OVERSUPPLY PROTOCOL #2
TO REDUCE SUPPLY
HOW IT WORKS: Oftentimes the milk supply has been driven up by early pumping. We feel that our breast is full, so we pump. This tells the body that more milk is required. Slowly milk production circles up. Infants become gassy, often stool color changes to green, sometimes it will contain foam, blood or mucous. They either gain weight very fast, or resist feeding at the breast- coughing, gulping, and sputtering during letdowns of milk.
In milk there is a small protein called the Feedback Inhibitor of Lactation. As the milk builds up there is more FIL; this slows down production. So an empty breast milk has less FIL and makes milk faster and a full breast produces milk slower. The goal with reducing supply is to stay full but not painfully engorged. For more serious situations sometimes I wait and try to start reducing supply with an antibiotic on board to offset the likelihood of full blown mastitis. These are rare situations and require teamwork between the IBCLC and MD.
BLOCK FEEDING: Block feeding is when you feed for a specific amount of time on one breast, or you pick a certain amount of feedings on one side.
I start blocks, at 1 feeding per side . Some individuals need to work up to 4 feedings or about 8 hours on one side. Start slowly and allow your body to adjust. If your supply is very big you need to go slowly.
You can pump briefly/nurse for 4 minutes for comfort but don’t fully drain the unused breast between blocks. Think about 1 oz.
If we use the Sudafed you will need to use the type behind the counter. You can talk to your Dr to make sure there is no issue with this medication - but typically it is compatable with breastfeeding. the side effect is that it can reduce supply about 20% ( see this study here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884328/ )
Take 120 mgs of Sudafed extended release in the morning the first day and we’ll plan on taking it for a few weeks. We will taper the dose down gradually.
Day 1: 120mg
Day4: 60mg ( let me know how it’s going)
Day 5: 60mg
Day 6: 60mg
Lecithin: The typical dose for treatment for plugged ducts is 3600-4800 mg . I start the dose at 4800mg once daily for prophylactic treatment for blocked ducts.
Happy Ducts Tincture: preventative treatment for mastitis.
PREVENTING/RELIEVING ENGORGEMENT: Encourage baby to breastfeed every 2-3 hours to remove milk from the breast. If engorgement occurs, fill a tub with warm water and soak breasts or heat a wet towel (or dry socks filled with rice) in microwave and place on breasts prior to feeding to help soften, allow baby to breastfeed to remove milk. After nursing try something cool versus hot to reduce inflammation.
So, before nursing is warm compresses, after is cool.
Ibuprofen: 600mg every 8 hours for the first few days with longer blocks to reduce inflammation and swelling from engorgement.
**Birth Control: The Minipill is ok for regular breastfeeding mothers. If we really need to reduce your supply and it resists normal treatment we can go on regular birth control pills because Estrogen reduces milk production. This is a last resort and you’d really want to talk that over with your Dr first. Don’t start this without talking to your LC first!
Can’t sleep at all because of the Sudafed? Benedryl is ok to take in the evening up to 25mg, but watch for sedation in you, not necessarily for your baby. Co-sleeping with Benedryl is not a good idea. If you take it, start with a pediatric dose for yourself which is 12.5mg. As always please make sure any over the counter medications are compatible for your own health conditions.
TEA: Lots of peppermint tea, make a large batch! Helps to tame a wild supply! Altoids are good too.
ESSENTIAL OIL if all else fails to lower supply:
For reducing your supply we are going to make a special combination of 15 ml of carrier oil to 1 drop cleary sage plus 1 drop peppermint. This should be applied topically to the armpits twice a day liberally, and then blotted off after about ten minutes of massage. Massage the whole breast, up to the armpit 3x a day for 5 days. So everything minus the actual nipple.
Sage tincture: May help reduce oversupply.
There is a new study coming out but it’s not yet published on aerophasia induced reflux. This is basically a long way to say that if you chug down enough air you are going to burp a bunch of your meal back out. The solution, while simple, takes a few weeks while we get your supply back under control.
The Oversupply Plan:
1.) block feeding 2 feeds per breast
2.) add in morning Sudafed (once a day)
3.) feed uphill, and burp baby
4.) take lecithin 4800 mg, 1x a day ( to prevent blocks)
5.) take 300mg of magnesium 1x a day ( for oald) working up toward 600mg
The Reflux Plan:
1.) Burp way more
2.) Uphill nursing
3.) Block feeding
4.) Reduce maternal oversupply
5.) Burp baby with less tummy pressure
6.) Log roll for diaper changes
7.) Trial of paci for 15 mins post feeding as you can, the additional swallowing may help down food
8.) Keep baby upright 15 minutes after daytime feedings
Lets talk more about the "stomach flu" better known as the Norwalk virus, which is the prototype strain of human caliciviruses named for the first town the epidemic was noted in, in 1972. It has a beautiful structure seen here:http://www.ncbi.nlm.nih.gov/pubmed/16641296. The are not exactly sure how it replicates according to a study done in 2002, it fails to grow on cell substrate in labs.
Believe it or not, people voluntarily infected themselves at Baylor College of Medicine so that it's viral shedding duration through feces could be documented (2008). In case you thought those first 2 days were the period of highest infection risk, you're probably right but "Virus shedding was first detected by antigen ELISA approximately 33 hours (median 42 hours) after inoculation and lasted 10 days (median 7 days) after inoculation."http://www.ncbi.nlm.nih.gov/pubmed/18826818 In other words, please don't go getting all relaxed about it, there is some documentation that shedding begins as early as the incubation period ( about 10-60 hours before you get sick). It generally lasts about 24-48 hours, and you can communicate the disease actively for 48 hours after resolution.
So how do you get rid of it when you need 2 parts/mil to get sick? Well good luck with that. You can use a steam cleaner, but the norwalk virus survives regular temps of heating to 60ºC for 30 minutes, so it has to be a real steam cleaner. According to Public Health Saftey of Canada, (data sheets available here: http://www.phac-aspc.gc.ca/lab…/…/psds-ftss/msds112e-eng.php) you come up with this: "SUSCEPTIBILITY TO DISINFECTANTS: Susceptible to 1% sodium hypochlorite, 2% glutaraldehyde" That's it folks.
So now you know what kills it, you're not sure how to get that dilution. If you are starting with 5% household bleach, you dilute 1 part bleach to 4 equal parts clean water.
Hope this clears up some of the conversation I've had with multiple sick folks!
Todays PSA. Did you know that your milk is amazing and fights cancer? Read up on HAMLET. This is also part of the reason why many adults with GI/Esophageal cancer are receiving human milk as part of their treatment. It's a protein that not only demolishes cancer, but now is also being used to help disable MRSA. Full article here: http://www.healthline.com/health-news/children-breast-milk-protein-kills-superbugs-050213