Oversupply is the name used to describe a mother who has “too much breast milk”. Oversupply is often discussed with “fast flow” or “overactive let down”. If you have plentiful milk your baby will usually gain weight well. Some babies may struggle to cope with milk flow and volume, perhaps by fussing or crying during feeds or coming off the breast while milk spurts everywhere. And some babies may seem uncomfortable after feeds or spit up lots of milk which might be labelled as reflux, milk protein allergy, lactose overload or colic.
In most cases the more milk the better
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 (Newman, 2014). He cautions that if an ample milk supply is seen as a problem and a mother is advised to rigidly block feed (feed from one breast for periods of time to reduce her supply), it is possible that her supply could reduce so much she now has the opposite problem of “not enough milk”. In most cases following the principles in One Breast or Two per Feed allows your supply to balance with your baby’s demand.
Causes of oversupply or fast flow
Sometimes a mother finds she has much more milk than her baby can drink despite feeding on demand. Other times a mother may inadvertently overstimulate her supply by too much pumping or by taking lactogenic herbs. A baby who isn’t latched deeply may both struggle to manage a fast flow of milk and may also add to the excess milk production by their frequent feeding. Sometimes medical causes and hormonal factors can contribute to oversupply or hyperlactation (contact your doctor). Your IBCLC lactation consultant can help you work out whether you really are over producing breast milk or whether your baby’s latch or positioning could be improved and what steps, if any, might be advised to manage your supply.
Signs of too much milk
If a mother has too much milk for her baby to handle, despite a deep latch and good tongue function, she might feel her breasts are still full after a feed, she may leak milk between feeds, keep getting sore nipples and painful engorgement or have blocked ducts or mastitis.
Her baby might:
- Choke, cough or come off the breast during feeds
- Seem irritable, fussy and restless, may hold himself stiffly or scream
- Tend to have short feeds before coming off unsatisfied and wide awake
- Clamp down and pinch the nipple because he quickly learns this slows the fast flow
- Spit up a lot and/or burp and have gas
- Have green, watery or explosive poops
- Get a high proportion of low fat milk causing symptoms of lactose overload
Coping with oversupply; mothers’ stories
Lots of milk and spitting up
Maria’s first baby Seb was 9lb 12oz born. After breastfeeds he would spit up milk regardless of whether he was upright or lying down. Frequent burping was helpful. There would always be a little pool of milk beside his head after a nap and his neck was always wet with milk. Before every feed Maria made sure she had plenty of bibs and towels to catch the over flow that would surely follow. Sometimes Seb would seem to bring back a whole feed and then ask to feed again. Maria always obliged by offering another breast and starting feeding all over again. For at least six months Seb needed to wear a bib but he was a very happy, placid baby who loved to sleep and gained weight quickly along the 97th centile.
Maria had read that spitting up was a normal thing for babies. She didn’t worry about reflux and nobody suggested block feeding (see below). As far as Maria was aware her oversupply and the reflux were not problems needing attention.
Oversupply and mastitis
Maria’s second baby Daisy weighed 10b 2oz. Maria’s milk came in with a vengeance (it’s quite typical for a mother to have 20% more milk with a second baby). Maria’s nipples completely flattened out with the engorgement and her baby struggled to latch. Daisy would only feed for five or ten minutes at a time and was slow to gain weight at first. Maria had a bad case of infective mastitis ten days after birth—there was so much milk Daisy wasn’t draining the breasts properly. Maria continued breastfeeding and started expressing through the mastitis, soon Daisy started to gain weight well and followed the 91st centile. However, Daisy seemed to have “colic” and would be fretful and grizzly every evening for several hours but she rarely spit up.
It is very important to express to comfort whenever your breasts feel uncomfortably full, follow the steps in Engorged Breasts to reduce engorgement and prevent mastitis. A technique known as reverse pressure softening and some gentle hand expression may have helped Daisy latch to Carla’s flattened nipples. While Maria’s first baby was perfectly happy with Maria’s plentiful milk, despite a lot of spitting up, baby Daisy was much more unsettled. Checking whether Daisy had finished the first breast before offering the second may have been helpful—see One Breast or Two per Feed. If Daisy was getting a lot of high volume low fat milk with her short feeds she may have had a slight lactose overload. Breast compression and keeping to one breast per feed or for longer blocks of time (see below), may have settled Maria’s supply more quickly.
One breast per feed
Carla had a lot of breast milk and a good storage capacity (how much breast milk a breast can store). Her baby Mike gained weight well following the 91st centile. His character dictated frequent contact with his mother day and night and he managed the ample milk supply by feeding very frequently from one breast per feed. Carla was vigilant for any signs of engorgement and expressed any excess milk to comfort until her supply settled. Mike didn’t spit up or show any signs of colic.
By feeding on demand and keeping Mike to one breast per feed unless he particularly showed signs of wanting the other side, Carla was able to balance her plentiful milk to meet her baby’s needs.
When Carla had her second baby Leo, she had a constant battle to avoid engorgement and mastitis in the first three months—despite offering one breast per feed. Leo couldn’t feed to sleep without constantly getting yet more milk he didn’t want, he would get over tired and upset and need settling by walking in a sling which Carla found tiring. A friend suggested she donate milk to a milk bank but Carla felt overwhelmed by all the milk and chose to reduce her supply by block feeding. Carla managed to avoid infective mastitis and Leo gained weight well, in time her supply settled down to Leo’s needs.
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 during that block of time. By gradually increasing 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 nursing may be useful to settle down over producing breast milk, it may only be needed short term. If milk supply drops too far your baby may start fussing because of too slow a milk flow. By following baby’s lead and offering both breasts again as needed, your baby can regulate his own milk supply. Keep an eye on weight gain and frequency of dirty nappies. It is also important to check that the baby’s latch is as good as possible.While block nursing may be useful to settle down a true oversupply, it may only be needed short term.Click To Tweet
Other tips for managing oversupply
- The full drainage and block feeding method (FDBF) is a form of block feeding that involves fully draining both the breasts and then keeping to one breast for periods of time (Caroline GA van Veldhuizen-Staas￼, 2007).
- Avoid missing feeds and over pumping.
- Consider donating spare breast milk to a milk bank1
- Some mothers reduce their supply by taking certain herbs in small amounts however there is not a lot of information about the safety of using herbs to reduce a breast milk supply. Drinking sage tea, eating peppermints and parsley are thought to reduce supply (The Womanly Art of Breastfeeding, 2010; Kelly Bonyata, 2011).
How well a baby can handle milk flow can depend on whether he has a deep latch and a good tongue function. If your baby gulps and gasps or lets go of the breast just after you have a let-down because the flow is too fast, try taking him off the breast for a moment or two until the flow slows a little. A container or towel can catch the milk and once the flow has slowed your baby may be better able to cope with his feed. Leaning back in biological nursing positions can help to slow flow (Mohrbacher, 2014).
Kelly Bonyata describes signs of a fast flow as follows, see the full article for tips to help a baby cope with fast flow:
Does your baby do any of these things?
- Gag, choke, strangle, gulp, gasp, cough while nursing as though the milk is coming too fast
- Pull off the breast often while nursing
- Clamp down on the nipple at let-down to slow the flow of milk
- Make a clicking sound when nursing2
- Spit up very often and/or tend to be very gassy
- Periodically refuse to nurse
- Dislike comfort nursing in general
Your IBCLC lactation consultant can check whether your baby’s latch or positioning could be improved or whether any steps need to be taken to manage your supply.