Oversupply: more milk than you can handle!

Although every breastfeeding mom dreads not having enough milk, having too much can be just as much of a headache. In fact, having oversupply is very much like being underweight – everyone who has the opposite problem envies you, but they don’t realize what a nightmare it really is! Oversupply comes with more than its fair share of problems: recurring blocked ducts and mastitis, leaking everywhere, a cranky baby and, believe it or not, even poor weight gain. Let’s take a closer look at this issue, and what you can do to address it.

Causes of oversupply

In most cases, oversupply seems to be genetic – some women are just more prone to it than others. Almost everyone has too much milk in the first week or few weeks of breastfeeding – that’s why postpartum engorgement is such a common problem (I suspect your body’s just making sure you still have enough milk in case you had twins!) In most cases, your body figures out how much milk is needed based on how much baby drinks; by about 6 weeks after the birth things usually settle down. But in some women, the breasts just don’t seem to get the message, and they keep over-producing. It is estimated that up to a third of breastfeeding women actually struggle with oversupply.

You can also create an oversupply if you are a bit too enthusiastic in the early weeks. For instance, if you start pumping regularly before your milk supply has settled, you will be overstimulating your breasts, and oversupply will be the result. That is why it is not recommended to start pumping before 6 weeks (unless, of course, if your baby is not breastfeeding well – in that case you will have to pump just to bring in a normal supply, but that’s a story for another post)

What oversupply is like

As I’ve mentioned, oversupply can be a pretty miserable situation for both mom and baby. These are just some of the problems you’ll face:

Effects for mom

When you have oversupply, it feels like you’re stuck in that postpartum period of sore breasts for months on end. Because your breasts make a lot more milk than what your baby needs, you often find yourself battling with uncomfortably full breasts, which morph into engorgement or blocked ducts at a moment’s notice. You’re also likely to find yourself battling frequent bouts of mastitis. As someone who’s been there, let me tell you, it’s no fun at all!

If you have oversupply, you also tend to leak a lot. Granted, it’s more an annoyance than a major problem, but it’s really irritating. And you can say goodbye to any hope of sleeping through the night – even if your baby stays down for eight hours, you will need to get up and pump if you don’t want to wake up with a blocked duct.

Effects for baby

Babies really struggle when mom has an oversupply. They struggle with a few things: the action of breastfeeding itself, the nutritional value of the milk and digestive upsets.

Struggling to breastfeed

Because the breast is very full, the milk usually flows very quickly. Often the baby struggles to handle this fast flow of milk – it’s like trying to drink from a fire hose on full blast. Just to catch his breath, baby will pull away from the breast, choking and crying, causing his poor mom to think that he hates breastfeeding. You will also see milk spraying everywhere. This can quickly turn every feed into a fight, and cause both you and baby to dread breastfeeding.

Insufficient nutrition

As I explained in this post about foremilk and hindmilk, the fat content of breast milk gradually increases throughout the duration of the feed – the first milk out of the breast is very watery, and the last milk is very fatty. In cases where there is an oversupply of milk, there’s so much milk in the breast that baby’s tummy is full before he gets to the higher fat milk. The fat in the hindmilk is very important for weight gain. And that is perhaps the most ironic thing of all: having too much milk can actually cause poor weight gain in baby, since he doesn’t get enough fat.

Digestive problems

Oversupply causes digestive issues in two ways. Firstly, because the milk is flowing too fast, baby needs to gulp to keep up with the flow of milk. This gulping causes baby to swallow a lot of air, which causes winds, cramps, colic and reflux. Baby may also spit up a lot of milk or even vomit regularly.

Oversupply can also cause some very nasty diapers – green, slimy or foamy and very stinky. This happens because, as I’ve explained above, baby gets only foremilk. The foremilk contains a lot of lactose, but very little fat. Fat helps slow down the movement of milk through the intestines, which gives the digestive enzymes time to break down the lactose. If there is not enough fat, the milk moves through the gut too quickly, and a lot of lactose gets to the colon without being broken down. This lactose is then fermented by the bacteria that live in the gut, causing all those nasty diapers, flatulence and cramps. Unfortunately, these babies are usually “diagnosed” with lactose intolerance by their doctors, and moms are advised to stop breastfeeding and put baby on a lactose-free formula. But such drastic action is rarely necessary: good breastfeeding management can make all the difference.

Managing oversupply

Making it easier for baby to drink

It can be very difficult for baby to drink if the milk is spraying out too fast. Here’s a few ways to make it easier:

• Feed in a laid-back position (the easiest way is to simply latch baby and then lean back until baby is lying face-down on top of you). This helps to ensure that all that excess milk doesn’t flood baby’s throat. A warning though: it will probably end up running down your breast, so keep a towel handy! Feeding in a side-lying position may also help.
• Express a bit of milk before feeding baby, so that the breast is not so full.
• When you feel a let-down (a tingling or squeezing in the breast), or when baby starts gulping, unlatch him and wait for the let-down to pass before continuing the feed. Have a towel (or even a cup) handy to catch the spraying milk.

Block feeding

“Block feeding” means that you only use one breast to feed baby for a certain block of time, while you allow the other breast to fill up. This will do two things:

• Firstly, because baby is emptying the one breast completely, he is getting all that lovely high-fat milk. This will help to ensure good weight gain, and also relieve some of the digestive issues.
• Secondly, the other breast is staying full, so it’s getting the message to slow down milk production. Of course, you shouldn’t let that breast get full to the point of developing blocked ducts or engorgement – if necessary, hand express a bit so that the breast is at least comfortable, but no more than that.

The question here is always: how long do I stay on the one breast before switching? The answer is: long enough that the breast is nice and soft at the end of the feed. It may be one feed, two feeds or several feeds.

An alternative method is to start with empty breasts: After a feed, pump both breasts completely “dry”. For the next two to three hours, feed only on one breast. Then switch to the other breast for the next two to three hours. This helps to prevent your breasts getting uncomfortably full.

Block feeding usually makes a difference within 24 hours, although sometimes it is necessary to repeat it for another day.

Switch nursing

Just to confuse matters, some lactation consultants recommend that you do the exact opposite to block feeding: switch baby to the other breast halfway through the feed. That way neither breast is fully drained, so they get the message to slow down milk production. The nice thing about this message is that you do not struggle with one full, uncomfortable breast as you would if you were block feeding. But there is a downside: baby will still only be getting low-fat foremilk until your supply has adjusted, so any digestive issues will remain and may even get worse. Because of this, I would rather try block feeding as a first approach, and only use switch nursing if block feeding doesn’t help.

Rule out medical issues

If you are struggling with oversupply that just isn’t responding to treatment, it may be a good idea to have your thyroid levels checked. Thyroid imbalances are not uncommon after pregnancy, and strangely enough, both and underactive and an overactive thyroid can cause oversupply issues (although and underactive thyroid more commonly causes low supply).

Herbs and medications to decrease milk supply

Some herbs can be used to decrease milk production. Sage tea or peppermint tea may be useful for slowing down milk production – drink one to three cups a day for a few days. Just don’t overdo it; you don’t want to reduce you milk supply too much.

Placing cold cabbage leaves directly on the breasts for several hours at a time can also decrease milk production. In fact, it’s a traditional remedy to dry up breast milk when a baby weans. Just don’t use it if you’re allergic to sulphites.

There are also a few medications that can decrease milk production. It’s very important that you should only use these under the guidance of both your doctor and a lactation consultant, so that they can monitor that you continue to produce enough milk for your baby. Some options include:

• A four- to seven-day course of estrogen-containing oral contraceptives.
• Pseudoephedrine, a decongestant found in cold medicines (be careful – pseudoephedrine can cause a permanent drop in supply, especially late in lactation)
• High-dose pyridoxine (vitamin B₆)
• Note: the dopamine antagonists that doctors usually prescribe when you choose not to breastfeed (e.g. Dostinex) don’t really work later in lactation. This is what your doctor will probably prescribe, so make sure your lactation consultant is part of the discussion.

As always in breastfeeding, using medications is a last resort, that you should only attempt if the situation is truly unbearable. Please seek out the help of a qualified lactation consultant before you resort to medical treatment.

In summary

Oversupply is an unwelcome, uncomfortable situation, which can cause

• Recurring engorgement, blocked ducts and mastitis
• An unpleasant breastfeeding experience for mom and baby
• All kinds of digestive issues, from winds, cramps and reflux to foul green stools and misdiagnosed lactose intolerance
• In extreme cases, poor weight gain

Oversupply can be managed by helping the breasts to regulate their supply to match baby’s requirements:

• Avoid unnecessary pumping, especially before 6 weeks.
• Help baby manage with milk that is flowing too fast by:
  • Changing position to a laid-back position or side-lying position, or simply leaning back once baby is latched.
  • Removing baby from the breast during the initial let-down, until the flow of milk slows down.
  • Pumping or hand expressing just a little bit (less than a minute) to remove that firs strong flow of milk.
• Block feeding: Use only one breast per feed. If that isn’t enough to regulate milk production over a few days, use one breast for two or more feeds, until the breast is soft at the end of the feed, then switch to the other breast for the next two (or more) feeds.
• Alternative method of block feeding: pump the breasts completely dry after a feed. Then feed on only one breast at a time for every 3-hour block, letting the other one fill up in that time. Do this for 24 hours.
• If block feeding doesn’t work, try switch nursing: switch breasts halfway through the feed, so that bay takes only a bit of milk from each breast. Be prepared for green stools and gassiness.
• If all else fails, drinking peppermint tea or sage tea can help to reduce milk production, as can placing cold cabbage leaves on the breast. There are also some options for medications that can reduce milk production, but these should be discussed with your doctor or lactation consultant.