By Evelina Fisher
You are not alone
As a Breastfeeding USA Counselor, one of the most common issues parents contact me about is milk production. This topic comes up frequently in online breastfeeding support forums, too. Often the concern is low milk production, but you may be surprised how many questions are about oversupply. Some parents haven’t felt comfortable asking about what is sometimes seen as a “good” problem to have. How can a plentiful milk supply be a bad thing? Others share symptoms of oversupply that are negatively affecting their nursing relationship. They aren’t sure why it is happening, or if the block feeding recommended by their friends is the way to go. I often start the conversation by reassuring the parents that oversupply is a common experience, especially in the first three months after giving birth. They are not alone. Then we talk about symptoms, causes, and safe and appropriate ways to handle oversupply.
Is it oversupply? Obvious and not-so-obvious symptoms
If you have ever experienced oversupply, chances are you knew what was going on. It may be that milk was spraying everywhere, frequently soaking through nursing pads and clothes. You may have felt forceful letdowns, and seen your baby gulp, choke, and sputter. Perhaps it wasn’t so obvious. Maybe you struggled for weeks or months to identify why your baby arched stiffly away from the breast and squirmed restlessly during feedings, why your breasts were sore, or why your baby seemed to have constant stomach discomfort. Perhaps you suspected your baby was sensitive to something you ate, but eliminating common allergens from your diet didn’t change your baby’s behaviors. There are several symptoms of oversupply, and some are less obvious than others. You may experience some or many of these symptoms if you have oversupply.
List of symptoms of oversupply
(Adapted from La Leche League)
- Your breasts feel very full or hard most of the time
- Your baby struggles to maintain a deep latch during feedings and may come off the breast when letdowns happen
- Milk sprays when your baby comes off the breast, especially at the beginning of a feeding
- Your baby often gulps, chokes, and sputters during feedings
- Your baby may clamp down on the nipple while feeding
- Your baby may arch away from the breast, sometimes fussing or crying
- Feedings can seem like battles, with your baby never relaxing at the breast
- Your baby may fill up fast so feedings may be short
- Your baby may struggle with trapped air and need to burp or pass gas frequently
- Your baby may spit up a lot of milk, frequently
- Your baby may have green, watery or foamy, explosive stools
- Your baby may gain weight rapidly, from taking in large amounts of milk – or they may have slower-than-average weight gain because they struggle to nurse effectively
- You may have sore nipples
- You may have frequent engorgement and plugged ducts, which can lead to mastitis
Ruling out tongue ties:
PLEASE NOTE: Even if you experience many of the symptoms listed above, you may not have oversupply – your baby may have a tongue tie. Ties can make it difficult to cope with normal milk flow, transferring milk effectively, and enjoying feedings. If your baby cannot drain your breast effectively your breasts may feel full or hard. You may also have sore nipples and frequent plugged ducts.
It is a bit like the chicken and the egg: Is your baby having difficulty latching and transferring milk because of oversupply? Or are you experiencing symptoms similar to those of oversupply because your baby is finding it hard to latch and transfer milk well for other reasons, such as a tongue tie?
If you have local Breastfeeding USA Counselors they can help you figure out what is going on and refer you to an appropriate healthcare professional. Alternatively, you can make an appointment to see an International Board Certified Lactation Consultant (IBCLC).
What causes oversupply?
Breastfeeding is the biological norm for the newborn, and your body automatically prepares to produce milk during pregnancy. Cells that produce milk and ducts that transport milk multiply. This is what makes your breasts grow when you are pregnant. In the second trimester, your body is already making colostrum. When your baby is born and the placenta delivered, changing hormone levels tell your body to start producing milk. At first, milk production is controlled by hormones (this is called endocrine control). It quickly becomes dependent on frequent and effective removal of milk (or autocrine control), although postpartum hormones continue affecting milk production for some time. We react to hormones differently, and it seems as if some parents’ bodies are running on overdrive from the beginning. Their bodies readily produce and respond to hormones, and they may experience oversupply as a result. Once the postpartum hormones regulate, your body can better adjust how much milk to produce based on how often and well your baby (and you) remove milk. The exact timing differs from person to person, and between pregnancies, but commonly lasts until the baby is about three months old.
How can you tell the effect of hormones is diminishing? The feeling of your breasts always being full or hard goes away. Sometimes this change causes the parents to worry they are losing their supply, when in fact their bodies are finally better able to adjust milk production.
Oversupply can also be created by how we manage breastfeeding. We live in societies where formula marketing can make us doubt our body’s amazing ability to give and sustain life. Parents who are concerned that their babies aren’t getting enough milk when in fact they are, may create oversupply by routinely pumping in addition to nursing, or through unwarranted use of galactagogues. Other parents develop oversupply by following advice from well meaning family and friends. One example is pumping too much before each feeding to make a full breast softer and easier for the baby to latch onto. Occasionally, oversupply happens completely unintentionally, and may only affect one breast. This can happen when a baby forms a preference for one breast and consistently feeds on that side more frequently, more effectively, or longer.
If you have oversupply, what can you do about it? Options to safely and appropriately regulate milk production differ depending on what is causing your oversupply and the age of your baby. As we discussed earlier, many parents experience oversupply before their body has had a chance to regulate milk production. In comparison, oversupply that has been created by how we breastfeed, or persists many months after birth, may have different causes. It can be helpful to first try to identify the causes of your oversupply.
Coping in the early postpartum period
Think of the first few months after giving birth as a period in which it is preferable to cope with oversupply, rather than actively trying to decrease production, awaiting the time when your body will regulate milk production more effectively on its own. If you try actively to reduce milk production early on, you may inadvertently overcorrect your production without immediately noticing it because of the temporary influence of hormones. Here are some suggestions for coping with a normal, postpartum-increased supply of milk.
- Uphill nursing: Feed in positions where the milk has to flow up the breast, rather than down the breast. For example: Laid back breastfeeding. You can play around with the degree of incline where you and your baby feel most comfortable.
- Unlatch for letdowns: When the first letdown happens, gently unlatch your baby and let the milk spray out until the pressure subsides. If you want to collect and save the milk, be ready with a clean bottle or milk saver bag. If your letdowns remain strong throughout the feeding, you can decide whether to unlatch your baby again or if that will disturb her feeding rhythm. Many babies are able themselves to adjust to changes in milk flow.
- Reverse pressure softening: If your breasts are engorged, use reverse pressure softening (RPS) instead of pumping immediately before feedings. You use your fingers to soften and make the breast more pliable. RPS often elicits a letdown, which also releases some of the pressure. It can help your baby latch better. In comparison to pumping, it does not stimulate more milk production.
- Avoid unnecessary pumping sessions: If milk is flowing and baby is gaining weight appropriately, there is no need to pump. Pumping to save milk in case of separation from baby can usually be delayed for at least several weeks postpartum, if not longer.
Addressing persistent oversupply
If you have tried the options above and they are not sufficient to help you and your baby cope with your oversupply, or your oversupply persists, here are some more things to try.
Since these options work to actively reduce your milk production, we suggest they should only be used under the supervision of an IBCLC.
- Block feeding: Choose one breast and, independent of how often your baby wants to nurse, offer only that breast for a set period of time. You might start with a two or three hour block. Some parents may need to do slightly longer blocks. Then switch to the other breast for the next block. If the breast that is “resting” gets uncomfortably full, hand express only enough milk to feel comfortable to reduce the risk of developing plugged ducts. Block feeding is appropriate for short-term use, and if it works, you usually notice a difference in milk production in a few days.
- Full drainage and block feeding: Drain the breasts as completely as possible mechanically. This means using a pump and effective pumping technique, such as the hands-on pumping technique. Immediately afterwards, offer your baby to nurse from both “empty” breasts until they are satisfied. This is believed to reset milk production by removing milk that has accumulated in the breast, called milk lakes. Follow this up with block feeding, as described above, for a few days.
- Cabbage leaf compresses: Many parents find that cabbage leaf compresses can alleviate discomfort from engorgement, and reduce milk production. Chill the cabbage leaves, wash them in cold water, and apply to your breasts for short periods of time between feedings, up to a few times per day. This is sometimes used to fully suppress lactation, so cabbage leaf compresses should be used with caution.
- Herbs: Sage is an example of an herb that inhibits milk production. Like cabbage leaf compresses, it is often used by parents who wish to stop lactation and should be used with caution for oversupply. There are different ways to use sage.
- Medications: Certain medications, including cold medicines containing decongestants, may reduce milk production as a side effect. Some parents also experience reduced milk production when using hormonal contraceptives. However, these drugs may have other side effects, and there may be personal health and safety concerns to consider. This may make use of medications an undesired approach to manage oversupply. If you have exhausted other options and want to explore this approach, it is important to consult your healthcare provider.
An alternative way of managing oversupply is to become a breastmilk donor. Some parents who experience oversupply choose to maintain their higher level of milk production, in order to express and donate milk. Donated breastmilk saves lives and improves the health of newborns who are admitted to a Neonatal Intensive Care Unit (NICU), including reducing the risk of Necrotizing Enterocolitis (NEC), a sometimes fatal intestinal disease. Donated breastmilk also allows parents who cannot nurse to choose to provide human milk for their child. Learn more about donating breastmilk to a Human Milk Banking Association of North America member. You can also explore community breastmilk sharing via organizations like Eats on Feets and Human Milk 4 Human Babies.
Non-evidence based practices to avoid
Chances are you have heard suggestions for how to reduce milk production, perhaps by well meaning family or friends or on social media, that are not evidence-based and are best avoided. Here are a few of the most commonly shared strategies that are generally not helpful.
- Scheduling feedings: This is not an evidence-based practice, and it can cause your baby to get too little milk. It can also cause issues with low production over time. Cue-based feeding is the preferred method for healthy babies, including if you are block feeding.
- Limiting your baby’s time at the breast: This is not an evidence-based practice. It too can compromise your baby’s intake of milk, and lead to low milk production over time. Instead, allow your baby to finish the breast she is nursing from on her own.
- Binding your breasts: This is not an evidence-based practice. Breast binding does not affect milk production, and may increase the risk for plugged ducts.
Making too much milk is a common experience, particularly in the first few months after giving birth. It can make feedings unpleasant, or seemingly impossible at times, which can cause parents anxiety and stress. It can affect your baby’s behavior and weight, sometimes resulting in inaccurate diagnoses like colic or food sensitivity. It can also be the cause of breast trauma, engorgement, and recurrent plugged ducts. This makes it important to identify and manage oversupply. Evidence-based support to cope with or actively address oversupply in safe and appropriate ways can help parents regain confidence in breastfeeding, and focus on enjoying their babies. Options range from nursing uphill and unlatching for forceful letdowns, to block feeding, full drainage and block feeding, and herbal remedies. An alternative option is to maintain the oversupply and donate breastmilk to formal or informal human milk sharing networks.
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Evelina is a freelance consultant in the field of reproductive health and rights, and has been a Breastfeeding USA counselor since 2013.
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