Dealing Successfully with Oversupply

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Dealing Successfully with Oversupply

• Marie Davis, RN IBCLC

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Disclosure Statement

• I have a financial interest in The Lactation
  Consultants Clinical Practice Manual as its
  author and publisher.

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Can a woman make too much milk?

• First described in at length in LC Series Unit 13
  by Andrusiak, Larose-Kuzenko 1987
• Woolrige and Fisher 1988
• Very little has been written since
• Almost no evidence based studies

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Culturally Defined Expectations

• Pre-conditioned to assume low supply
• Breastfed babies dont get colic
• An allergen in moms diet

• Treatment
• By educated deduction
• Not uniformly applied
• Treatment aimed at mother

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Wheres the baby?

• Screaming Miserable

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Blame Game

• Mom cant make the right milk
• When is it hindmilk?
• Hence,
• Pump and give from a bottle
• Or
• Formula must be the right milk
• Colicky moms make for colicky babies

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The Problem With the Internet

• Google 40 K sites
• Same breast for 12 to 24 hours
• Cabbage to dry up milk
• Elimination diet not working
• Measured feedings

Hummingbird Effect
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Nomenclature

• Inconsistent definition results in inconsistent
  treatment
• Almost all adjectives indicate pathology or place
  the blame solely on mom

Polygalactia Foremilk/hindmilk imbalance
Overactive Letdown Galactorrhea
Hyperlactation Hyperactive letdown
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Definition remains elusive

• Problem described differently depending upon
  perspective
• Overabundant Milk Supply and Forceful Letdown
  Reflex

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The main barrier to research is a lack of an
objective and universally applied definition
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• Syndrome
• A syndrome is a group of symptoms that
  consistently occur together or a condition
  characterized by its associated symptoms

Oversupply Syndrome is a predictable sequence of
symptoms in both Mother and Baby
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Once the syndrome is defined

• Treatment can be standardized
• Research can begin
• Evidence based practice results

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Informal Study

• Not a researcher
• Chart Review
• 304 contacts
• evaluation treatment
• 187 who followed up

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Protocol

• Purposenot cookbook
• Systematic approach
• Allows practitioner to see trends

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Diagnostic rut?

• Allergy if -----
• GER
• 6th time youve seen these symptoms this week

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Presenting symptom is usually colicsymptoms

• Colic rule of 3s
• cried for more than 3 hours a day,
• and more than 3 days a week
• over at least 3 weeks
• True colic defined as colic that occurs without
  a known cause, therefore, not the result of OSS

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Differential Diagnosis
Plugged ducts/ Mastitis Sore nipples
Latch on Problems Low supply
Allergy Vomiting
Congestive heart failure Pyloric stenosis
Sepsis GE Reflux
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Medical findings

• Overlapping symptoms
• Colic
• Reflux
• High tone

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Babys Symptoms

• Excessive, early weight gain plus

Gassy, fussy Unusual stooling patterns
Short feedings Gulps or chokes
Makes popping sounds Frequent demand
Many wet diapers per day
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Babys Symptoms

• Stuffy nose
• Poor latch
• Unsatisfied sucking need
• Early ear infections

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Moms Symptoms

• Persistent sore nipples.
• Linear crack across the nipple face.
• Nipples reddened, bruised or purple
• pc nipple pinched, white
• often has ridge
• Milk sprays or gushes when baby comes off the
  breast
• Opposite breast leaks large amounts while
  nursing/pumping

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Moms Symptoms (continued)

• Problems with nipple thrush Recurrent plugged
  ducts
• Early or recurrent mastitis
• Initial engorgement
• Moderate to severe
• Lasting 2-5 days
• Letdown sting or burn (about 50 say cant feel)
• PPD

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Familiar Component

• Some women appear to be genetically predisposed
  to excessive milk supplies
• 1/3 report sister or mom with OSS
• Tends to get worse with subsequent pregnancies
  unless managed early postpartum

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Understand the Controls

• Maternal
• Initial supply hormonally driven
• Local Feedback
• Managing feeds

• Infant
• Fat slows gastric transit
• Excess Lactose Fermentation
• Air swallowing

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Classes of OSS

1. Primary No apparent cause
2. Secondary result of disorder elsewhere
   (pituitary tumor, allergy)
3. Induced caused by something the mother is doing
   (excessive pumping, galactologues)

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Temporary Oversupply

• Strongly recommend not to begin treatment other
  than 1 breast per feed until baby is 3 weeks of
  age unless prior history

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Phases of OSS

• 1st Phase relativity mild colic, easy to treat
  symptoms
• 2nd Phase Copious amounts of milk Baby is
  beginning to fight at the breast, milk supply out
  of control, frequent plugs and or breast
  infections (stasis)
• 3rd Phase Baby refusing the breast and loosing
  weight, mom's supply severely diminished

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First phase treatment

• One breast per feeding 2-4 hours
• Cue feeding
• Posture feeding elevated clutch hold
• Frequent Burping IF TOLERATED
• Allow some fullness in breast
• Work on latch-on problems as flow slows

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Anticipitory Guidence

• 1st 24 hours
• 24-48 hours
• 72 hours
• Change in stool usually first clue

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Second Phase Treatment

• More time on one breast but not beyond 4-6 hours
• Addition of Sage tea and/or Pseudoephedrine
• Timing of meds is important
• Dose
• Mint - Aromatic oil through milk drying and may
  help soothe infant stomach
• Suggest conservative elimination diet Dairy
• Dietary supplements
• Pump out Re set milk production
• Consider infant meds
• Nipple shield

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Severe OSS
Mom Baby
Trial of BCP Gentle back to breast-self attachment
Pump and feed Rebirthing
Consider unilateral weaning
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Special Situations

• The pumping mom
• Mom with twins
• Previous history
• Supply wont down regulate
• Babys with huge appetites

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Suggestions for further study

• Substances/foodstuffs known to decrease supply
  should be studied

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Marie Davis RN IBCLC

• marie_at_lactationconsultant.info
• Extended bibilography available by request