After struggling with this issue with our son James, I think the first step to take when attempting to manage excess supply is to try and see things from your infant's perspective. Your baby is probably fussy and reluctant at the breast, and you are probably overcome with consternation as well. It was easy for me to feel upset with James. I thought to myself, "Why can't you just stay latched-on?!" James would often latch onto the breast and then about 10 seconds later, pull away, screaming and upset. This would, of course, make me frustrated and upset, but perhaps a bit of perspective is in order:
A woman who overproduces milk may have an overactive letdown reflex as well. When your baby attempts to nurse, he may receive an extreme and forcefully delivered volume of milk, versus the normal, manageable volume that is emptied into the infant's mouth at a slower dribble. Your infant may have trouble sucking, swallowing, and breathing in the midst of such an overwhelming letdown. Often, he may become choked at the breast - a feeling that is not only annoying, but painful!
Furthermore, in response to an overactive letdown, your infant may suck less vigorously, so as not to draw too large a volume of milk from the breast at one time. This only works, however, until the initial forceful letdown is relieved, and then the infant must suck to receive further letdowns and/or the hindmilk. With James, this proved to be quite confusing to him. He would begin a feeding with light suckling so as to avoid being overwhelmed by the milk, but he did not seem to understand that in order to finish the feeding, he needed to continue sucking strongly. Often, after an initial letdown had finished, James would become angry and hit my breast as if to say, "Hey! Where's the rest?!" Yet nothing was delivered to him because he did not continue sucking. Your infant may struggle with this same confusing learning-curve.
Secondly, if you overproduce milk, you are likely to have a great amount of foremilk. While foremilk is important, it is mostly composed of sugars and water, versus the hindmilk that comes later during a feeding and is composed of fats and proteins. Babies need both foremilk and hindmilk, but in an overproducing woman the baby may become completely full with foremilk before any hindmilk is delivered at all! This leaves the infant with a full feeling in his stomach, yet "still hungry" signals are being sent throughout his body because he has not received the proper amount of fats and proteins to complement his meal. This can cause the infant to instinctively nurse once more, but he may experience frustration at the uncomfortable, overly-full sensation he is receiving from his tummy, yet while also receiving "hungry" signals from his brain.
Finally, because an infant who recieves only foremilk during feedings has consumed only sugars and water, it can disturb the osmotic balance of the GI tract. Infants receiving only foremilk may experience quite a bit of gas and have uncomfortable, runny bowel movements.
There are a few very practical and easy solutions to these problems, which I will introduce here. If these solutions do not work, you may have to try more involved therapies (see tomorrow's post). However, these simple fixes may work well for many women dealing with initial engorgement, oversupply, or prolonged engorgement.
- If you are engorged, one way to make it easier for the baby to latch-on is to take your hands around the nipple/areola, and basically push back on your breast. You are attempting to push the milk BACK into the ducts, and make the areola area softer and smaller for the baby to latch on to (although you may also accidentally cause some milk to squirt out, this is not your primary goal). The milk with not clog your ducts, it will merely come back down the ducts and be released when your baby starts nursing.
- If you are experiencing an overactive letdown or overproduction of foremilk, PUMP OFF SOME FOREMILK before nursing your baby. Your production will slowly go down; don't worry about causing yourself to be perpetually engorged by pumping your breasts and nursing. I promise that your production will slowly decline. Pumping the foremilk may help your letdown to be less forceful, and it will give your baby the opportunity to learn that suckling is required to obtain the hindmilk.
- If you experience prolonged engorgement or a truly excess production of milk, try unilaterally block feeding your baby. You can read a research article explaining this method here. First, pump all your excess milk from both breasts. Then, feed your baby on only one breast for any time period of 2-12 hours before you switch breasts, depending on your level of overproduction. After the specified time period, you will switch breasts and then nurse your baby on ONLY the second breast for the same time period. As explained in the article, this technique helps to down-regulate milk production, so that your time intervals should become shorter and shorter as your milk production decreases until you are finally able to nurse your baby on both breasts at one feeding.