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Forceful Let-down (Milk Ejection Reflex) & Oversupply
By Kelly Bonyata, BS, IBCLC
Is
forceful let-down the problem?
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 nursing
- Spit
up very often and/or tend to be very gassy
- Periodically refuse
to nurse
- Dislike comfort
nursing in general
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. Forceful let-down runs the gamut
from a minor inconvenience to a major problem, depending upon how
severe it is and how it affects the nursing relationship.
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.
Help baby deal with the fast milk
flow
- Position baby so that she is nursing "uphill" in relation to
mom's 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 nursing positions
to try:
- Cradle hold, but with mom leaning back (a recliner or lots
of pillows helps)
- Football hold, but with mom leaning back
- Elevated football hold - like the football hold, but baby
is sitting up and facing mom to nurse instead of lying down
(good for nursing in public).
- 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, mom is lying on her back
and baby is on top (facing down), tummy to tummy with mom.
Avoid using this positioning frequently, as it may lead to
plugged ducts.
- Burp baby frequently if she is swallowing a lot of air.
- Nurse more frequently. This will reduce the amount of milk that
accumulates between feedings, so feedings are more manageable
for baby.
- Nurse when baby is sleepy and relaxed. Baby will suck more gently
at this time, and the milk flow will be slower.
- 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 nursing.
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 nursing on the first side and wants to continue
nursing, 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 nursing 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.
- Do not restrict nursing at all, but any time that baby
needs to nurse simply keep putting baby back to the same side
during that time period.
- 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.
Even if these measures do not completely solve the problem, many
moms 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.
Sometimes babies of moms with oversupply or fast let-down get very
used to the fast flow and object when it normally slows somewhere
between 3 weeks to 3 months. Even though your let-down may not be
truly slow, it can still seem that way to baby. See Let-down
Reflex: Too Slow? for tips.
Page last modified:
10/10/2005
Written: 05/18/2001
Additional
Information
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
