Milk Aplenty: What to do with milk oversupply and/or forceful let-down?
Many of us go into the experience of breastfeeding wary of the possibility of low milk supply. You may have heard the stories of friends or acquaintances who were told they didn’t have enough milk and hoped this wouldn’t happen to you. What is less commonly heard about is the possibility of oversupply of milk and/or forceful milk let down.
While this might seem like a dream to someone with low supply, those who are experiencing this know that it comes with its own set of worries and challenges. So… what does oversupply with forceful let-down look like?
A combination of the symptoms listed below could mean you are struggling with this issue:
Maternal symptoms
• Recurrent blocked ducts, milk blebs, and/or mastitis
• Frequent breast fullness accompanied by pain or discomfort
• Nipple pain as babies sometimes clamp down to try to control the flow
• Abundant milk leakage between feeds
• Strong milk spray if baby pulls off the breast during a feed
Infant symptoms
• Coughing, gagging or pulling off the breast, especially during the initial let down
• Short and frequent feeds
• Frequent spit ups after feeds
• Increased gas and fussiness (both on the breast and away from the breast)
• Difficulty settling
• Above expected weight gain
As these symptoms can also be caused of other conditions, such as poor latch, tongue tie, or reflux, it’s important to reach out for support to explore possible causes.
If the issue is deemed to be oversupply and/or forceful let-down, here are some strategies that can help:
Try different nursing positions.
Different positions can be helpful by making use of gravity to slow the milk flow (ie. with mom in a more reclined position, such as laid back nursing). Alternatively, repositioning baby to be more upright to better manage the strong milk flow (ie. straddle hold) works for well for some babies. Latch is really important here too. If the nipple is positioned correctly toward the roof of the baby’s mouth, the strong flow of milk will be buffered by hitting the baby’s palate rather than shooting straight back into the throat.
Express some milk out prior to feeds.
Expressing some milk out prior to feeds (especially the first morning feed when milk flow is often at its highest) can help you past the strongest flow and allow you to attach baby once the flow is not as strong. This can make for a more comfortable feed for your baby. You can accomplish this with hand expression or pumping, being cautious to remove just enough so that baby experiences a less forceful letdown, but not so much that it keeps your milk production in overdrive. As a rough guideline, 1-2 minutes of hand expression or pumping can do the trick.
Use pressure to slow the milk flow or remove baby.
If you haven’t had time to express some milk out prior to the feed, and your baby is latched and struggling with the flow, you can use gentle but firm pressure with the flat part of your hand on your chest to try to slow the milk flow. If baby is still struggling, you can consider removing your baby through the initial let down, and catch the milk flow in a cup or on a towel and reattach baby after the milk slows.
Block feeding (with caution).
If the above strategies aren’t working, some moms and babies benefit from a brief period of block feeding. This is a strategy that involves feeding baby only on one side for 4-6 hours before offering the other side. As each breast gets stimulated less this way, it can send a message to the brain to slow milk production. I usually recommend trying this for 48-72 hours under the guidance of a lactation consultant, to not risk decreasing supply too much and also to make sure you’ve explored other possible causes of your symptoms prior to trying this. Note that in extreme cases, herbal or prescription medication may be considered to suppress milk production.
If this is your struggle, please don’t hesitate to reach out for support with our team of lactation consultants.
Sources:
Academy of Breastfeeding Medicine. (2020). ABM Clinical Protocol #32: Management of Hyperlactation. Breastfeeding Medicine, 15 (3). Retrieved from: https://www.bfmed.org/assets/DOCUMENTS/PROTOCOLS/Protocol%20%2332%20-%20English%20Translation.pdf
Australian Breastfeeding Association. (2023). Oversupply. Retrieved from: https://www.breastfeeding.asn.au/resources/oversupply
La Leche League GB (2023). Oversupply. Retrieved from: https://laleche.org.uk/too-much-milk-and-oversupply/
La Leche League International. (2024). Breastfeeding Info: Oversupply. Retrieved from:
https://llli.org/breastfeeding-info/oversupply/
Trimeloni, L. & Spencer, J. (2016). Diagnosis and Management of Breast Milk Oversupply. The
Journal of the American Board of Family Medicine, 29 (1) 139-142; DOI:
https://doi.org/10.3122/jabfm.2016.01.150164