How to handle oversupply and overactive letdown

Every time Maria Sarris of Kingston, Ont., went to feed her infant daughter, the milk would flow so quickly, and there would be so much of it, that Gabriela would choke, sputter, pull off the breast and wail. “Nursing in front of other moms was really hard. People would say, ‘Is she OK? Is she really fussy today?’ And I was like, ‘Every feed is a fussy feed.’”

Sarris’s challenge is known as oversupply, which happens when you produce significantly more milk than your baby needs, explains Cassie Kent, a Halifax lactation consultant. It often crops up when the baby is between two weeks and three months old. True oversupply isn’t common­—often it’s more of an issue with the latch or how frequently a woman is breastfeeding her baby. But it does happen.

Figuring out what’s causing the spluttering and fussing takes a bit of detective work. A lactation consultant can help. An overactive letdown—that gushing effect that occurs when the milk comes down very forcefully—can be a sign of too much milk. But it can also be a sign that you waited a bit too long between feeds, or that your baby’s latch isn’t great, potentially caused by a tongue-tie. “The more milk stored in the breast, the more pressure there is, making the letdown seem like a firehose,” says Kent. With true oversupply, your baby might gain more than twice the normal amount or might be gaining poorly and have blood in her stool. Another clue is frothy, explosive green poops or gas, which, in this case, would be caused by your baby filling up on mostly foremilk, which is lactose-rich and harder to digest, explains Kent. It’s important to note that you can also have a normal letdown when you have oversupply.

Oversupply and forceful letdown aren’t just problems for the baby: They can cause nipple pain, because the baby has developed what’s known as a defensive shallow latch to help cope with the flow, says Kent. In Sarris’s case, Gabriela was biting down on the nipple to stop the milk. “It was so painful because she was pinching my nipple with her tongue,” recalls Sarris. Oversupply can also cause recurring blocked ducts—which may lead to an infection known as mastitis—because the baby is not fully emptying the breasts.

If a lactation consultant confirms you have too much milk, the first step would be to manage the symptoms, like any latch problems that have developed, says Dallas Parsons, a lactation consultant in South Surrey, BC. You can try laid-back nursing, where you sit leaning back on a pillow, with babe’s tummy to your tummy. This position helps give your baby more control over her latch and also lets her manage the flow of milk, which slows down because gravity is working against it, explains Kent.

You can also hand-express a bit of milk at the beginning of a feeding so that first letdown isn’t as powerful, suggests Kent.

If these techniques aren’t quite enough, your lactation consultant might suggest block feeding to actually decrease the amount of milk you make. For example, you would offer your baby the same breast for any feeding done within a three-hour period and then switch to the other breast. But this technique should only be tried under the supervision of a lactation consultant, and once your supply is well-established. There is the risk of blocked ducts and mastitis (causing inflammation of the breast tissue), and if not monitored properly, block feeding can be detrimental to milk supply.

In some cases, time will make all the difference. As your baby grows older and her mouth gets bigger, she may learn how to adjust her latch to better manage the flow, or your supply might regulate on its own. For Sarris, relief came once Gabriela hit three months—and finally stopped clamping down on her mother’s nipples. “My supply seemed to balance out,” she says, “She was able to eat peacefully.”

Milk donation

Some moms who have too much milk (as confirmed by a lactation consultant) choose to express their surplus milk to donate to a milk bank. Research shows that breast milk can protect a specific group of infants—preterm or very low-birth-weight babies—against life-threatening illnesses. Donor milk banking has been endorsed by the Canadian Paediatric Society, the American Academy of Pediatrics and the World Health Organization.