Have an oversupply of breastmilk?

Tinest babies

Concern about not having enough breast milk to feed your infant, is the number one reason that mothers wean their babies early, but having too much milk can also be a problem. When you consider the fact that a small percentage of women don’t have the capacity to produce enough milk for their babies no matter what they do, then
having too much milk is a relatively good breastfeeding problem to have, and is usually fairly easy to resolve.

When a mother has more milk than her baby can handle, the following behaviors may be common:

  • Baby cries a lot, and is often very irritable and may become restless
  • Baby may sometimes gulp, choke, sputter, or cough during feedings at breast
  • Baby may seem to bite or clamp down on the nipple while feeding
  • Milk sprays when baby comes off, especially at the beginning of a feeding
  • Mom may have sore nipples
  • Baby may arch and hold himself very stiffly, sometimes screaming
  • Feedings often seem like battles, with baby nursing fitfully on and off
  • Feedings may be short, lasting only 5 or 10 minutes total
  • Baby may seem to have a “love-hate” relationship with the breast
  • Baby may burp or pass gas frequently between feedings, tending to spit up a lot
  • Baby may have green, watery or foamy, explosive stools
  • Mother’s breasts feel full most of the time
  • Mother may have frequent plugged ducts, which can sometimes lead to mastitis (breast infection)

Moms who produce too much milk may experience a few seconds of intense pain as the letdown (or milk ejection) reflex occurs, because it is so forceful. The cause of the problem is usually a combination of an overactive letdown reflex along with a foremilk/hindmilk imbalance. Let’s say that the ‘average’ mother has one half ounce of foremilk (the thin, sweet milk produced at the beginning of the feeding that is high in lactose but lower in fat) and two ounces of hindmilk (the higher calorie, thicker milk that is produced as the milk lets down and moves through the ducts, collecting fatty particles). This ‘average’ mother’s baby will get a total of about five ounces of milk if he nurses on both breasts. The mother with too much milk, on the other hand, may have an ounce of foremilk and three ounces of hindmilk in each breast. This
means that the baby may get four ounces of milk on the first breast, and if you switch him to the other side, he may be so full that he will only get the ounce of foremilk that comes out at the beginning of the feeding. This results in a disproportionate amount of foremilk. Why is this a problem?

Foremilk is high in lactose, a normal and necessary milk sugar that in large volumes causes gassiness and discomfort, frequently with green, watery or foamy stools. Over a period of time, undigested lactose can irritate the lining of the intestines, causing temporary secondary lactose intolerance and possibly small amounts of bleeding into stools that can be misdiagnosed as a food allergy. Adjusting breastfeeding to increase the amount of fat the baby receives (“finishing” the breast before switching) usually corrects the problem.

Here are some tips that can help you reduce and cope with an overabundance milk supply:

  1. Offer only one breast at each feeding. Let your baby nurse as long as he wants to on that side. If he has nursed less than 15-20 minutes on that breast, and wants to nurse again in less than an hour or two, put him back on the same breast until he has stayed on for at least 15-20 minutes.
  2. If he does nurse for 15 minutes or so on one side, don’t offer the second breast unless he seems to want it. He probably got all the milk he needed on the first side. Many babies (especially newborns) will take the other side if you offer it, not because they are hungry, but just because they love to suckle. If the other breast gets uncomfortably full before the next feeding, express just enough milk to relieve the discomfort, but not enough to empty it completely.
  3. Try altering your nursing position. Lean back slightly, and hold him so that he is facing your breast, and straddling your leg, with his head elevated above our nipple. Lying on your side may be helpful as well. You also may try lying on your back, with your baby lying on top of you. In all of these positions, the force of gravity will reduce the flow of milk and let your baby control his intake more easily. If your baby is very small, try using the football hold, but make sure that his head is higher than the rest of his body. In any of these positions, you may want to use a towel or cloth diaper to catch the leakage, because there will probably be some as the excess milk dribbles out of his mouth.
  4. Try to relax during the letdown. Usually the milk will spurt out in forceful sprays in the beginning, and then slow down. You may want to catch the initial forceful sprays in a towel, put him on the breast after the sprays have settled down into steady drips. You many also want to express a little milk into a cup before you put him on the breast. Save this milk – it’s great for cereal later on. If your baby starts to choke or gag during a feeding, take him off the breast, express a little milk, and then put him back on after he calms down.
  5. Babies who gulp and choke when their mom has a forceful letdown will often swallow air. Burp him often, especially if you hear him continuing to gulp during the feeding. Don’t be surprised if he spits up a lot, especially while your supply is adjusting. Spitting up most often occurs in babies who are gaining weight well, but are taking in too much milk at a feeding. It’s usually more of a laundry problem than medical problem. However, if your baby spits up forcefully after every feeding, isn’t gaining weight well, or has other signs of illness such as fever or diarrhea, it may indicate a medical problem and you should consult your healthcare provider.
  6. Try to avoid pumping or expressing your milk unless you absolutely have to. Pump or express only if you need to relieve the fullness, because if you pump to empty your breasts, you may be more comfortable temporarily, but you will be sending your body the signals to make more milk.
  7. Drink a cup of sage tea at bedtime. Sage contains a natural form of estrogen that can decrease your milk supply. Discontinue use when your supply begins to level out.
  8. Usually within a week, you will notice a significant decrease in your supply as it adjusts to meet your baby’s demands without overproducing. You may findthat you need to use a pacifier if your baby wants to do a lot of ‘comfort sucking’.

If you do have a fussy baby who needs to nurse for comfort, offer the same breast during a two- hour period instead of switching sides every few minutes. Five minutes on one breast, then five on the other can result in him taking in too much foremilk, leading to symptoms of intestinal discomfort.

Usually, the problem of too much milk will resolve as your baby matures and is able to handle the flow better, and also as your body settles down to make the milk your baby needs and not a lot extra. Like all other breastfeeding problems, this too shall pass.

excerpts from breastfeedingbasics.com