I have major progress to report. Baby and I spent a few days focusing on correcting this problem. I think we have figured out what works for us.
After reading this extremely helpful website (
https://www.llli.org/faq/oversupply.html) we spent two days doing block feeding. the first day we did one breast per feed but that didn't seem to fully fix the problem so then we spent another day doing two-feed blocks (one breast, two feeds). The choking and gasping reduced dramatically and as did the spit up. I ended up overcompensating a bit because during a couple of feeds my breasts were a little too empty for her and she was not impressed. So I then gave her both breasts to try to get the supply up just a little bit. This seemed to work. She is protesting a bit about having to work a little harder earlier in a feed, since the milk no longer plunges out for a long time. But usually by the end of the feed she is drowsy, if not fast asleep. We still need to improve the latch because I think she and I developed a bad habit of shallow latching during all of the garden hose feeds these past few weeks. She does not open her mouth very wide and when she does get on nicely she sometimes re latches mid-way to a more shallow latch. If anyone has tips on how we can fix this please let us know!
I do not think she has reflux after all because the spit up is mostly minimal now, unless we have a bad feed.
Some other things that we changed in the past few days:
-we abandoned the breast-feeding rocking chair and the breastfeeding pillow. Neither allow her to be under the breast enough.
-our best place to feed is on the couch, with me slumped back with terrible posture and her slightly on top of me and on a slight diagonal
-at night we feed in bed and try to replicate the posture we have on the couch but it is not quite as good (still way better than the chair though)
-I hold her upright or slightly reclined for 20 minutes after a feed, although I may be able to reduce or stop this soon because the spit up has decreased a lot. I am going to be cautious until I know for sure.
I am not going to get smug yet, as we still have some work to do. But I am feeling more positive. A few days ago I thought we may have to give up breastfeeding but now I think we can continue.
PS- We tried the side lying hold. It was peaceful and seemed like an amazing feed all three times we tried it. However, she spit up a lot all times so we don't do that anymore. Too bad, because it was handy for the 4am feed. Anyone have any thoughts on why that led to more spit up?