by Anne Smith, IBCLC
Although concern about not having enough milk is the number one reason that mothers wean their babies early, 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.
Babies whose moms have too much milk will often exhibit symptoms such as fussing, pulling off the breast, colicky crying, gassiness, spitting up, and hiccupping. They may want to nurse frequently, and they may gain weight more rapidly than the average baby (who usually gains 4-8 ounces each week during the first 3 or 4 months), or they may gain weight more slowly than the average baby. Their stools may be green and watery, and their bottoms may be red and sore. The mother's letdown reflex may be so forceful that the baby chokes, gags and sputters as he struggles with the jet of milk that sprays too quickly into his mouth.
Mothers who produce too much milk may suffer from full, engorged breasts, plugged ducts, and mastitis. (See article on Breast Infections and Plugged Ducts). Sometimes they feel 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 -- and since foremilk is high in lactose, he may become gassy and spit up as a result of too much lactose being emptied into his bowel. Because he doesn't get enough of the fatty hind milk, his stomach empties quickly and he wants to eat again soon.
Here are some tips that can help you reduce and cope with an overabundant milk supply:
• 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.
• 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.
• 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 your 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 he 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.
• 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.
• 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 doctor.
• 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.
• 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.
• 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 find that 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.
• Consider donating to a milk bank if there is one in your area. Some mothers with abundant supplies can pump several extra bottles each day with minimal effort. Often this is more that their baby can possibly use. I have seen mothers who can produce 20 or more ounces during one pumping session. While this is an extreme, some mothers choose to use the extra milk to help sick or premature babies whose mothers can't or won't provide milk for them. This can be very rewarding. Human milk banks usually require testing for HIV and Hepatitis, but they pay for the testing and arrange for transporting the milk. When you consider the fact that a tiny baby may only take a few ccs at a feeding (one ounce of milk contains 30 cc), a donation of a few ounces a day can make a huge difference. There are only eight milk banks in the US: in California, Colorado, North Carolina, District of Columbia, Delaware, New York, Texas, and Massachusetts. For information on donating milk, contact the Human Milk Banking Association of North America at www.hmbana.org. These are organizations which will do everything they can to make it easy to donate your milk. Contact them at: http://www.leronline.com/milkbank.htm. If you live in North Carolina, you can call the Triangle Mothers Milk Bank in Raleigh, NC at 919-250-8599.
Here's a true funny story about an overactive letdown reflex: a mother whose husband was a high school basketball coach was nursing her six-month old baby on the front bleachers. When everyone started cheering, he pulled off the breast to look around and see what all the noise was about. Mom's milk had just let down, and it squirted so far that it landed on the basketball court. They had to stop play while the referee came out and wiped it off with a towel. Imagine her embarrassment! Bet it makes a great story to tell his girlfriend when he brings her home to meet his parents someday.
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.
If you continue to have problems with leaking even when your baby is older (especially if you are returning to work) check out the BLIS (Breastmilk Leakage Inhibitor System) on the product page. It really works.
Anne Smith, IBCLC has breastfed a total of six children (three boys, three girls). She feels that her first hand experience plus her more than twenty years experience of counseling nursing mothers are among her most important credentials. Anne has been a La Leche Leader since 1978 and IBCLC since 1990. As a nursing mother, LLL Leader, and IBCLC, Anne has worked in many areas over the years. She has led support group meetings, taught breastfeeding classes, trained breastfeeding peer counselors to work with low income mothers, worked one-on-one with mothers to solve breastfeeding problems, helped thousands of mothers with breastfeeding questions over the phone, held workshops for health professionals on various breastfeeding topics, taught OB, Pediatric, and Family Practice Residents breastfeeding at Bowman Gray School of Medicine, and run a breast pump rental station with over 100 pumps, scales, and nursing bras for the past eleven years. We invite you to visit Anne's website.
Copyright © Anne Smith. Permission to publish granted to Pregnancy.org, LLC.