While it’s good to have plenty of milk, some mothers produce more milk than their babies need. This is commonly called oversupply and can be very challenging.
Some babies cope very well with a generous milk supply; however, some babies, whilst appearing to thrive, will be unhappy and uncomfortable. Oversupply can also make nursing uncomfortable for the mother and increase the risk of mastitis.
Symptoms
How does oversupply happen?
A note about foremilk and hindmilk
How your milk supply is established
What can I do to remedy symptoms of oversupply?
Reducing your milk supply
Coping with leaking
As milk flow slows
Adjusting to the new normality
Symptoms
The main symptoms of oversupply for a baby are:
- Very large weight gain (as much as 400g/14oz per week), moving upwards through centile lines
- Explosive green, frothy poos
- Struggling to control milk flow
- Pain and excessive wind or ‘gas’
You may also notice the following:
- Choking, coughing, spluttering at the breast
- Fussing, arching and pulling on and off the breast
- Clamping down or biting (to slow the flow of milk)
- Frequent spitting up
- Always appearing ravenous and unsatisfied despite large weight gain
- Unwillingness to nurse to sleep or find the breast a restful and calming place
- Breast refusal
- Faltering weight gain (due to breast refusal)
- Lots of wet and dirty nappies
- General ‘colicky’ behaviour
A mother with oversupply may have the following symptoms:
- Breasts that are rarely soft or comfortable
- A forceful or ‘over-active’ letdown
- A painful letdown
- Profuse leaking
- Painful nipples (from baby clamping and pulling on and off)
- Recurring blocked ducts and/or mastitis (see here for more info)
- Distress about your breasts not providing the calming place for your baby you had expected
Some of these symptoms may have other causes and they may also fall within the normal range, so it is important to rule things out before taking steps to reduce your milk supply, as this can have longer term consequences.
It is also important to consider all, and not just any one, of the symptoms and to consider them in context; for example, an occasional green poo does not indicate oversupply, and it is not uncommon for newborns to be gassy and have ‘colicky’ symptoms. Allergies, reflux and other problems can also present similar symptoms.
How does oversupply happen?
Some mothers naturally produce large quantities of milk and occasionally there are medical reasons for an over-abundant milk supply. In addition, we tend to produce more milk with each baby. Oversupply can also occur as a result of breastfeeding management, for example, if a baby’s feeds are scheduled or if a mother is told to feed from each breast for a certain amount of time.
You may be given conflicting information about foremilk and hindmilk and how long a feed ‘should’ last, or you may be encouraged to express milk to stay ahead of demand. Sometimes these ‘rules’ interfere with the regulation process. Milk production is best regulated by your baby’s appetite.
When you breastfeed responsively, following your baby’s cues (and your body) rather than a schedule, milk production adapts to their needs. Occasionally, an ineffective latch can contribute to oversupply, as a baby might feed very frequently to get the volume they need; however, more typically, this tends to reduce milk supply over time.
A note about foremilk and hindmilk
There is a common misconception that the breasts make two different kinds of milk – thirst-quenching, lower-fat foremilk and fat-rich hindmilk – and that one is inferior to the other; this is not the case! All breastmilk is good; however, typically, the fat content increases during the feed, as the fat globules stick to the ducts and tend to be drawn down towards the end of a feed.
You may be encouraged to feed on one side for a certain length of time in order to ‘get to the hindmilk’; however, it is not the length of a feed that is important, it is the length of time between feeds. Why? The length of a feed doesn’t determine its fat content; some babies get everything they need in 5 minutes! Fat content is determined by the fullness of the breast. If there is a long gap between feeds and the breast is full, the baby may get a large quantity of lower-fat milk before much of the fat starts getting pulled down. The same may be true if a mother naturally produces very large quantities of milk. In the absence of fat-rich milk, the lower-fat milk moves through the gut faster than it can be digested, leading to fermentation and signs of lactose overload, such as green, frothy stools, ‘gas’ and pain.
What is most important to a baby’s weight gain is the total volume of milk every 24 hours. When your baby is feeding effectively and you allow them to determine the length and frequency of breastfeeds, they will also get the right balance.
You can find more about the fat content of milk here
How your milk supply is established
Before you baby is born, milk production is hormonally driven. After birth and the delivery of the placenta, milk production is regulated on a supply and demand system; the more milk your baby removes, the more milk you are likely to make. How quickly or slowly milk is made depends on the fullness of the breast. When the breast is less full, milk is made more rapidly. When the breast is full, milk production slows down.
Typically, milk supply takes 6-8 weeks, and sometimes up to 12 weeks, to regulate. Nature can be overly generous at first and it can take time for your supply to settle down to what your baby actually needs. It is not unusual in the early weeks to feel as if you have too much milk and it is not unusual to have periods when the breasts feel engorged. Feeding frequently and removing milk from the breasts is essential to resolving engorgement; it won’t make the engorgement worse or result in too much milk.
Periods of increased nursing due to development changes and growth spurts can also cause fluctuations in supply. Many mothers find there are changes to their babies’ nursing patterns during holidays and family get-togethers, or during periods of stress. Milk supply is very adaptable; if you follow your baby and your body, rather than the clock or a schedule, your supply will most likely regulate itself at these times.
What can I do to remedy symptoms of oversupply?
In the first instance, you might like to consider adjusting positioning and attachment to help your baby manage a fast letdown, feeding responsively (‘on demand’) and/or offering more frequent feeds, and using breast massage.
Managing a Fast letdown
When your baby suckles at the breast, a neurohormonal reflex causes milk to release. This is known as the Milk Ejection Reflex (MER) or, more commonly, letdown. In the early weeks, it is not uncommon for this to occur just by thinking about or hearing your baby!
When the milk ‘lets down’, it is not unusual for it to spray out, and sometimes with a degree of force. Whilst some babies aren’t bothered by this fast flow, others are upset and distressed by it. They may gulp and cough and pull on and off the breast, as they struggle to coordinate sucking, swallowing and breathing. A fast letdown can be a symptom of oversupply; however, it is possible to have a fast letdown with an average milk production.
Unless your baby is showing other signs of oversupply (explosive green poo, pain and large weight gain), then it might be worth reviewing and experimenting with the following:
- Ensure that your baby is deeply attached at the breast – it is easier for a baby to manage a fast flow if they are deeply latched. An LLL Leader can help you adjust positioning and attachment.
- Adjust your body – make use of gravity by feeding in a ‘laidback’ (reclined) position. Some mothers find it helps to feed in an upright position or side-lying so that the excess milk can easily dribble out. Breastfeeding in a position where your baby’s head is higher than your breast, so that you are not leaning over, can help your baby to manage the flow.
- Allow your baby to come off the breast when he needs to catch his breath. Keep your supporting hand down near your baby’s shoulders and neck to avoid pushing on the back of his head. Have a muslin to hand to catch the spray.
- Let the flow subside by taking your baby off the breast, catching the spray in a muslin and then bringing him back to the breast. Your baby will have an easier time nursing when the flow slows. Some mothers hand express a little to slow the flow before bringing the baby to the breast; however, if this is done frequently, it may exacerbate oversupply. If your breast is very full and engorged, you might try reverse pressure softening to move fluids away from the nipple area, which can help your baby to latch more deeply. You can read more about this here
- Feed frequently so that the spray doesn’t have quite so much volume and force behind it.
- Try breastfeeding before your baby is really hungry or while they are slightly sleepy – if your baby is relaxed she may nurse more gently, be more coordinated and receive a slower flow of milk.
Responsive feeding
How do you know how often or how long to feed your baby for? Let your baby tell you! We all have different milk storage capacities and this may determine how frequently your baby feeds and whether they feed from one side or two.
A good approach is to let your baby take as much milk as they want from the first breast. If they come off looking satisfied and your breast feels soft and comfortable, then offer the second breast; they may or may not take it. If your baby isn’t satisfied and wants to nurse again after a short period of time and the first breast still feels full, offer the first breast again, then offer the second breast.
Sometimes babies will only take one breast and sometimes two (or three or four!). Most babies will take both breasts, at least some of the time. Babies are very good at letting us know how often they want to feed and, if in doubt, it is always fine to offer.
Breast massage
You could also do what is sometimes called the ‘breast milkshake’. This term was coined by American lactation consultant Christina Smillie and involves gently massaging each side for half a minute or so before feeding and then using a combination of massage and breast compressions during a feed to help dislodge some of the fat. Massage during a feed can also help to prevent blocked ducts or areas of engorgement.
Sufficient fat-rich milk leads to the production of cholecystokinin (CKK) at high enough levels to give a feeling of satiety. 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 may want to nurse even more, for comfort as well as food, creating a vicious cycle.
You can find information about breast compressions below
Reducing your milk supply
If your baby is gaining more weight than average and you and your baby are happy, then you don’t need to change anything. If you or your baby are suffering from some of the above symptoms, you have ruled out other causes and changes to breastfeeding management do not help, then you may want to consider taking steps to gradually slow milk production.
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.
Monitor your baby’s weight gain to ensure it doesn’t drop below expected levels (at least 20-30g a day, on average, during the first three or four months) and keep a close eye on nappy output.
One side per feed
Limit your baby to one breast per feed. If your baby wants to come to the breast again for comfort or connection before the next full feeding, stay on the first breast. When a mother has a generous milk storage capacity, her baby may only need to feed on one side and this approach may help to calm things down. Should the unused breast feel uncomfortably full before the next feed, then express to comfort only. This will help avoid developing blocked ducts or mastitis and may also make milk flow more manageable for your baby. Avoid excessive pumping, as it can make things worse.
Block feeding
Block feeding involves feeding on the same side for set periods of time, e.g. for two or three hours (or longer depending on the severity of your oversupply). If your baby wants to feed again within that timeframe, offer the same side. Again, If the other breast feels uncomfortably full before the next feed, then express to comfort only. As a starting point, you might like to:
- 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 every two hours. If your baby is asleep, switch breasts when he wakes.
It is important not to have a rigid approach to block feeding; it is much more a matter of reading your breasts and your baby than the clock. By doing this, you will find the time interval that works best for you and your baby, by slowing production at the same time as ensuring that your baby is fed.
It is possible to experience oversupply in just one breast, in which case you could nurse for longer periods on the unaffected side. Watch for blocked ducts and sore areas on your breast. If you’ve been expressing regularly, reduce this gradually to avoid further problems.
By sticking to one side per feed or for set intervals of time, the unused breast will be fuller. A full breast makes milk more slowly and, therefore, you will gradually reduce your supply.
Full drainage and block feeding method
For more severe oversupply – for example, if you are suffering from recurrent blocked ducts or mastitis and your breasts never feel soft and comfortable, even after a breastfeed – you will need to keep your breasts well-drained while you take steps to reduce milk production.
You could try the following, in consultation with an infant feeding specialist, in addition to block feeding:
- Express from both sides thoroughly to “empty” your breasts as fully as possible.
- After expressing, immediately offer both “empty” breasts to your baby.
- Next, limit your baby to one breast changing sides every two or three hours (as per block feeding above).
Some mothers will need to 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.
Herbs
Some mothers have had success using herbal preparations, such as sage, parsley and peppermint, or homeopathic remedies to slow milk production. Prescribed and over-the-counter medications (such as pseudoephedrine) can also be used in this way. When using herbs or medications, it is important to consult with someone knowledgeable in their use and with your healthcare provider.
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 blocked ducts and mastitis.
Some women with extreme oversupply have gone as long as six or more hours before switching breasts to adjust milk production. Rarely, a hormonal imbalance may cause overproduction of milk. A visit to your doctor may be helpful if the suggestions offered here aren’t enough.
Block feeding should be a temporary measure. Typically, it is suggested that it is done for no more than one week and only when babies are gaining double (or more) the average weight. Once supply has settled, you can return to a more normal feeding pattern, following and trusting your baby and your body.
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 and areolas 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 for a few seconds before releasing. If it doesn’t work first time, try again for a little longer, but bear in mind that if your breasts feel full, this may be a sign to take the time to nurse your baby.
As milk flow slows
Babies used to an abundant milk flow can become fussy at the breast when milk flow slows. They may also have become used to having a more shallow latch, as they have not had to work as hard to get milk. Ensuring your baby has a good, comfortable latch can help them remove milk effectively. You can use breast compressions to increase milk flow and encourage your baby to keep feeding actively. Breast compressions can also help to release more of the fat-rich milk:
- Support your breast with one hand – thumb on one side, fingers on the other.
- 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.
- Rotate your hand around your breast and repeat step 2 on different areas of the breast as needed. Go gently – this should not hurt.
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 lactose overload. A healthy baby will nurse to get the calories he needs – so follow his cues. 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 ‘catch-down’ 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 supply. 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 between feeds during the early weeks 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 Charlotte Allam, 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
Allergies and Intolerances
Fat Content of Breastmilk – FAQs
Positioning and Attachment
Other websites
UK–WHO Growth Charts: www.rcpch.ac.uk/growthcharts
Gastro-oesophageal Reflux: https://abm.me.uk/wp-content/uploads/ABM-reflux-breastfeeding-baby.pdf
Oversupply of Breast Milk: https://breastfeeding.support/oversupply-breast-milk/
Block Feeding Dos and Don’ts: http://www.nancymohrbacher.com/articles/2013/10/9/block-feeding-dos-donts.html?rq=oversupply
Foremilk and Hindmilk: http://www.nancymohrbacher.com/articles/2010/6/27/worries-about-foremilk-and-hindmilk.html
Books
The Womanly Art Of Breastfeeding. LLLI, London: Pinter & Martin, 2010
LLLGB kindle edition of Positioning & Attachment
References
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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