Too much milk? Breastmilk is the perfect food for babies. Can there really be such a thing as too much of it?
Some mothers find that in the early weeks as their milk comes in, their baby begins to show signs of struggling with their mother’s overabundant supply and the strong let-down reflex that often accompanies it. To those struggling to increase their milk supply, this may sound like a wonderful problem to have, but it can actually be a frustrating and confusing time for mothers and babies in this situation. The good news is that decreasing supply is always possible and almost always straightforward.
If you have overabundant supply or a strong or overactive let-down your baby may:
- Need a lot of burping
- Spit up regularly
- Pass a lot of gas
- Act fussy during feedings, or come off the breast choking, sputtering or arching away
- Clamp down on the breast while feeding
- Wake hungry soon after falling asleep, even if he was just breastfed
- Act colicky
- Have explosive green or watery stools, or sometimes blood in the stools
- Gain weight very quickly, sometimes more than a pound per week
- Gain slowly or not at all if he begins to refuse the breast
If you have oversupply or overactive letdown you may:
- Have breasts that leak a lot during and between feedings
- Have breasts that always or frequently feel full and/or hard
- Find that when your baby comes off the breast, milk continues to spray out of your breast for several seconds or longer
- Have painful nipples from baby clamping down or chewing on them during feedings
- Be prone to plugged ducts and/or mastitis
Often a mother with oversupply will interpret her baby’s fussy behavior as a sign that he is not getting enough milk, and think that because he baby is gaining weight so fast, he must need even more milk than she can provide.
A mother with an oversupply has so much milk, that her baby’s tummy fills up with lower-fat foremilk. This gives the baby a feeling of fullness, but not for long, because it is the hormone leptin in the fat of the milk that gives the baby the sensation of fullness and satisfaction. The baby who does not seem satisfied after feedings but is gaining well may not be getting enough of the higher-fat hindmilk to get enough leptin. Foremilk also has more lactose than the hindmilk and this is what can cause the green watery stools that are commonly seen with oversupply.
So how can you reduce your supply? The key to decreasing supply and making sure your baby is getting a good balance of foremilk and hindmilk is to breastfeed the baby on one side for longer.
If you have a mild oversupply, just offering one breast per feeding for a few days may be enough to bring your supply down to a more comfortable level for you and your baby.
If you and your baby are experiencing many of the challenges described above, you may want to try a technique called “block feeding.” Most mothers start with a 2 or 3 hour block. Then however many times the baby wants to feed during that block, it is always on the same side. At the end of the block of time, you switch sides. With one breast staying full for longer, your body gets the message to reduce the supply. If your resting breast gets overly full and uncomfortable, you can hand express or pump to comfort, but don't empty it. A full breast gives your body the signal to slow down milk production, but this needs to be balanced with preventing plugged ducts and mastitis. Be sure to keep the breast from becoming uncomfortably full. Using cool compresses or cabbage leaves on the resting breast can help. When the baby stays on one side longer, he will tend to get higher-fat milk and may be more satisfied. Some mothers need to try longer blocks to bring down their supply, but I normally suggest starting with 2-3 hours and going from there as needed.
If after a few days you and your baby are still feeling the effects of oversupply, you can take block feeding one step further and try a technique called “full drainage and block feeding.” The first step is to pump and empty your breasts as thoroughly as you can. Then start block feeding with 3 hour blocks. If your breasts become uncomfortably full again, pump them until empty again, and increase the length of the blocks by an hour or two. Little by little you should be able to stop the pumping sessions and see your supply regulate. Some mothers may only need to pump once, and 3 hour blocks may be enough. Others will need to pump a few more times and may need to use blocks as long as 4, 6 or 8 hours, or very occasionally even longer.
Occasionally a mother’s supply doesn’t come down even with very long blocks. In these cases some mothers may work with their physicians to use a short term course of oral contraceptives or pseudoephedrine to decrease their supply.
Once your supply has regulated some, your baby may start wanting both breasts each feeding again, or he may be satisfied with one. Either way is normal and fine.
Sometimes overabundant supply is caused by a baby with an extremely strong need to suck. If that seems to be the case with your baby, in addition to the suggestions above, letting the baby suck on a parent’s clean finger or pacifier between feedings may be helpful.
Please note that a baby having green poo is not a guarantee that the mother has an oversupply. If a true oversupply is present, the mom and baby will usually be experiencing several other challenges. Green stools can also be caused by iron supplements, vegetables or seaweed in the mother’s diet, or sometimes by a sensitivity to dairy protein. Many mothers become very concerned about foremilk/hindmilk imbalance, but I find that as the baby grows and matures, most mothers and babies find their own rhythm with breastfeeding. Most of the time the green poos disappear and the oversupply and let-down regulate by the time the baby is about 3 months old. The questions never end though, and the mother with the nicely regulated milk supply will likely move on to a new stage of questions. Perhaps a distractible baby?