while I don’t remember what spurred it, I ended up doing some online research about overactive letdown yesterday. basically, the thought is that some moms have some combination of either too much milk getting stored in their breasts and/or the milk that is there is ejected from the ducts very forcefully. this can cause a number of issues. baby gags or gulps her food down, taking a lot of air with it, leading to burping and spitting up. baby fills her stomach too quickly, which leaves her uncomfortable after eating and more prone to reflux. baby fills up on a larger quantity of lactose-rich foremilk, rather than fat-rich hind milk, causing her to eat more often (for calories) and possibly get gassy from insufficient lactase enzyme. mom may notice pain during letdown too and significant leaking from one side while feeding on the other. well, we have all of those things. there are some other signs that we don’t have, so I’m suspecting that it’s not a hugely overactive letdown, but it’s there.
frustratingly, I probably contributed to the problem. for a few days, we were worried about low supply, so I supplemented with fenugreek. (regular readers may remember exactly why we did this, but, even though it was only two or three weeks ago, I certainly don’t!) that clearly wasn’t necessary, and I did stop after about two or three days. and then last weekend, I had two days notice to pump enough milk for two extra feeds, telling my boobs, over the course of two days, to produce a total of what was probably 54 oz, instead of 48oz. that’s a nontrivial difference!
in an attempt to deal with this issue, in the hopes of reducing Daphne’s reflux and/or gassyness, I’m attempting the standard first approach to the problem – stop feeding both sides each time she eats, and offer one side for an extended time, offering the other only if she decided she’s still hungry after seemingly finishing the first. of course, I don’t have fill lines on my boobs, so “after finishing the first” is as much educated guess work as anything else. basically, after she has gotten a couple (3 or 4) good rapid swallow sequences down (appears to coincide with multiple letdowns, another overactive letdown sign), and is just comfort sucking for a while, if she hasn’t fallen asleep or come of herself (or tried to), I take her off. as much as I rely on those signs, though, I’m also watching the clock; our (new) normal feeds have generally been 20 to 30 minutes. I figure that she has to work a little harder for food now, so I encourage her to stay on the same side for at least 20 minutes. I’ll giver her the other side only if she seems hungry after initially coming off one side and seeming relatively content, and is she’s stayed on that first side for 20 minutes.
yesterday afternoon was the first time I tried this. I only got two iterations in (each side twice) before the first (expected) night feeding. it seemed to be going well during the day, going about two hours between feeds (finish to start), which isn’t abnormal during the day. but then there were two more feeds an hour apart, and when I first gave her both sides before her expected long nap, it was just two and a half hours until she ate again. we got a longer three and a half hour break after that, but then again two and a half and one and a half for the next two feeds.
it hadn’t seemed to make an obvious difference in fussyness, but it’s hard to say since her daytime and nighttime fussiness levels are diffeent. she’s certainly still showing subtle silent reflux symptoms and gas symptoms. it does, however, mean more unproductive sucking at one breast than she had been doing in a while, and since she’s still compressing my nipple, it’s making things more raw and painful.
after talking to Jason, with neither of us seeing any real improvement in reflux or gassyness, but seeing bruising coming up on my nipples, we think we’re going to abandon this experiment (yes, I know it wasn’t for long, but my nipples are well guarded assets at the moment). as we’ve been talking about for the past week, though, we are going to look into treating her reflux for a while, and see if that helps things. my midwife noted that often treating reflux early means not having to treat it as long, and I’m hopeful that is the case.
such a puzzle! and not the fun, exciting kind.