Feel like you could feed the nation from your power boobs? 

Some women find they seem to have too much milk and their babies have trouble coping with it. For most mothers, the swollen overfull breasts of engorgement are only temporary and can be resolved with appropriate help. It can take about six weeks for the breasts to adjust to producing the right amount of milk for this baby at each feed.

Occasionally a mother may have continuing problems. There are several different ways you can have too much milk, so it's important to get a clear idea of what's really happening in your case.

In the first week or two, when you are both learning to breastfeed, your breasts may be hard and painful, and you may have a mild fever. This is engorgement, not mastitis, which can be eased by some practical management such as feeding baby more often, making sure you don't miss any feeds, giving night feeds or expressing in the night, cutting out any water, glucose water, or formula feeds, and letting your baby finish the first breast first. This means letting your baby have a good long thorough feed from the first breast before you offer the second one. Your baby should be having 8 - 12 feeds in 24 hours.

Signs of too much milk in the early months are

• rapidly filling breasts
• lumpiness, tightness usually disappearing with breastfeeding
• baby gags, gulps at start of feed, often will not take second breast
• baby may bring up quite a lot of milk at the end of the feed
• often a high weight gain, occasionally a poor gain
• baby may be extra fussy between feeds, especially in the evening
• often a bowel motion each feed, often green and frothy.

As your baby gets older, other signs can include milk dripping out of his nose or the corner of his mouth, pulling off during the let-down when milk will spray from the nipple openings, or lots of possetting. Perhaps you have a normal supply but a very fast flow. Your baby will probably ask for the second breast each feed, weight gains will be adequate, but your baby may be pulling off at the beginning of the feed when the milk is spraying (letting down).

If some of this sounds familiar to you, you probably have a forceful let-down. This is often associated with too much milk (oversupply). Some mothers notice that the problems with fast letdown or oversupply don't start until 3-6 weeks of age. Some mothers do not consider it to be a problem at all, and if you baby manages it just fine, it may suit you both perfectly , with the added bonus of a fast little feeder!

• How do I know if thats what I have?

Does your baby...

• Gag, choke, strangle, gulp, gasp, cough while breastfeeding as though the milk is coming too fast
• Pull off the breast often while feeding
• Clamp down on the nipple at let-down to slow the flow of milk
• Make a clicking sound when feeding
• Spit up very often and/or tend to be very gassy/ farty
• Periodically refuse to feed “nursing strike”
• Dislike comfort feeding in general

What can I do about it?

There are essentially two ways you can go about remedying a forceful let-down: (1) help baby deal with the fast flow and (2) take measures to adjust your milk supply down to baby's needs. Since forceful let-down is generally a byproduct of oversupply, most moms will be working on both of these things. It may take a couple of weeks to see results from interventions for oversupply, so try to be patient and keep working on it.

Apparently tribal women experience no gas problems/ wind problems with their babies, and this is to do with the fact that they breastfeed with the baby almost upright (often while working.. the mum, not the baby that is..). It makes sense to feed like this when you think about it. We don’t drink lying down either....

So making use of this observation:

Position baby so that she is breastfeeding "uphill" in relation to your breast, where gravity is working against the flow of milk. The most effective positions are those where baby's head and throat are above the level of your nipple. Some positions to try:

• Cradle hold, but with mum leaning back (a recliner or lots of pillows helps)
• Football hold, but with mum leaning back
• Elevated football hold - like the football hold, but baby is sitting up and facing mom to nurse instead of lying down .
• Side lying position - this allows baby to dribble the extra milk out of her mouth when it's coming too fast .
• Australian position (mom is "down under", aka posture feeding) - in this position, mum is lying on her back and baby is on top (facing down), tummy to tummy with mum. Avoid using this positioning frequently, as it may lead to plugged ducts.
•  Burp baby frequently if she is swallowing a lot of air.
• Feed more frequently. This will reduce the amount of milk that accumulates between feedings, so feedings are more manageable for baby.
• Feed when baby is sleepy and relaxed. Baby will suck more gently at this time, and the milk flow will be slower.  Dont wait for your baby to get really hungry, as they will be gulpier.
• Wait until let-down occurs, then take baby off the breast while at the same time catching the milk in a towel or cloth diaper. Once the flow slows, you can put your baby back to the breast.
• Pump or hand express until the flow of milk slows down, and then put baby to the breast. Use this only if nothing else is working, as it stimulates additional milk production. If you do this, try to express a little less milk each time until you are no longer expressing before a feed.
• Adjust your supply to better match baby's needs
• If baby is gaining weight well, then having baby nurse from only one breast per feeding can be helpful.
• If baby finishes on the first side and wants to continue, just put baby back onto the first side.
• If the second side becomes uncomfortable, express a little milk until you're more comfortable and then use cool compresses - aim for expressing less milk each time until you are comfortable without expressing milk.
• Avoid extra breast stimulation, for example, unnecessary pumping, running the shower on your breasts for a long time or wearing breast shells.
• Between feedings, try applying cool compresses to the breast (on for 30 minutes, off for at least an hour). This can discourage blood flow and milk production.
• If one side per feeding is not working after a week or so, try keeping baby to one side for a certain period of time before switching sides. This is called “block nursing.”
• Start with 2-3 hours and increase in half-hour increments if needed.
• If the second side becomes uncomfortable, express a little milk until you're more comfortable and then use cool compresses - aim for expressing less milk each time until you are comfortable without expressing milk.
• In more extreme cases, mom may need to experiment a bit with time periods over 4 hours to find the amount of time per breast that works best.

Additional measures that should only be used for extreme cases of oversupply include cabbage leaf compresses and herbs. (more helpful if weaning rather than establishing feeding)

Even if these measures do not completely solve the problem, many women find that their abundant supply and fast let-down will subside, at least to some extent, by about 12 weeks (give or take a bit). At this point, hormonal changes occur that make milk supply more stable and more in line with the amount of milk that baby needs.

 Additional Information

• www.kellymom.com
• Too Much Milk? by Becky Flora, IBCLC
• Oversupply by Kathy Kuhn, IBCLC
• Tips for taming a monster milk supply by Kathy Kuhn, IBCLC
• Gaining, Gulping, and Grimacing? by Diane Wiessinger, MS, IBCLC
• Oversupply: Too Much Milk by Anne Smith, IBCLC
• Colic in the Breastfed Baby by Jack Newman MD, FRCPC
• Finish the First Breast First by Melissa Vickers (LEAVEN, September-October 1995, p. 69-71)
• Overactive Let-Down: Consequences and Treatments by Mary Jozwiak (from LEAVEN, September-October 1995, pp. 71-72)
• Common Side Effects of an Overactive Let-Down by Mary Jozwiak (from LEAVEN, September-October 1995, p. 69)
• Too Much of a Good Thing by Kate Drzycimski, from New Beginnings Vol. 19 No. 9, July-August 2002, p. 129.
• Resolution of Lactose Intolerance and “Colic” in Breastfed Babies by Robyn Noble & Anne Bovey, presented at the ALCA Vic (Melbourne) Conference on the 1st November, 1997