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Dealing Successfully with Oversupply

Dealing Successfully with Oversupply. Marie Davis, RN IBCLC. Disclosure Statement. I have a financial interest in “The Lactation Consultant’s Clinical Practice Manual” as its author and publisher. Can a woman make too much milk?.

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Dealing Successfully with Oversupply

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  1. Dealing Successfully with Oversupply Marie Davis, RN IBCLC

  2. Disclosure Statement I have a financial interest in “The Lactation Consultant’s Clinical Practice Manual” as its author and publisher.

  3. 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

  4. Culturally Defined Expectations • Pre-conditioned to assume low supply • “Breastfed babies don’t get colic” • An allergen in mom’s diet • Treatment • By educated deduction • Not uniformly applied • Treatment aimed at mother

  5. Where’s the baby? Screaming & Miserable

  6. Blame Game “Mom can’t 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

  7. 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

  8. Inconsistent definition results in inconsistent treatment Almost all adjectives indicate pathology or place the blame solely on mom: Nomenclature

  9. Definition remains elusive Problem described differently depending upon perspective Overabundant Milk Supply and Forceful Letdown Reflex

  10. The main barrier to research is a lack of an objective and universally applied definition

  11. 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

  12. Once the syndrome is defined • Treatment can be standardized • Research can begin • Evidence based practice results

  13. Informal Study Not a researcher Chart Review 304 contacts evaluation & treatment 187 who followed up

  14. Protocol Purpose—not cookbook Systematic approach Allows practitioner to see trends

  15. Diagnostic rut? • Allergy if ----- • GER • 6th time you’ve seen these symptoms this week

  16. Presenting symptom is usually “colic”symptoms Colic rule of 3’s 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

  17. Differential Diagnosis

  18. Medical findings • Overlapping symptoms • Colic • Reflux • High tone

  19. Baby’s Symptoms Excessive, early weight gain plus

  20. Baby’s Symptoms • Stuffy nose • Poor latch • Unsatisfied sucking need • Early ear infections

  21. Mom’s 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

  22. Mom’s 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 can’t feel) • PPD

  23. 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

  24. Maternal Initial supply hormonally driven Local Feedback Managing feeds Infant Fat slows gastric transit Excess Lactose Fermentation Air swallowing Understand the Controls

  25. Classes of OSS • Primary: No apparent cause • Secondary: result of disorder elsewhere (pituitary tumor, allergy) • Induced: caused by something the mother is doing (excessive pumping, galactologues)

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

  27. Phases of OSS 1st Phase:relativitymild 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

  28. 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

  29. Anticipitory Guidence • 1st 24 hours • 24-48 hours • 72 hours • Change in stool usually first clue

  30. 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

  31. Severe OSS

  32. Special Situations • The pumping mom • Mom with twins • Previous history • Supply won’t down regulate • Baby’s with huge appetites

  33. Suggestions for further study • Substances/foodstuffs known to decrease supply should be studied

  34. Marie Davis RN IBCLC marie@lactationconsultant.info • Extended bibilography available by request

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