The Medela LC got back to me almost right away. She felt that I am definitely overpumping, and probably making my oversupply issues worse. I have to look over all of her tips and try them, and also ask her some followup questions. Here's what she said: I've bolded the biggest takeaway.
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I think that it's hard to address just the pumping issues without the breastfeeding ones, as they may be tied in.
I see no reason why you need to pump 3 times while at work, as this just encourages the oversupply that you have and probably makes the overactive let-down worse too. You will have a supply drop if you pump less frequently, but that would be a good thing. Oversupply can cause a number of problems for the baby (as you know) and probably for the mom. You don't mention that you have had any problems with chronic plugged ducts or mastitis,
but chronic engorgement may be contributing to the pumping pain. I wouldn't suggest that you cut out the one pumping session all at once, as you will probably be sick with either plugged ducts or mastitis and miserable if you do.
So, can you try pumping an oz. less each day until you have weaned from that pumping session? You may not be able to go that fast. You may need to pump 6 oz. for a few days, then 5 oz. for a few days, etc...Babies only need 9-12 oz in a nine-hour separation (assuming 8 feedings in 24 hours) and at 18-22 oz. a day, you are pumping about twice that.
I assume that you and your LC are exploring Raynauds, but here is a good (very long) article on this:
For information on Nipple Vasospasm and Raynaud's Syndrome, please see:
http://www.sdgp.com.au/client_images/18175.pdfwww.drjacknewman.com also has information on nipples that turn white and blanch during feedings.
Nipple vasospasm can be treated with medication, but additional measures are also helpful. Can you make sure that you keep your breasts and nipples warm before and after pumping? Keep your shoulders covered and your feet should be warm too. Milk will flow better when mothers are warm--and milk that flows faster means quicker pumping sessions.
Also, on the pumping pain, it sounds that your nipples are small, despite being large breasted (but with a small frame). Have you tried the 21 mm breast shields? It sounds like you have a lot of "give" to your skin, and if the nipple will fit in the tunnel for this size, perhaps less of the breast would be yanked in.
Make sure that your nipples are absolutely centered in the tunnel. It can be big problem if they aren't.
I am sending you some information on overactive let-down (though you probably know all this) and also a list of some anti-galactagogues--a fancy word meaning things that the mom can take to reduce her supply.
Here is some information for you from La Leche League International's Breastfeeding Answer Book, by Stock and Mohrbacher, '03 ed.
Some mothers with a forceful let-down or an overabundant milk supply have found that the nursing positions that work best are those that allow the baby to nurse "uphill," with his head and throat higher than the mother's nipple. In the football hold, the mother can lean back. In the cradle hold, the mother can prop the baby in her lap on two pillows and lean back in a rocking chair or recliner.
Other mothers have found that side-lying position work best, because it is easier for the baby to let the milk dribble out of his mouth if it is coming too fast rather than having to swallow quickly to prevent choking.
If the baby has a difficult time coping with his mother's let-down or milk supply after trying the above suggestions, the baby may do better with one breast per feeding. Nursing the baby from just one breast may help prevent him from being overwhelmed with milk. For the mother with an overabundant supply nursing on only one side at each feeding helps reduce her milk supply and bring it closer to her baby's demands. If the baby wants to nurse again within an hour to an hour-and-a half, the mother can continue to offer the same breast. If the mother finds that restricting nursing to one breast leaves her other breast feeling overly full, she can either express just enough milk to make her comfortable or she can offer that breast to her baby and nurse just long enough to alleviate the feeling of fullness. It is important to express or pump only a little bit of milk…just until the mother is barely comfortable—not ounces and ounces, which will only encourage more milk to be produced.
After four to seven days of this change, if the baby continues to have trouble coping with milk flow at feedings and/or continues to have other symptoms, the mother can limit the baby to one breast for a longer time to give the baby more hindmilk and further decrease the supply. Depending on the mother's supply, she may start by keeping the baby on one breast for 3 hours and see if that helps. If the baby still seems overwhelmed at feedings and is having other symptoms, she can go to four hours or longer, switching to the other breast after this period of time and limited baby to that breast for the same period.
Rather than postponing nursing sessions, which is often the first impulse for the mother whose baby is having problems coping with a fast flow of milk, feedings may be easier if the baby is nursed more frequently. This will reduce the amount of milk accumulated in the breast, making feedings more manageable for the baby.
In many cases the problems associated with a forceful let-down are a result of a combination of characteristics of both mother and baby--a mother who naturally has a fast flow of milk and a baby with a very strong suck. Nursing immediately upon baby's waking--even before the baby is fully awake, if possible--can be helpful because the baby may suck more gently in his relaxed state, making the flow of milk slower and reducing the likelihood of the baby gulping air.
In addition to the above:
Frequent burping can be helpful to the baby, particularly if he tends to gulp air during feedings, because it will reduce gas and fussiness.
When the milk does let-down, you can let it spurt out onto a cloth diaper or towel for a minute, then put the baby back on. He may feed better if you do this.
Some lactation consultants recommend that mothers use a "scissors hold" or "cigarette hold" to support the breast and to apply pressure to restrict milk flow during let-down to slow the flow.
Antigalactagogues are herbs, foods, or medications that can reduce the milk supply. Please consult an herbalist and/or your doctor before using.
All of the following have an A or B safety rating from The Nursing Mother’s Herbal, c. 2003, by Sheila Humphrey.
Barley sprout
Cabbage (external anti-galactagogue—to be put on the breasts. Use only inner washed leaves, and do not place over the nipple and/or areola.)
European corn mint
Jasmine flowers (external antigalactagogue—like cabbage)
Mugwort
Osha
Parsley leaves, only in large amounts, NOT the essential oil
Peppermint. Can add of ¼ tsp of essential oil or spirits of peppermint immediately before drinking peppermint tea. Several cups a day are recommended. Can also try strong peppermint candies. Don’t use peppermint if mother has heartburn or reflux,
gall bladder or liver disease.
Pigeon pea
Pygeum
Sage (leaf). A trick here is to make a peanut butter and honey sandwich, peel down one corner, put on 1 tablespoon of powdered sage and eat that corner first.
Also can use 1 tablespoon of sage in a cup of broth, steeped for 10-15 minutes.
Drinking carrot juice in the mornings
Pseudoephedrine, in some preparations of many over-the-counter medications for colds and allergies. (Be careful, this can make you feel very wakeful and jittery).
Birth control medications (pills or injections or IUDs with hormones) containing estrogen. Some mothers also have a reduced supply when taking the combination estrogen/progesterone pill or the progestin-only mini-pill. This can be too much, however, and may drop your supply too much, so be very careful, and start slowly, with the weakest herbs that can drop supply, and proceed with the help of your doctor and IBCLC, who can weigh your baby frequently and make sure that you get to the right amount of milk, not more , and not less.
Basically, I am wondering if the possible Raynaud's Syndrome and an oversupply are contributing greatly to your pumping pain.
I hope that this helps you out. Can you please write back and let me know how things are going for you?
