I think it’s normal for most moms to worry about their breast milk supply. I always find that on the second night postpartum when a mom’s adrenaline plummets and her baby has a bad case of the fussies, there are concerns raised about not making enough milk. “She must not be getting enough!” many worry. The perception of low supply is the most common reason mothers cite for not reaching their breastfeeding goals. Most physicians are aware of low supply, and can prescribe medications to assist and they can monitor babies closely. Low supply is a serious problem that warrants watching and intervening as necessary. Overactive letdown and oversupply, however, is rarely mentioned.

Afterall, if under-supply is so worrying, how can making too much milk ever be a problem?

Overactive letdown and oversupply can cause a lot of issues for both mom and baby, and the lack of knowledge from practitioners and the general public can make these moms feel confused and alone. Hyperlactation is often an under-diagnosed condition for otherwise healthy women who are nursing. In case you’re unsure what we are talking about, an oversupply of breast milk simply means that the mom is producing more milk than her baby needs, and an overactive letdown means that the breast milk comes out too forcefully for the baby to handle.

Overactive letdown and oversupply can cause a myriad of problems if left unchecked, so I am here today to share with you some tips on how to get some relief for both you and your baby.

What Exactly Does Overactive Letdown and Oversupply Look Like?

Our experience with overactive letdown and oversupply started with extreme engorgement, and now our 3 month daughter gags, chokes, burps, and spits up during feeds. Her lips make a clicking noise during milk letdowns, which tells me that she is pulling away from the breast when the milk is spraying too fast. This causes her to swallow more air than normal, so I need to be extra vigilant about burping her. The burps and farts that come out of her honestly can rival an adults, and they appear to cause pain. She spits up after almost every feed.

Feeding her in public is very difficult because she pops on and off, fusses frequently and gulps and burps at the breast, which makes blending in at the doctor’s office or family function pretty much impossible. I make it work because I refuse let it affect our busy life with three kids, but usually I find myself heading to the safety of our super cool minivan.

I can never nurse her to sleep and she rarely wants to nurse for comfort – she prefers a soother instead, which before having her I was against giving to my babies. I have to wear bra pads at all times, and even then I still can find myself laying in a pool of milk in the mornings… I know, a very pleasant thought, right?

Honestly though, I’m probably being a little dramatic and people probably think I have it all together when we go out, but I have implemented these measures to survive.

If my story sounds similar to your own and you think you are dealing with oversupply and overactive letdown, I’ve prepared some quick info for you to help make your life a bit easier.

Do You Have a Problem with Overactive Letdown?

Here are some signs that an overactive letdown may be the culprit of your breastfeeding worries:

Does your baby…

• Chokes, sputter, gulp, gasp, burp and/or cough during feeds?
• Make a clicking noise during feeds?
• Clamp down during letdown to slow the flow of milk?
• Excessively spit up and seem extra gassy?
• Dislike nursing for comfort of to go to sleep?
• Refuse to nurse at times?
• Have excessive gas or green, frothy stools?
• Fast weight gain in the beginning, with weight gain slowing due to low-fat feeds or baby’s aversion to breastfeeding (Adrusiak et al)

If these problems sound familiar then you may have an overactive letdown reflex, which could potentially be caused by an oversupply of breast milk.

Tips for Battling an Overactive Letdown

Basically there are two ways to battle an overactive letdown:

Fix Your Oversupply

• During the first six weeks while your milk supply is still being regulated, try to focus on feeding your baby on demand, without worrying about pumping extra or block feeding. Doing so will give your body a chance to regulate on its own.
• Train your body to reduce milk production by block feeding. Block feeding is where a breastfeeding mom restricts nursing to only one side within a certain amount of time, such as in three or four hour increments. As an example, if you feed on your left breast for 15 minutes, and then your baby shows signs of hunger in an hour and a half, you would offer your left breast again during that feed, since it is still within the 3 hour time frame that you have chosen. This allows your baby to completely empty your breasts and to receive an adequate amount of hind milk, while your right breast becomes slightly engorged. This engorgement is what will tell your body to slow down milk production.
• Another article by van Veldhuizen-Stass (2007) recommends starting block feedings with both breasts completely emptied with a pump. The baby is to latch on right after pumping to receive the higher hind milk content than she is used to, and will most often fall asleep content on the breast. She then recommends block feeding on each side for 3 hours, and increasing the hourly increments as needed. Pumping may only be required once for uncomplicated oversupply, and should only be done again with uncomfortable engorgement to avoid mastitis or plugged ducts.
• ***You will want to ensure that oversupply is truly a concern for you before block feeding, as doing so has the potential to result in under-supply issues if not done carefully. Follow-up with a lactation consultant or laleche league leader is highly recommended.***

Help Your Baby Handle Your Fast Flow

If you have already tried to fix your oversupply to no avail or if your fast letdown is unrelated to having an oversupply of breast milk, you may want to try some strategies below to help your baby become more comfortable during feeds.

• Feed your baby in a reclined nursing position. You can do so in a laid-back, cradle, or football hold just by leaning back with some extra pillows. This position allows gravity to slow down the flow of milk so that your baby can handle feeds easier.
• Try feeding in the side-lying position, as it allows baby to dribble excess milk out of the side of their mouth if necessary. You may want put a towel down first to catch the milk
• Unlatch your baby when letdown occurs and let your milk spray into a container or towel until it slows, then re-latch your baby.
• Try to slow the flow of milk with the scissoring technique (using your index and middle fingers to scissor your areola in an attempt to slow milk flow during letdown) – honestly, this seemed to help my baby, but it gave me a terrible hand cramp!
• Try to nurse when your baby is sleepy and relaxed as your baby’s suck will be more gentle.
• Nurse frequently as it will help lessen the flow of milk.
• Burp your baby multiple times each feed, to reduce the amount of spit-up and fussiness from excess gas.
• Check for lip and tongue ties to make sure your baby’s difficulty latching is actually related to fast flow.
• With support from a lactation consultant, using a nipple shield during feeds can sometimes help infants handle an overactive letdown.
• If all else fails and your baby is refusing the breast, try pumping off your first letdown until your flow settles, and then latch baby on your breast for the feed. This is your last choice as the extra stimulation can increase your milk supply, thus further perpetuating oversupply. If you do try this option, slowly work towards a lesser and lesser pumping time that your baby can tolerate.
• Avoid unnecessary pumping sessions to build a freezer stash until your baby can feed more easily on the breast.
• Know that oftentimes, overactive letdown and oversupply will get better with time, usually around the three-month mark.
• Get help! Although many general practitioners won’t know what oversupply and overactive letdown involve, all lactation consultants should! They are a great resource to you. Use them!

Overall, dealing with oversupply and an overactive letdown is no fun, but please know that you are not alone! If you have any questions please don’t hesitate to leave a comment, and please share with your fellow breastfeeding friends to help get the word out.

If you need some help working through your oversupply, please book an online lactation consultation here.

Tori Hamilton, BScN, RN, IBCLC

References

Andrusiak, F., Larose-Kuzenko, M., Martens, P., Romphf, L., Yates, S. The effects of an overabundant milk supply and forceful let-down reflex. Retrieved from http://overactiveletdown.com/documents/files/EffectsOfOAM.pdf 

van Veldhuizen-Stass, C. (2007). Overabundant milk supply: An alternative way to intervene by full drainage and block feeding. Int Breastfeed J, 2:11. doi:  10.1186/1746-4358-2-11