could we say with any certainty that it is the cause of overfunction? Seems like a vicious cycle and a question of "Which came first, the chicken or the egg?" The oversupply is causing the leaking and the leaking is encouraging oversupply! Could we somehow (perhaps by reducing the # of MER's), eventually retain more of the milk inside the alveolus in contact with the membrane, and thereby use the milk itself for feedback inhibition? (In other words, reverse the physiology by deliberately and studiously doing what makes so many mother mysteriously "dry up"?) This is an alternative that at least one mother I talked to found helpful. I explained milk production to her, and the possibility of nursing off the same breast for, say, all feedings in a 3-4 hour period, or even a 4-6 hour period before switching breasts. I also told her that I had heard that some primitive agricultural tribes used to sling the baby on the non-dominant side all day to use the dominant hand in the fields, then, round the campfire and all night, nursed on the opposite breast. She took in the info, and decided on her own to very gradually change to the12 hour pattern for all nursings on one breast and vice versa the opposite 12 hours. I had warned her to take just a little out of the opposite side as needed for comfort, anti-gravity positions etc. and trigger MER before latchings, to spare the baby the coping stress if need be. Till the baby could handle it comfortably, I suggested she let "the surge" flow for a moment before latch, on that one side only, and gradually add control of leaking on the unnursed breast with manual pressure with the heel of the hand for a few minutes. By doing it gradually and observing carefully to avoid signs of plugs etc., she successfully navigated the rapids to the "just one side in each 12 hour pattern" and found she and the baby were very comfortable with the end result, and no leaking. Just my $.02. Jean *********************** K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html