Re: Trying to correct oversupply/tummy issues
Welcome to the forum and congratulations on the new baby!
The first thing to know about oversupply (a.k.a. foremilk/hindmilk imbalance) is that all milk- including the so-called foremilk- contains everything a baby needs to grow and develop, and that includes fat. A baby will grow well, sometimes extremely well, on a diet of "foremilk" alone, provided he gets enough of it. The only problem with milk produced by a mom with an oversupply is that it may give the baby green or in rare cases bloody poops, extra gassiness, and fussiness. These are more annoyance than they are health problems (and yes, that even includes situation where oversupply causes bloody poops). So please do not drive yourself crazy worrying about the fat vs. lactose content of your milk, or risking potentially derailing breastfeeding by exclusively pumping.
It is normal for oversupply to come and go repeatedly. So the fact that you are experiencing engorgement again doesn't necessarily mean much. However, I am a little concerned about the engorgement because:
1. You just transitioned baby back to the breast
2. You are using a shield
3. You're not feeling much change in fullness after the baby nurses
4. You're so engorged that you feel "rock hard".
Those 4 things, taken together, make me wonder if the baby is able to get much milk out right now. Rock-hard engorgement and shield use can reduce the baby's ability to drain the breast. And a baby who has just been transitioned back to the breast may not have all the suckling skills he needs to get milk from the breast, due to becoming used to the bottle.
I am also concerned because you are in severe pain, which makes me worried about mastitis (bacterial breast infection). Mastitis is more common in women who are overproducing milk and who are having difficulty in draining the breast.
So, in your shoes, I would want to do the following:
1. Watch the baby's diaper output very carefully for the next few days. As long as the baby is peeing/pooping enough, he's getting enough to eat.
2. If baby will nurse without the shield, stop using it. If the shield is the only way your baby will latch, continue to use it. It's more important to have the baby nursing at the breast than to worry about the impact of the shield.
3. If baby is unable to latch due to extreme fullness, either hand-express (preferably) or pump a small amount of milk to soften the breast prior to latching your baby on. An ounce or two of milk removal should do the trick (hopefully).
4. Use reverse pressure softening (http://kellymom.com/bf/concerns/moth...oft_cotterman/) to enable the baby to latch.
5. Watch yourself very carefully for symptoms of mastitis, which include extreme breast tenderness or pain, hard lumps in the breast (these would be engorged ducts, indistinguishable from engorgement, so probably not a useful symptom for you at this point), red patches or streaks on the skin of the breast, fever and chills, and whole-body aches and pains. If you have some or all of these symptoms, please contact your health care provider, as you may need antibiotics, nurse as much as possible, and get out the pump and drain the affected breast or breasts as fully as possible. Using the pump and fully draining the breast/breasts will not help the oversupply situation, but in case of mastitis, oversupply becomes a secondary consideration.
3. Use comfort measures, like ice packs or cold cracked cabbage leaves tucked into your bra (if you're wearing one).
Please give yourself some time and be very patient with your body. I know your return to work is stressing you, but this is the time to focus on caring for yourself and on nursing the baby. Let's get that going right before we start worrying about pumping at the office. Okay?
Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
Coolest thing my little girl sang recently: "I love dat one-two pupples!"