Oversupply: too much, too fast, too strong.
When it comes to milk production problems, low supply gets all of the attention. Identifying the cause and resolving it, supplementing the breastmilk intake and supporting the mother emotionally.
The mother who appears to have far more breastmilk than her baby needs almost seems to be mocking those who have too little. Talking about their frustration or their baby’s symptoms in groups can attract nasty comments and mothers soon learn who to share their feelings around. However for some women, too much breastmilk has a significant impact on their daily life and that of their infant.
Hyperlactation or hypergalactia occurs naturally in some women and is self-induced in others. Physical causes can include thyroid or pituitary disorders. Prolactin is a hormone produced by the pituitary gland which has a key role in milk production. High levels of prolactin can be responsible for hyperlactation. Where oversupply is having a significant impact on either mother or baby it is worth having your doctor run some tests to rule out any medical cause. However, in the majority of cases, there is no underlying medical condition.
Mothers who experience an oversupply of breastmilk might experience engorgement and breast fullness beyond the typical period of 6-12 weeks after birth. Left too long between feeding or pumping, the breasts fill to an uncomfortable or painful level. Overfull breasts can be harder for babies to latch on to, meaning less efficient drainage which can add to the fullness. Mastitis and/or blocked ducts might be more common in women who over-produce milk or have trouble effectively “emptying” the breast. [It should be noted that breasts are never actually emptied and always contain milk. An average baby might leave around 67% of the available milk after feeding. It is likely a hyperlactating breast would have a higher residual volume]
Over-production can be associated with a forceful let-down reflex and fast flow of milk from the breast, particularly early in a feed. This rapid flow can fill a babies stomach quickly, without enough time for the glands of the breast to release the higher fat milk in response to the milk-ejection reflex. Babies can seem hungry sooner due to the composition of the milk. The imbalance of sugars and fats in the milk means it also travels quickly through the digestive tract and babies can experience discomfort associated with this rapid digestion. The term lactose overload describes this imbalance and should not be confused with lactose intolerance, a very different condition.
This milk, expressed by a hyperlactating mother and left to stand, has separated into two layers. The “cream” on top is the fat while the “skim milk” has lower fat content.
Lactose overload can be improved with some simple breastfeeding management techniques:
Some babies respond to a strong rush of milk at let-down by releasing the breast. Mothers can catch the excess flow of milk in a cloth or container and allow the baby to reattach as it eases. If a baby objects to this process or is too overwhelmed, mothers can initiate the milk-ejection by hand expressing the initial flow and only offering the baby the breast once is slows. The volume needed to be expressed varies between mothers but can be as much as 20-50mls (eg one or two tablespoons).
Block feeding is a technique which uses the breasts’own regulation system to put the brakes on production. A protein known as the Feedback Inhibitor of Lactation (FIL) is released when a breast is full. The more frequently milk is removed from the breast, the lower the levels of FIL. Block feeding involves pausing milk removal (feeding and/or pumping) from one breast for a period of several hours, with all feeds in that period being from the one active breast. After the time limit, the breasts swap with the rested breast now becoming active while the other now pauses. This means levels of FIL will regulate production in each breast without either going too long without release. The period of blocking time is variable between mothers but around 3-4 hours seems to work. Block feeding is a temporary measure and care needs to be taken that the resting breasts doesn’t become painfully full or develop mastitis. If necessary, a small amount of milk can be expressed to release some pressure.
Laid-back breastfeeding can help a baby feel more in control of a fast flow and works against gravity by the breast having to “pump” the milk uphill! However, to ensure effective relief to all parts of the breast, finish the feed sitting upright or hand express any areas which feel firm after the baby is satisfied.
Babies who are experiencing lactose overload can have very liquid bowel motions, accompanied by gas which can make them frothy. The poo can be quite green, as undigested sugars are present. Babies who are unable to comfortably coordinate their suck/swallow/breath rate due to a strong flow of milk often gulp while feeding and vomiting quantities of milk during or immediately after feeding is common. These babies are “happy chuckers” and don’t appear to be in pain as they vomit and are usually relieved by the release of excess air and milk from distended stomachs. It is typical for them to return to the breast after doing so and feed well now the flow has eased.
Better out than in!
Some mothers intentionally or inadvertently create hyperlactation through frequent pumping of milk. Many mothers choose to create a “freezer stash” or expressed breastmilk (EBM) in preparation for their return to paid work, to donate to other mothers or to have a reserve just in case. Sometimes this can create a cycle of oversupply which the mother needs to manage with continued frequent pumping and can become an unwanted chore. Careful weaning down the amount being pumped over a period of weeks can bring the supply back into balance with the baby’s needs and give the mother back the time she spends pumping each day.
Galactagogues are substances known or believed to increase milk production. When used by mothers with low supply, they may resolve some supply issues. Mothers with hypergalactia should probably avoid these!
Substances which might reduce milk production should only be used on medical advice. While simple herbs are unlikely to have a significant impact, use of drugs and medications which supress lactation may not be appropriate while breastfeeding.
Babies of mothers with oversupply of breastmilk are typically rapid weight-gainers and those supporting you might worry your baby will become overweight in later life as a result. It is reassuring to know that these well-rounded babies generally slim down once they become mobile and that formula fed children are more at risk of obesity in adulthood.
