And just because someone has the opposite problem, doesn’t mean that oversupply isn’t a problem in its own right.
This was originally posted on the blog of Pittsburgh area doula and childbirth educator Vanessa Manz.
Photo credit: http://www.flickr.com/photos/54490598@N07/
Fighting the Battle Against Oversupply
With less than half of women breastfeeding at the six month mark we have to assume that many women believe they don’t make enough breast milk. But what about the others? The ones at the other end of the spectrum, making enough to feed a small village of babies? As one of these women, I can say that we are often told to be grateful for it because women who don’t make enough would be happy to have our problem. Well… I’m here to say that oversupply ain’t all it is cracked up to be. And just because someone has the opposite problem, doesn’t mean that oversupply isn’t a problem in its own right.
Oversupply isn’t just about having too much milk. If that was all there was to the problem, it probably wouldn’t be a problem. Oversupply is usually accompanied by a letdown that causes mom to spray milk at a high rate, which causes the baby to choke and swallow air. What eventually happens is that the baby fills up on the milk, which contains very little fat and air and this leads to gas and stomach pains. This causes the baby to appear colicky and have explosive gas and bowel movements. And also want to nurse constantly, perpetuating the cycle of oversupply and colic.
My oldest daughter had colic. It lasted way beyond the typical three months. In fact most of her first year is a blur due to her constant crying and nursing. My middle daughter didn’t have it, mostly because I was still nursing her older sister as a toddler and she helped mitigate any extra milk. When my milk came in, three days after the birth of my youngest, I recognized the signs of strong letdown immediately.
We tried block feeding (nursing on only one side per session) for several weeks. This along with positioning the baby above my breast really didn’t seem to help at all. I resorted to pulling her off when my milk let down and spraying into a cloth then relatching her. But women have multiple letdowns during each nursing session, so this was extremely inconvenient when not at home. I was desperate for answers… so I turned to Dr. Google and came across a very interesting study in the International Breastfeeding Journal.
The Protocol
You can read the study for free here. But basically the protocol consists of pumping your breasts dry. I used a hospital grade pump from A Mother’s Boutique, but I’m sure you could use a regular double electric pump. Followed by a nursing session where the baby nurses freely from each side. This lasted several hours! And was followed by a very deep, comfortable sleep by my baby. When she woke up, I began nursing from one side and stayed on that side for 3-4 hours. Then I switched for the next block and continued on for the next week.
Day One
The day after doing this our baby was noticeably less fussy. She also had a really nice poop that she did on her own without much fuss. She was less gassy and easier to nurse. I did experience a bit of engorgement about 30 hours after the initial pumping session. This led to a crazy letdown. But I did not repeat the pump out and just allowed the milk to spray into a towel and then relatched.
Day Two
I was noticeably less engorged, but still full. Again, I had to take her off for the first couple of letdowns during the first nursing session of each block. But other than that, I did notice that my breasts were softer at the end of the block and I was certain she was getting more fat. She was still much less gassy and fussy.
Days Three and Four
I almost never have to take her off for any letdowns. I am leaking way less during feedings and even though I have spontaneous letdowns in between nursing sessions, I don’t leak at all during them. Her gas is back to a normal amount for a baby. She is still not really pooping regularly, but I no longer feel worried that it is due to an imbalance of too much fore milk.
Day Five (today)
No engorgement and my breasts always feel soft. I never have to take her off for letdown and my leaking is almost nonexistent. She was a little more fussy and gassy last night and today, but I suspect the six week growth spurt is the culprit. We are planning to return the pump tomorrow or Thursday because I am sure I won’t need to repeat the draining.
I am so happy that I discovered this study. It does not seem to be well known because the Breastfeeding Center of Pittsburgh consultant that I spoke to had never heard of it. I hope that writing about it on my blog will help others find it.
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{ 24 comments… read them below or add one }
I would always recommended having your supply issues evaluated by an IBCLC before beginning on a protocol to reduce your supply. Many other issues can be misdiagnosed as over supply such as tongue tie and poor positioning, even under supply. If this is the case then reducing the supply will make things worse.
Hi Helen,
The great thing about this protocol is that it really doesn’t diminish a supply that is already at a normal level. According to the study, the initial “pump out” reduces the “milk lakes” that women with oversupply form when their milk initially comes in. Someone who didn’t have this problem would simply be removing milk, which would stimulate additional production. When I spoke with an IBCLC about trying this she consulted with a physician and they both agreed that it would not hurt my supply if oversupply was not the problem.
But it always helpful to have the baby’s latch checked by an expert anytime there is pain or fussiness! Thank you!
Oh my gosh, I wish I’d known this when I had my first son! Since I’m still nursing both my sons (22 months and 3 months), it isn’t as much of an issue for my second, except for the strong letdown. I just let him fall off and catch it in a washcloth until he’s ready to try again, and as he’s getting older (and bigger) he can handle it sometimes. While I do have multiple let downs during a feeding, the subsequent ones aren’t nearly so bad. The rest of my oversupply problem is actually a solution for some babies. I pump the excess and donate it. Since I don’t work, this is a viable option for me. I realize it isn’t for everyone, but I feel pretty good about my choice.
Pumping and donating is admirable! I detest pumping and have two much older children, plus the letdown was a huge problem for my infant, so it was not a viable option. I truly needed to reduce my supply in order to fix the letdown. Pumping regularly would have increased my supply.
Thank you for helping babies with your donations!
Steffie, I think that is wonderful that you donate the over supply! As a waiting adoptive mom, I am trying to produce even a small supply so that I may nurse when we get a baby. I know that I may not be able to produce enough and will need to supplement and want very much to use breast milk instead of formula.
http://www.mobimotherhood.org/MM/article-LMS.aspx
I like this article on how to increase supply. It also defines a “nursing relationship.” Even if you aren’t able to induce a supply, you can still comfort nurse your new one for the bonding experience.
Birth mother to adoptive mother, thanks for loving a child. Good luck!
I had awful oversupply that went undiagnosed until my little went on a severe nursing strike at 11weeks. This strike went on for many many months and even though I was able to get my supply under control and her back to nursing we battled a bad latch due to bad habits learned before the strike until she weaned at 3yrs. The strike was caused by the fear the severe letdown caused her, the constant discomfort that was created. Now that I am much more educated on the subject I realize that this is a very normal reaction for many babies. Oversupply has been sited even by Dr Jack Newman in his guide to breastfeeding as a major cause of nursing strikes. I wish more people would understand that Oversupply is not a blessing for a singleton. Thank you for sharing this info. For my next child I will be ready to get things in check early before it gets out of hand. Also I tried large doses of the dried herb Sage. This worked wonders! Also I have seen a study using low dose birth control used for only 2 weeks as a method to reduce severe oversupply.
Thank you so much for sharing! Oversupply is hard to diagnose and treat. I’m glad you were able to nurse her in the end. Good for you for sticking to it!
Wow…I had no idea that over supply could cause problems like that. I have an oversupply of milk as well, and a very forceful letdown. She detaches and latches on 10 times sometimes. It was painful at first, but now I’m used to it. She also gets lots of air bubbles and ends up crying sometimes while she eats because of pain from the gas. She also will gag when she first starts. The oversupply is a problem physically if you don’t pump or force the baby to eat more…or hand express. I had such an oversupply in the first three weeks that I got thrush (from the constant moisture from leaking, and yes I changed my breast pads frequently), and that led to a crack in the nipple, which got infected and turned into Mastitis. It was a horrible mess!! I had to stop nursing on one side for 3 days until the crack healed. Things are better now…but I still have lots of milk. Now I just pump it and freeze it for when I want a night out with the hubby. Although it is a problem in it’s own right, I would rather have that problem than not enough milk. I love breastfeeding and don’t want to stop for anything!
Cabbage leaves will help reduce milk supply. Some women in different cultures will put cabbage leaves in their bras when they want to wean their babies. It helps so mom does not get too engorged, which can lead to mastitis.
It is so great to read this – I had a big (sorry) problem with oversupply – and like you, scoured google for papers. I also had a great lactation consultant who diagnosed the problem – it was difficult as my baby also reacted badly when I consumed dairy – but I didn’t realise at the time. I did the pump-out and block feeding just as you described and it worked very well.
With my second babe I cut out dairy from the moment she was born and did block feeding from that time as well. Hindsight is a great thing. Thanks for your post – I don’t think oversupply is well recognised. I was told by a doctor at a hospital to begin my baby on lactose free formula *eyeroll* which would not have helped at all – lactose intolerance is very rare… OK. I’ll stop now. This issue is close to my heart.
I’ve written about it here.
Thanks for sharing! I had an undiagnosed overactive letdown with my first child (5 bouts of mastitis in the first 4 months and countless food elimination diets thinking I was dealing with a food intolerance…and now with my second (at 2 months old) I am more educated on this issue and can handle the situation with grace (well most of the time
My question is related to the protocol you mentioned above. Do you just pump dry that one time or every morning?
My first child weaned and so, I pump every morning after my son nurses so I can store and give some to my older child in a cup. If I do this protocol should I not pump every morning?
Thanks!
The idea is to not pump more than you have to. If you read the cases presented in the article, you can see that some women just pumped that one time and others had toe repeat the pump out one or more times. I had to repeat pump last week after my baby had a growth spurt. She increased my supply again, but then didn’t nurse as much afterward so I had engorgement and a crazy letdown.
after you pump dry/out, do you get a milk supply immediately? i’m not sure if I have an over supply but my let down sounds like yours… it sprays my baby’s face, he chokes, cries, gets mad… when my partner saw it, he even said “no wonder why he get frustrated…” and we are dealing with gas/fussiness, green frothy poops… i do know my son has a lip tie and maybe a tongue tie too… so he doesn’t have the best latch…
Hi Fatima,
Do you have access to an IBCLC? They would provide excellent support for diagnosing a tongue/lip tie and help with resources for resolving it. A poor latch can cause a baby to have difficulty managing the flow of milk and swallow too much air.
My milk never returned in as large amount as it was before I pumped out, but I did feel full within 48 hours. My letdown never really got slower, I believe that mechanism is separate from the supply. But after reducing my supply by pumping it all out once, I noticed that she was less gassy and her poops were more normal. She was less fussy and slept better from that point on. One thing that helped was keeping a pre fold around and delatching when I felt the first, strong letdown and spraying the milk into a cloth and relatching after a few seconds.
Some babies struggle to pass gas and poop for a few weeks or the first couple months. It requires coordination of muscles and like anything, it comes easier to some babies than others.
I wish you all the best!
we got the lip tie taken care of… and my midwife suggested block feeding… she didnt tell me to pump out… ever since i did block feeding, we have been getting normal yellow poops… but now, he is having a hard time pooping sometimes… i wonder if it’s something i am eating… i just consulted with an IBCLC and she said the latch is fine and baby is gaining good… but i have a breast abscess (had a plugged duct but didnt get mastitis) the clogged duct was present for 2wks and finally I went to an obgyn to have it checked, worried it was a breast mass… so IBCLC is suggsting only feeding him where the abscess is to drain breast everytime and pump left breast… but i dont want to pump because i want my supply regulated… so i’m at a lost right now…
Block feeding is a very effective way to manage over supply or fast flowing milk. I block fed my baby until about four or five months old, when my supply naturally leveled out.
I hope you heal quickly from the abscess. It sounds like you are getting good advice from your CPs. Know that your body will better adjust to demand and your supply will normalize as your baby grows.
Hi there!
I am battling this with my baby too. I am wondering how your baby’s weight gain progressed after you reduced your supply? My boy was gaining 14-16 oz per week dor the first 6 weeks and crying at the breast. I am block feeding in blocks of 2-3 hours. In addition to oversupply we believe he has reflux, which I know can be confused with oversupply Nd vice versa. At about six weeks his weight gain dropped to 3-5 oz per week and the lactation consultant said my supply was coming down but that I needed to reduce it more. However, I think I only have an oversupply on one side and am wondering how to reduce it there, but not on the other side? At the same time she also warned against him losing weight if he continues to vomit or starts refusing to nurse. I am so confused about what to do. She suggested block feeding, in that I nurse on one side, then 45 min later nurse on that same side again. Then the next time switch to the other side. Do her suggestions seem consistent with the issues she brought up, and the fact that I only have over supply on one side (engorgement, crazy letdowns, always full)? Thank you for your comments and impressions.
K and I struggled with oversupply for months! K spent the first 6 months very unhappy and once we figured it out, she was an entirely different baby. Block feeding helped us out tremendously, but I had to switch sides every 12 hours for it to work! Thank you for sharing this article as I have met many moms who also have suffered with oversupply and there isn’t enough literature and support out there for it!
Kristina-
My daughter’s weight was in the 25-50th %ile (WHO chart) steadily until she started becoming mobile at 9 months. She gained about 1 lb a month until six months, when she was over 14 pounds. I do remember the pediatrician telling me that it is common for newborns to gain quickly (like a pound every week or two), but that weight gain tapers off around 4-6 weeks.
In my research, I have not specifically heard of oversupply on only one side, but that doesn’t mean it isn’t true for you. Some women do notice that one breast seems to make more milk than the other. Block feeding is effective to maximizing the amount of fatty milk the baby gets by nursing for a set amount of time on a side before switching. You would have to gauge whether the fullness you feel on the oversupply side is better or worse over time to know if it helps in your situation.
When a baby is born, mom’s hormones control the milk-making and that is why milk is abundant at first. Over time, the body stops producing so many hormones and the production switches gradually to demand-based supply. By the time most babies are four months old, many mothers find their oversupply issue is solved.
Hello Vanessa.. Thank you so much for your posting. I started yesterday with draining out my breasts and block feeding. But today I have horrible engorgement and the breast that I don’t use for the blocking kills me in pain. WhAt do you suggest doing?
This article was very helpful for me when I was battling this issue. https://www.llli.org/faq/oversupply.html
My oversupply has come back twice and I’ve had to repeat the block feeding process, but the second and third times the supply decreased much more quickly (24 hrs. vs. 4 days the first time). I had horrible engorgement the first time on the side I wasn’t feeding on, but try not to pump or express too much because you want your breast to get the message that its full and that milk is not needed. Remember, a full breast sends the message to stop producing whereas an empty breast sends the message to make more. I am continually trying to regulate this problem, but I’m not going to give up! My son is 7 weeks old.
Oh, wait, I’m not supposed to have enough milk for a dozen babies?! I battled oversupply with my son but just roughed it out until my supply leveled out. My daughter (5 weeks old) is more vocal about her dislike of firehose-style feedings and constant gas. So I started to protocol today.
My question is for when supply levels out. Do I continue block feeding? Or should I try just one breast per feed and switch the next time? If this works as well as the study shows, I really want to maintain it!
Ashley, I would block feed for as long as you feel the need to. I did it for way over a year maybe close to 2 years. Also the length of each block is totally dependent upon if your getting the desired results. Start with 2 or 4 hr blocks where you only nurse on one side and see if your breast feels drained and soft after each feeding or does it still feel hard and full. I kept increasing my block length until I could truly drain my breast and get the rich fatty hind milk. This also triggers the other breast to slow down production reducing your supply. I had to increase my blocks to 12 hours in order to get the desired results. This is not an exact science and you have to listen to your baby. In times of growth spurts I would find my breast emptying quicker than 12 hrs and I would switch to the other side to keep my babe happy and fed. Then after things leveled out again the block length would increase.
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