• 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.