Oversupply of Breast Milk

Sometimes a mother may seem to have far more breast milk than her baby needs. Some babies will be very happy with such plentiful milk—gaining weight well and spitting up any excess milk if they take too much. However some babies may begin to fuss, cough or choke at the breast if there is too much milk. They may keep coming on and off the breast while milk spurts everywhere. The mother with too much milk may constantly have full and engorged breasts and find she keeps getting blocked ducts or mastitis. This article looks at possible symptoms and causes of too much breast milk—also known as oversupply or hyperlactation—and how to manage it if it is a problem.

Is there too much milk?

Sometimes it is not clear whether there is “too much milk” or not. Some of the symptoms encountered with oversupply have similarities with other issues such as normal engorgement in the early weeks, mastitis, reflux, cows’ milk protein allergy, lactose overload, colic, or a baby who has a poor latch (the way a baby is attached to the breast) or an uncoordinated suck. A breastfeeding specialist such as an IBCLC lactation consultant can help you work out whether you really do have too much milk or whether breastfeeding management or your baby’s latch could be improved.

In most cases the more milk the better

It’s important not to assume that plenty of milk is always a problem needing action. Jack Newman, Canadian paediatrician and breastfeeding expert, cautions against labelling a mother with oversupply; he says that generally the more breast milk the mother has the better.¹ He explains that if an ample milk supply is seen as a problem and a mother is advised to reduce her milk volume (see below), it is possible that her supply could reduce so much that she now has the opposite problem of “not enough milk”. In most cases following the principles in One Breast or Two per Feed? allows milk production to balance with a baby’s needs.

What are the symptoms of too much milk?

If a mother has more milk than her baby needs she might have:

• Breasts that are still full or engorged after a feed
• Breasts that often feel lumpy or tender or sore nipples
• Breasts that leak milk between feeds (and before baby is born)
• Frequent blocked ducts or mastitis
• A very painful let-down at the start of a feed
• A very forceful milk ejection reflex (fast let-down)

A baby who is getting an overabundance of milk might:

• Gain weight at a higher than average or excessive rate, or conversely…
• Not gain weight very well, may seem unsatisfied and feed frequently due to having a very large volume of lower fat milk*
• Gulp rapidly, choke or cough frequently during a breastfeed due to the forceful let-down
• Clamp down and pinch the nipple because he learns this slows the fast flow—causing sore nipples
• Bob on and off the breast and seem to have difficulty staying attached or seem to have a loose latch
• Spit up a lot (reflux)
• Have excessive wind or “gas” and burp frequently
• Have green, watery or explosive poops (symptoms of lactose overload) and lots of wet and dirty nappies
• Seem irritable, fussy and restless, may hold himself stiffly or scream
• Be difficult to settle and not enjoy breastfeeding for comfort/to fall asleep.

Could there be other causes of these symptoms?

Some of the symptoms in the list above may be normal for a particular baby or have other causes. For example it is normal for babies to swallow rapidly with an initial let-down and occasionally to cough or splutter with the let-down. Sore nipples may be due to a shallow latch—latching on the nipple instead of with a deep mouthful of breast tissue. Difficulty staying attached could be due to a mother’s flat or inverted nipples or due to a tongue-tie or other anatomical variation. Excessive reflux can be associated with allergies while green poops or being fussy at the breast can have several causes. Check with a breastfeeding specialist if you’re not sure what is causing yours or your baby’s symptoms before assuming oversupply.

*A note on fat content in milk

In most cases you won’t need to worry about the fat content in breast milk as it balances out during a breastfeed. However for a mother with a larger storage capacity and an excess of breast milk it is possible that her baby could get a high proportion of lower fat milk (foremilk) and less higher fat milk (hindmilk or “cream”). Foremilk will be full of lactose (the main sugar in breast milk) so baby will often gain weight well but if there is too much lactose this may cause colic type symptoms and green poops. A larger volume of low fat milk might also leave baby feeling unsatisfied and wanting to keep feeding—which can add to his discomfort. For more information about foremilk and hindmilk see Forget About Foremilk and Hindmilk.

What causes too much milk?

It is common to have a temporary oversupply in the early weeks after a baby is born. This plentiful milk helps to get breastfeeding off to a good start. The volume of milk normally settles down over time so that the breasts only make the amount needed by the baby. Possible reasons for a mother to still seem to have “too much milk” after the early weeks include:

• Following rigid rules about breastfeeding such as how often to feed, how long to feed for and how many breasts to use per feed instead of following a baby’s cues so they can self-regulate the milk supply.
• Plenty of milk making tissue. The more glandular (milk making) tissue in the breast the more breast milk a breast will be able to make and store and, depending on how breastfeeding is managed, this may take a bit longer to settle down.
• Overstimulation. Sometimes milk production can be overstimulated by too much pumping or by taking lactogenic herbs.
• Herbs and medications. Some herbal remedies or prescription medications can affect milk supply, see “Herbs and drugs” below and What is a Galactagogue?
• Medical reasons. Occasionally an underlying health issue may contribute to oversupply or hyperlactation. For example endocrine/hormonal issues including thyroid disorders, a prolactinoma (a benign tumour of the pituitary gland) or any condition affecting the part of the brain that regulates the pituitary gland (hypothalamic-pituitary disorders). Your doctor will help diagnose these situations.
• Poor latch or difficulty feeding. How a baby is latched (attached to the breast) and how competent they are at coordinating sucking, swallowing and breathing affects how easily they can get the milk they need. A poor latch is sometimes thought to add to excess milk production if a baby feeds very frequently to try to get the volume they need. In many cases however, a poor latch or difficulty breastfeeding will tend to reduce a milk supply over time.

Tips for managing oversupply

Check with a breastfeeding specialist

By 43 to 44 gestational weeks of age a baby will normally have overcome birth related difficulties and milk production will usually have adjusted to baby’s needs.²  If a baby is still constantly struggling to manage a fast let-down or fast flow of milk after this time period, a thorough evaluation with a lactation consultant or other breastfeeding specialist is recommended before assuming oversupply or taking measures to reduce a mother’s milk supply. The lactation consultant will consider the issues affecting milk supply in the previous section and will review:

• baby’s ability to feed
• baby’s attachment and positioning at the breast
• baby’s growth chart
• general breastfeeding/pumping management
• medical history of mother and baby.

Try baby-led feeding

When a baby feeds on demand, sometimes they will want one breast and sometimes two, three or four breasts. By following baby’s lead at each feed, milk production can adapt to a baby’s needs. Conversely, following set rules to always use one breast or always use both breasts or always feed for a certain number of minutes could be a cause of oversupply.³ Try following your baby’s cues instead of rules and see One Breast or Two per Feed?

Breast massage

Receiving a large volume of lower fat milk can contribute to a baby not feeling satisfied or getting uncomfortable due to a temporary lactose overload. Christina Smillie, an American lactation consultant and physician suggests helping to blend the milk within the breast can be a helpful technique for oversupply and she calls this the “breast milkshake”. She explains that using a short breast massage before the breastfeed, or gentle breast compressions during breastfeeding, can help to release more fat-rich milk (hindmilk or cream) and increase the calorie content of breast milk.⁴⁵ Releasing more hindmilk will help satisfy a baby’s hunger so they go a little longer between feeds which will in turn help to adjust milk production. Gentle breast massage during the feed will also help to prevent blocked ducts or areas of engorgement which can be an issue with oversupply.

Avoid over pumping

Excessive use of a breast pump in addition to breastfeeding can be a cause of oversupply.

Adjust the volume of milk (slowly)

The traditional recommendation to solve too much milk is to make adjustments to breastfeeding management such as keeping to one breast per feed or block feeding. The rationale is that when one breast is not emptied and becomes full it slows production in that breast. When reducing a milk supply, keep an eye on baby’s weight gain and frequency of dirty nappies and bear in mind that if milk supply drops too low a baby may start fussing with slow flow.

One breast per feed

If a mother has a lot of milk and a good storage capacity her baby may only need one breast per feed and this regime may settle the supply. Should the undrained breast feel uncomfortably full before the next feed, expressing just enough milk to stay comfortable will prevent engorgement. Over time a baby’s needs can change so it may be that after a few days or a week or two you can start offering both breasts per feed again.

Block feeding

Block feeding involves keeping to one breast for blocks of time e.g. one, two, or three hours. If baby wants to feed again in the block of time allocated, they are offered the same breast. If the other breast becomes uncomfortably full before the time period is over, mothers can express just enough milk until they are comfortable again. By gradually adjusting the time kept to one breast a mother can find the time interval that works for her to reduce her supply a little, but keep her baby well fed. While block feeding may be useful to settle down a true oversupply of breast milk, it may only be needed for a few days. By following baby’s lead and offering both breasts again as needed, your baby can regulate his own milk supply.

Caution: A rigid approach to block feeding may make symptoms of oversupply worse by increasing milk production in the breast that is being used and causing more separation between the milk and the cream (hindmilk) in the breast that isn’t being used. A mother may also notice an increase in blocked ducts if she is feeding from each breast less often (Smillie, 2005).

Lactation consultant Nancy Mohrbacher explains when to use block feeding:

The most reliable gauge of whether block feeding may be helpful is baby’s weight gain. If breastfeeding is going well, during the first 3 months, most babies gain on average about 2 lb/mo. (0.90 kg/mo.). If baby’s weight gain is double this or more, block feeding for no longer than 1 week makes sense. If baby’s weight gain isn’t this high, it is likely that block feeding will cause more problems than it solves.

The full drainage and block feeding method (FDBF)

This is a variation of block feeding that involves fully draining both the breasts and then keeping to one breast for periods of time.⁶ The principles include:

• Pump both breasts to thoroughly drain them as a one off exercise
• After drainage, offer both “empty” breasts to baby
• Divide the rest of the day into blocks of time, starting with three hours
• Breastfeed without restriction but keep baby to one breast for three hours before switching to the other side for the following three hours.

Try switching sides frequently

Another strategy that works for some mothers is the opposite of using one breast or block feeding and is described by Fleur Bickford on her website and involves switching breasts frequently during each breastfeed:

…switch sides halfway through the feeding (although you can switch sides more frequently if that works better for you and your baby). So if baby normally feeds on one side for 10 minutes, mom would switch to the other breast at 5 minutes (this is the only time that I would recommend that moms watch the clock!). If baby normally feeds for 5 minutes on one breast, then switch breasts at 2.5 minutes (if baby wants to keep nursing past the usual number of minutes mom can keep baby on that side or switch again). By using this method of switch nursing, both breasts are still getting stimulation, but they are also getting the message to slow milk production down a bit because there is milk left over in the breasts.

Herbs and drugs

Some mothers with severe oversupply reduce their milk volume by taking certain herbs in small amounts—for example drinking sage tea, peppermint tea and eating parsley are thought to reduce milk production.⁷⁸. Certain drugs may also reduce milk supply a little e.g. pseudoephedrine.⁹ Discuss taking drugs and herbs with your health professional incase they are not compatible with existing medication or your medical history. For places to find safety information on taking medications during lactation see Medications and Breastfeeding and many herbs are listed on e-lactancia and LactMed.

Donating milk

You could consider donating spare breast milk to a milk bank. Some countries organise their milk banks into milk banking associations eg the Human Milk Banking Association of North America (HMBANA) or the European Milk Banking Association (EMBA) and see Milk Sharing in an Age of Social Media.

Managing engorgement

Engorgement after the birth is very common and is an indication that a mother’s milk supply is increasing or “coming in” following the birth of her baby. This is not the same as oversupply. If your breasts feel uncomfortably full; feeding your baby, or expressing a little milk if your baby isn’t ready to feed, will make them feel comfortable again and avoid painful engorgement or mastitis. A technique known as reverse pressure softening and some gentle hand expression can help a baby latch if the breast is very full. For more reading see Engorged Breasts, Engorgement Relief When Milk Won’t Flow, Blocked Milk Duct and Mastitis Symptoms and Treatment.

Managing a fast let-down

When the pressure of milk is high in the breast, milk can sometimes flow very forcefully during a milk ejection reflex (let-down). While some babies can cope with and enjoy a fast flow, others find it difficult to coordinate suck, swallow and breathe in order to protect their airway. Some babies might choke or cough with a very fast flow and become fussy at the breast. There are ways to help a baby manage a fast flow such as using reclining breastfeeding positions that slow the flow of milk, letting the fast flow subside before putting baby to the breast, and ensuring baby is attached to the breast in a deep latch. Your IBCLC lactation consultant can check whether your baby’s latch or positioning could be improved or whether any steps could be taken to reduce milk production where the fast let-down is linked to oversupply. For more information about managing a fast flow of milk when it is causing a baby stress or discomfort see What is a Fast Let-Down?

Summary

In most cases an “oversupply” of breast milk is a temporary situation because breast milk volume will adjust to meet the baby’s requirements. For some mothers however, the feeling of too much breast milk persists past the early weeks after birth and can cause engorgement, frequent blocked ducts and mastitis. Oversupply can cause problems for some babies making them appear unsettled and fussy at the breast despite gaining weight well. There are a number of management strategies that can help or hinder oversupply and a breastfeeding specialist is a helpful partner in the process to find the right way forward for each mother and baby.