Coping with oversupply

By Cordelia Uys, NCT Breastfeeding Counsellor

Chloe Merali (in the photo above) had considerable oversupply with her 2nd child: ‘I found that the best things for helping with oversupply were to feed responsively, so my baby could manage what she was able to take in herself, and to use gravity to our advantage, which for us meant feeding in a sling or in an upright position.’

When your baby is born, it takes about a month to achieve a balance between their needs and how much milk your breasts produce. It’s vital you are breastfeeding at least 10 to 14 times in 24 hours to establish a good supply, and to avoid blocked ducts and mastitis. Even after 4 weeks, some mothers still produce much more milk than their baby needs. It’s often assumed that a very generous milk supply is a good thing, but oversupply can be miserable for both mother and baby.

Here are some of the issues that can be caused by oversupply:

Lots of wind and ‘colic’
Fussy behaviour
Short feeds
Baby struggling with fast flow
Spluttering and choking
Bringing up lots of milk
Babies who aren’t able to feed for comfort or to fall asleep
Baby clicking and losing their grip
Baby not taking a deep mouthful of breast
Breast refusal
Frothy green poos
Blocked ducts and mastitis

Pain for babies

It’s normal for babies to suffer from tummy discomfort in their early days as their digestive system matures, and for them to take a while to learn to coordinate their sucking, swallowing and breathing, but when mothers have oversupply, babies often do so much gulping, choking and spluttering that they experience significant abdominal pain. Since this pain is often coupled with a lot of vomiting due to the large volumes the baby is drinking, (which they can’t fit in their tummy), they are frequently misdiagnosed with reflux disease, and given strong medications unnecessarily.

Fussiness at the breast

Some babies find the force with which the milk shoots out of the breast so overwhelming that they will pull away, resulting in a shallow latch, or they may clamp down on the nipple to slow the flow, both of which can cause maternal pain. They can lose their grip, coming off repeatedly, or do lots of clicking on the breast. They might come off before they’re full, resulting in the ironic situation of a mother with oversupply having a baby with slow weight gain. In extreme cases, babies might start to refuse the breast because the experience is so unpleasant for them.

Not being able to feed for comfort

Breastfeeding will usually calm babies, but when a mother has oversupply, she can’t offer the breast for comfort or to help her baby fall asleep, as staying on the breast for more than a few minutes results in lots of discomfort for the baby.

Foremilk, hindmilk and lactose overload

There is a lot of misunderstanding about foremilk and hindmilk. A mother’s breasts make just one kind of milk, however, at the beginning of a feed, a lot of the fat in the milk clings to the milk producing cells, so the initial milk babies receive (the foremilk) is lower in fat, and higher in water content. As more milk is removed from the breast, more fat is released and therefore the milk increases in fat content (the hindmilk). The fuller breasts are when a baby feeds, the less fat there will be in the milk. The ‘emptier’ the breast, the fattier the milk.

Lactose, the sugar in breastmilk, needs to be broken down by the enzyme lactase in order for the baby to be able to digest it. Fat slows down the passage of milk through the gut. If the amount of fat in the milk is low, milk can pass through the baby’s gut so fast that it doesn’t get properly digested.

Normally mothers don’t need to worry about how much fat is in their milk, or how long their baby spends on the breast: there is some fat in breastmilk even at the beginning of a feed, and as the feed progresses, the baby will get more fat. Babies know if they need a drink, a snack or a three-course meal. But if a mother has oversupply, her baby may fill up on milk that is relatively low in fat, and not have room for the fattier milk. Having lots of lactose in their stomach makes babies very uncomfortable, and results in them having frothy, explosive green poos.

Engorgement, blocked ducts and mastitis

When mothers have oversupply, their breasts may be permanently uncomfortably engorged, as the baby isn’t able to remove enough milk to soften breasts a bit between feeds. These mothers are at high risk of blocked ducts and mastitis.

Diagnosing oversupply

If you suspect you have oversupply, please seek support from a lactation consultant or breastfeeding counsellor. Sometimes oversupply is obvious, but not always. For example, green poos can also by a sign of low supply.

How to cope with oversupply

Oversupply usually settles down significantly within 6 to 8 weeks. In the meantime, some of these suggestions might be helpful:

Apply cold compresses to your breasts between feeds. You can make a cold compress by pouring cold water in a clean nappy and putting it in the freezer for an hour.
Apply a warm compress just before feeds. Pour warm water into a clean nappy and apply to the breast for no more than 2 minutes before feeding.
If your breast is so engorged your baby can’t latch, after applying the warm compress, do 3 minutes of reverse pressure softening. (See kellymom.com link below).
Hand express off a bit milk before latching your baby, to relieve some of the fullness in the breast.
Alternatively, latch your baby for a few seconds and then take them off and catch the initial spray in a muslin.
Work on getting as deep a latch as possible.
If using a position in which the baby is horizontal, work on the exaggerated latch technique (see link below) to get a deep latch.
Avoid doing any pumping (including with a Haakaa or similar pump) as this will encourage even more milk production.
Paracetamol and ibuprofen can help with pain and inflammation (if normally tolerated).

Use a position that helps the baby cope with the fast flow and allows gravity to work against the direction of flow.

Use the side-lying position - this is the best position for oversupply.
Once you’ve latched your baby in your usual position, lean back, so the baby is almost lying on top of you.
Alternatively, use the laid-back nursing position (also known as biological nurturing or baby-led) in which you recline comfortably, and then place your baby on top of you vertically (rather than across your body) with their mouth level with your nipple.
See: https://www.cordeliauys.co.uk/in-praise-of-the-babyled-breastfeeding-position
Use an upright (koala) position, with the baby sitting astride one of your legs.
All these positions help the baby feel more in control and less overwhelmed by the copious jets of milk.

Difference between forceful let-down and oversupply

Some women have a forceful let-down but don’t have oversupply. If that’s your case, it’s important you don’t do anything that might reduce your milk supply. Usually, if there’s oversupply, babies will be gaining 450g-plus a week.

For many mothers with oversupply, and especially for those who ‘just’ have a forceful let-down, leaning back while feeding, or using the laid-back position, quickly relieves the baby’s abdominal discomfort, and many babies will no longer bring up as much milk after feeds.

If oversupply has been caused by pumping

Reduce the length and frequency of pumping sessions very gradually.

If oversupply continues to make breastfeeding challenging for longer than 8 weeks:

You might want to work on reducing your milk supply. However, this should only be done if:

Your baby is gaining more than 1.8kg a month.
You are getting support from a lactation consultant or breastfeeding counsellor.

Extreme caution must be exercised as it is very easy to reduce supply too much, and also to give yourself blocked ducts and mastitis.

None of these measures should be undertaken without specialist lactation support.

Block feeding

Whenever breasts get hard and full, a negative feedback mechanism (the Feedback Inhibitor of Lactation) kicks in, telling them to stop making milk. This means milk production slows down when breasts are full. Therefore limiting your baby to one breast for a set amount of time will slow milk production.

If you have been offering both breasts per feed, change to only offering one breast.
If your baby already only takes one breast per feed, offer just one breast over a period of 3 hours. This means if your baby asks to be fed again less than 3 hours after their last feed, put them back on the same breast.
Don’t restrict feeds!
If your other breast feels uncomfortably full, hand express just enough to relieve any discomfort, but no more.
If 3-hour gaps aren’t doing the trick, you could (cautiously) increase the block of time during which you continue to offer the same breast.
Apply cold compresses between feeds.
Don’t block feed for more than a week.

More extreme measures

If the above measures don’t work, you could try an extreme form of block feeding, whereby you firstly drain both breasts as much as possible with a hospital grade pump, and then block feed.

Herbs and medications that can drastically reduce supply

Cold cabbage leaves, applied to the breast for long periods, might suppress milk production.
Take a quarter teaspoon of dried sage (Salvia Officinalis) 3 x a day for 1-3 day.
Take a single 60-mg dose of Sudafed (pseudoephedrine).
Consider taking a contraceptive pill that contain oestrogen.

Useful links:

The episode on oversupply from Emma Pickett’s podcast Makes Milk:

https://podcasts.apple.com/gb/podcast/makes-milk-with-emma-pickett/id1697865705?i=1000638253569

Other articles on oversupply:

https://www.emmapickettbreastfeedingsupport.com/twitter-and-blog/youve-got-so-much-milk-youre-so-lucky-no-im-bloody-not-oversupply-colic-and-reflux

https://breastfeeding.support/oversupply-breast-milk/

https://physicianguidetobreastfeeding.org/maternal-concerns/mastitis-and-associated-complications/

Coping with fast flow: http://www.nancymohrbacher.com/articles/2014/8/25/coping-with-fast-milk-flow.html

Green poo: http://www.nancymohrbacher.com/articles/2014/5/21/green-poop-when-should-you-worry.html

Reverse pressure softening: https://kellymom.com/bf/concerns/mother/rev_pressure_soft_cotterman/

Exaggerated latch technique: https://www.youtube.com/watch?v=41fC0fQs1P8&feature=youtu.be

Laid-back breastfeeding position: https://www.youtube.com/watch?v=DiT6wPC6iIc