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.