While it’s good to have plenty of milk, it can be a real problem if you produce much more milk than your baby needs. Your baby may seem to be thriving, gaining as much as 400g (14oz) in a week; but he may also be unhappy or uncomfortable.
Whether you’re coping with a fast flow of milk, producing more milk than your baby needs, or both, don’t despair. It is possible to make breastfeeding more manageable for you both.
Forceful milk flow
Coping with leaking
Too much milk
How oversupply happens
Reducing your milk
Dealing with engorgement
Oversupply with blocked ducts or mastitis
Adjusting to the new normality
Forceful milk flow
Mothers whose milk flows very quickly may have an overactive or forceful letdown. If a baby can’t cope with the milk flow, he may gulp, choke and splutter while nursing. He may pull away from the breast, especially at the start of a feed, or become fussy. Anything that affects your baby’s ability to coordinate sucking, swallowing and breathing can make it harder for him to cope with milk flow— even congestion from a cold.
A mother may suffer from sore nipples, as her baby pulls and tugs at the breast, or clamps down or pinches the nipple when trying to reduce the flow. Some babies are reluctant to nurse or refuse the breast when they can’t cope with the flow of milk.
Try frequent nursing
Nursing more frequently helps relieve engorgement—your breasts will feel more comfortable and the flow of milk will be slower and more manageable for your baby.
Breastfeed…
• Before your baby is really hungry.
• When he wakes—before he is fully awake if possible.
If your baby is relaxed he may nurse more gently, receive a slower flow of milk and gulp down less air.
Finish the first breast first
Adjust positioning and attachment
Aim for a deep, comfortable latch with your baby’s head slightly tilted back, nose clear of the breast and chin tucked into the breast. A baby who turns his head to nurse will have difficulty swallowing—his ears should be in line with his shoulders.
When milk flow is fast, try nursing while you are reclining so your baby’s head and throat are higher than your nipple. Or, lie on your side so your baby can allow milk to dribble out of his mouth when it flows too quickly. An LLL Leader can help you adjust positioning and attachment. Information can also be found on our Comfortable Breastfeeding page, and in our kindle version of Positioning & Attachment.
Soften the breast
If your breast is full and hard, you can use reverse pressure softening to move fluids away from the nipple area so your baby can latch on more easily. Apply gentle steady pressure with your fingertips on the areola around your nipple for about a minute. You can also press with the sides of your thumbs or fingers. Denting the breast at the edge of the areola with a finger and placing your baby’s chin in the dent may also help. Gently hand express a little milk too if needed. If you choose to use a breast pump, set it to minimum suction.
Allow your baby to come off the breast
Put your baby in control by letting him come off the breast to regain his breath. He needs to be able to breathe properly to feed effectively. Keep your supporting hand down near your baby’s shoulders and neck to avoid pushing on the back of his head. Have a clean cloth or towel to hand to catch the flooding milk—your baby will have an easier time nursing when the flow slows.
Avoid…
• Dummies and bottles.
• Regularly expressing milk until flow slows. Although this can be useful occasionally, when used frequently it can lead to oversupply problems.
• Pumping milk to follow a routine.
• Pumping more milk than your baby needs.
These can affect your baby’s nursing frequency and alter the delicate balance between mother and baby that regulates milk production.
Coping with leaking
Breast pads inside your bra will provide some protection from leaks. Avoid plastic backed pads, as these can trap wetness next to the skin and cause soreness. If you feel the tingling of your milk beginning to flow, pressing hard on your nipples for several seconds may prevent leaking. This can be done quite unobtrusively by crossing your arms tightly across your chest and pressing firmly on your nipples with the palms of your hands. Hold for a few seconds before releasing and all should be well. If it doesn’t work first time, try again for a little longer. You can practise this at home, but bear in mind that if your breasts feel full, this is a sign to take the time to nurse your baby.
Too much milk
Symptoms of oversupply include:
For a baby:
• Gains large amounts of weight—more than 900g (2lb) per month.
• Feeds very frequently but doesn’t seem satisfied.
• Regularly brings up lots of milk.
• Regular periods of fussiness or colic.
• Watery, explosive poos.
• Very wet nappies and occasional green poos.
For a mother:
• Breasts that never feel soft and comfortable, even immediately after a feed.
Allergies, reflux and other problems can have similar symptoms. Contact a La Leche League Leader for further information before assuming oversupply, especially if your baby is gaining less than 900g (2lb) a month.
How oversupply happens
At first, milk production is driven by high hormone levels. Later on, the rate at which a breast makes milk is mainly determined by how much milk remains in the breast between feeds and a mother and baby’s joint nursing behaviour. Frequently drained breasts make milk faster.
The main causes of oversupply are:
• A baby who isn’t nursing effectively. He may have difficulty getting a good proportion of the fattier milk available. He then tries to compensate by nursing more frequently, increasing his mother’s milk production and taking larger volumes of milk.
• Switching breasts before the first side is adequately drained.
• Hormonal factors leading to a tendency to produce plenty of milk.
• Routine pumping, or pumping because of separation in the early weeks. This can make oversupply more likely.
Periods of increased nursing due to development changes and growth spurts can add to the challenge of oversupply. Many mothers find changes in their babies’ nursing patterns during holidays and family get-togethers; periods of stress may also be a factor. Mothers with oversupply often experience blocked ducts, mastitis and sore nipples.
Despite getting lots of milk and feeling full, your baby may not necessarily feel satisfied. Instead he may seem constantly hungry. The amount of fat in your milk increases during a feed as your breasts become softer. Your baby needs a balance of thirst-quenching lower-fat milk at the start of a feed as well as the fat-rich milk at the end. The balance of milk is more important than the volume. Sufficient fat-rich milk leads to the production of cholecystokinin at high enough levels to give a feeling of satiety. Some mothers say their babies have an ‘after Sunday dinner’ look of blissful contentment as they come off the breast.
Without enough fat-rich milk, a baby acts hungry even though he has a full stomach. He feels uncomfortable and windy because of his overfull stomach so he may want to nurse even more, for comfort as well as food. There are ways to manage breastfeeding to resolve the problem and break this vicious cycle.
Source: United States Breastfeeding Committee
Balance is more important than volume
Despite getting lots of milk and feeling full, your baby may not necessarily feel satisfied. Instead he may seem constantly hungry. The amount of fat in your milk increases during a feed as your breasts become softer. Your baby needs a balance of thirst-quenching lower-fat milk at the start of a feed as well as the fat-rich milk at the end. Sufficient fat-rich milk leads to the production of cholecystokinin at high enough levels to give a feeling of satiety. Some mothers say their babies have an ‘after Sunday dinner’ look of blissful contentment as they come off the breast.
Reducing your milk
Consult an LLL Leader before using these approaches. This is especially important if your baby is under one month old, or you are experiencing other problems such as sore nipples or mastitis.
Consider whether you are feeding your baby every time he stirs. When your baby is not particularly hungry, other mothering may help you meet his needs without nursing. Many mothers have found carrying, cuddling, playing with and talking to their babies can be helpful when managing oversupply.
Pay attention to positioning and attachment, as your baby may need to learn to breastfeed more effectively. When oversupply is a problem, babies may pull, tug and clamp down or pinch the nipple while feeding. Even if you haven’t experienced any soreness, your baby may have developed an inefficient or weak suck in order to cope with the flow of milk.
Monitor your baby’s weight gain to ensure it doesn’t drop below normal levels.
Try one or more of the following approaches, talking things through with an LLL Leader if necessary. Aim to:
• Reduce breast stimulation by decreasing the frequency and duration of breastfeeding, by effective positioning and attachment and by limiting your baby to one breast for one or more nursing sessions.
• Allow each breast to have periods of comfortable fullness to slow milk production. At the same time, make sure enough milk is removed to avoid developing blocked ducts or mastitis. If necessary express off just enough milk so your breasts remain comfortably full for long enough to slow milk production.
You may need to switch breasts sooner in the evening if your breasts feel soft and well drained and your baby starts to fuss even when using breast compression (see As milk flow slows). It is possible to experience oversupply in just one breast, in which case you could nurse for longer periods on the unaffected breast. If you’ve been expressing regularly, reduce this gradually to avoid further problems.
Limit your baby to one breast— the standard approach. This can be a good way to begin reducing milk production.
To start with:
• Limit your baby to one breast for about two hours, allowing him to nurse as often and as long as he likes, but only on that one side.
• Continue in this way, switching breasts only every two hours. If your baby is asleep, switch breasts when he wakes.
Follow your baby’s need to nurse—fussing, rooting (head turning) and fist sucking are signs he may want to feed. It may take several nursing sessions for your baby to receive a complete feed from one breast but you may soon see that he is more settled. Your baby should get a balanced meal in a more manageable amount of milk.
Dealing with engorgement
While limiting your baby to one breast, the unused breast is likely to feel full. This fullness and your baby taking less milk will tell your body to slow milk production. If the unused breast becomes very full and uncomfortable, gently express some milk to the point of comfort only. This will help avoid any blockages and may also make milk flow more manageable for your baby. Avoid excessive pumping, as it can make things worse.
As milk flow slows
Babies used to an abundant milk flow can become fussy at the breast when milk flows slows. Use breast compression and work on improving his latch to help your baby get the satisfying fat-rich milk that flows more slowly:
1. Support your breast with one hand—thumb on one side, fingers on the other.
2. Wait while your baby breastfeeds actively, his jaw moving all the way to his ear. When he stops swallowing, compress your breast firmly. Hold it squeezed until he stops nursing actively and then release your hand.
3. Rotate your hand around your breast and repeat step 2 on different areas of the breast as needed. Go gently—this should not hurt.
If you still have problems
After 4–7 days your breasts may be more comfortable. If your baby still has trouble coping with the supply of milk, and/or has other symptoms and you are not experiencing uncomfortable engorgement, you can increase the block of time you keep your baby to one breast. It’s important to build up the time you limit your baby to one breast very gradually—an extra hour or two at a time—so you experience comfortable fullness while avoiding mastitis.
Some women with extreme oversupply have gone as long as six or more hours before switching breasts, to adjust milk production. It’s important to only gradually increase the time you limit your baby to one breast. Rarely, a hormonal imbalance may cause overproduction of milk. A visit to your doctor may be helpful if the suggestions here aren’t enough.
Expect to use this approach for only a short time, to achieve balanced milk production, before returning to a more normal nursing pattern.
Oversupply with blocked ducts or mastitis
If you are suffering from blocked ducts or mastitis and your breasts never feel soft and comfortable, even after a feed, you will need to keep your breasts well-drained while you take steps to reduce milk production.
You could try the following in addition to the standard approach of keeping to one breast for periods of time.
• First, gently pump or express milk from the affected breast(s) until your breast(s) feel soft and comfortable.
• Feed your baby within an hour—offer both breasts if needed and ensure he latches on well.
• Next, limit your baby to one breast (as in the standard approach), changing breasts every two or three hours. Your baby may want to nurse several times on one breast before switching to the other.
Some mothers will need use this approach only once. However, if your breasts feel uncomfortably full you may need to repeat it, increasing the interval between each pumping, before your breasts completely readjust.
Photo courtesy of Kimberley Seals Allers
Adjusting to the new normality
Always monitor your baby’s wet and dirty nappies, weight gain and overall well-being while following these strategies. Your baby’s weight gain may slow, especially if he has been comfort nursing to cope with the discomfort of having too much milk. A healthy baby will nurse to get the calories he needs—so follow his cues. However, you may be worried that your baby is getting less milk. The important thing is that your baby is getting balanced and satisfying feeds, not the volume of milk he receives. A growth chart will indicate how he is doing (see Further Reading). Monitor weight over a period of several weeks to see a trend. If your baby has been gaining excessive amounts because of oversupply you may see ‘catchdown’ growth. Your baby will gain weight steadily but may gradually drop against the percentile lines as your milk production adjusts. His weight should then settle into following a new percentile line on the chart.
Crossing more than one percentile line may be a sign you need to stop reducing your milk. Most mothers with oversupply usually find it easy to increase milk production by switching breasts more often if their babies’ weight gain drops too low or when their babies have a growth spurt.
As things get more manageable, your breasts will feel softer and more comfortable and leaking will be reduced. Soft comfortable breasts are normal and a sign that your milk production is in tune with your baby’s needs. As your baby grows, gradual baby-led weaning can help avoid problems caused by sudden changes in feeding pattern and missed feeds. These strategies really can make a difference to both you and your baby if you have an overabundance of milk. You may also find it helpful to meet with other mothers at your local LLL group where you can exchange practical tips on nursing and mothering.
Written by Karen Butler, Sue Upstone and mothers of La Leche League GB.
Kimberly Seals Allers’ photos on this site are used under a creative commons license of Black Breastfeeding 360° http://mochamanual.com/bb/
Further Reading
Mastitis
Engorged Breasts – Avoiding & Treating
Hand Expression of Breastmilk
Is My Baby Getting Enough Milk
Comfortable Breastfeeding
Rhythms & Routines
The Unhappy Breastfed Baby
Other websites
UK–WHO Growth Charts: www.rcpch.ac.uk/growthcharts
Gastro-oesophageal Reflux: http://abm.me.uk/wp-content/uploads/2012/10/ABM-Reflux.pdf
Books
The Womanly Art Of Breastfeeding. LLLI, London: Pinter & Martin, 2010
LLLGB kindle edition of Positioning & Attachment
References
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, TX: Hale Publishing, 2010.
ABM Clinical Protocol #4: Mastitis. Breastfeeding Medicine 2014; 3(3): 177-180.
Livingstone, V. The maternal hyperlactation syndrome. Medicine North America 1997; 20(2): 42-46.
Smillie, C. Campbell, S. & Iwinski, S. Hyperlactation: how left-brained rules for breastfeeding can wreak havoc with a natural process. Newborn Infant Nurs Rev 2005; 5: 49-58.
Van Veldhuizen-Staas, CGA. Overabundant milk supply: an alternate way to intervene by full drainage and block feeding. Int Breastfeed J 2007; 2(11) available online at: www.internationalbreastfeedingjournal.com/content/2/1/11
Wilson-Clay, B. Consultants’ Corner—Milk oversupply. Journal of Human Lactation 2006;22(2): 218-220.
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Copyright LLLGB 2016