This week I have been supporting a mum who has oversupply. She had been coming to the group for a few weeks and overheard a conversation with another mum about lactose overload, caused by oversupply, when the penny dropped for her.
When we were talking about a plan together, I realised that she had been using a haaka pump for weeks, more on that later, but she really wanted me to talk about them and the impact they can have on supply. So here I am today.
Boobs that feel like balloons about to pop!
Oversupply is when the body makes milk that constantly is more than the baby needs and causes that feeling of fullness and engorgement most of the time. This causes a lot of discomfort not just for the mum, but also for the baby. I have mentioned before that I had oversupply when I had my first baby, it was a steep learning curve and I will share my story with you.
I started off feeding both sides, every feed, as soon as she was born, she only ever fed for about 5-10 minutes and would be full, but would feed again quite quickly, usually after an hour or two at the most. I remember saying this to the community midwifery care assistant, who told me I should make her wait at least 3 hours between feeds and force her to for for 20 minutes on each side. This really got my back up and I knew she was wrong, she would be screaming by 3 hours and how can you force a baby to feed?! So, I carried on as I was, offering both sides as I couldn't believe she would have had enough milk after 5 minutes! I was worried I wasn't making enough and wanted to make sure my supply was good. After maybe two-three weeks, I decided that I needed to start expressing milk to give her a bottle, so I started expressing a few times a day. I was amazed with how much milk I was making, I could express 100ml straight off in about 15 minutes. I realised I didn't really need to offer both sides each time, but by this point, we had hit really big problems.
By this point my letdown was crazy, she would offer cough and splutter and when she pulled off, she and I would get covered in milk (looking at the positive, my skin looked amazing from all the milk squirted in my face), I leaked constantly, smelt like moldy milk, felt full of milk all the time and I only felt empty for a really short time after feeds.
And my baby, my beautiful lovely baby, would scream, and I mean, scream, for hours and hours at a time. I used to sit on a birth ball, bouncing her up and down, staring out the window and waiting for my husband to come home to come and relieve me for just 10 minutes. It was the worst pain cry and I couldn't work out what had caused it.
Feeding was not nice, I love breastfeeding now, but this was not a pleasant experience at that time, she would go on and off, cry, be restless and uncomfortable when feeding.... it felt like a vicious cycle.... I could see she was hungry and needed feeding, but, when I fed her she seemed to hate it. Then, she would have the most humungous vomits, big gassy ones, she would actually projectile vomit across a room.
Then there was her weight gain, the most key clue in this story, she was born on the 25th centile, but by week 3, she was on the 75th centile. This is a huge jump up. And the poos, at this point, I started googling, they were bright green, frothy and explosive, she had nappy rash and I was really scared something was seriously wrong.
The weigh in literally made me gasp.
And like I said, it was a kellymom article that gave me the lightbulb moment of realisation and I finally, knew what I needed to do. I decided to block feed when she was 6 weeks old, I had carried on for as long as I could and tried a few different things first, but I knew something had to change soon, I only did it for 24 hours and noticed a slow down in milk production, I stopped expressing (which if i'm honest was a relief because she hated the bottle) and after a few days, things settled.
I think my little girl's gut was probably hugely affected by my oversupply, again, I didn't realise that her intestines would probably need to heal and she was very sensitive to dairy later on. Even after the oversupply was sorted, the reflux (probably associated with her gut not being very happy) didn't stop for 10 months and I did end up giving medication for it to start with. By a year, life was much better, thank goodness!!
Party at age one!
So why does oversupply happen?
Firstly, we need to look at how milk production happens. So, after birth your body just makes milk, it's hormonally driven by the placenta and baby being born and no matter how a woman plans on feeding her baby, she will produce milk in this time, after a few days the baby's feeding pattern determines how much milk is made, the more they drink, the more you produce. Engorgement in the early days and first few weeks is totally normal after a baby is born. Engorgement is when milk becomes more watery or 'comes in' and you produce a lot, causing breasts to feel super uncomfortable (like a balloon that is about to pop!), but this will generally be short lived and will improved when your supply gets tailored to how much your baby needs by feeding. Sometimes, when you haven't fed your baby for a longer stretch, you might find that breasts get engorged after the first few weeks, but this should quickly get sorted after a feed or two.
Oversupply happens later- after the first few weeks and is when the body produces much more milk than the baby needs, causing a feeling of engorgement that is barely relieved after feeding and is more or less constant.
Some people (like myself) may just have a large supply of milk from the off, this means that the baby will feed for shorter periods.
Feeding both sides every time, swapping before the baby has finished one side (finishing usually looks like spitting the nipple out or falling asleep) and this can contribute to oversupply.
People express for many reasons- so another care giver can feed is one of them
Expressing milk via a pump, often very frequently when on a feeding plan or soon after baby is born for other reasons, and then continuing to pump very frequently- can cause oversupply.
One of the things that wasn't around in the days when I had my first baby was haaka pumps. When I expressed milk it was not a passive activity and I knew I would be making more milk because of it. Haaka pumps can feel quite different to this. You just pop it on the other side from the side you are feeding on and it 'catches' the milk you would have leaked out. Except, they don't quite just do this. They apply a little bit of suction and pressure, which can increase the amount of milk that the breast that isn't being fed on produces. For many women, they would say that this isn't a problem for them and that's great, it's a handy tool. But when used for every feed, they can contribute to the issue of oversupply. It might seem like it's helping relieve the feeling of engorgement, but of course, any additional milk coming out will tell the body to make more milk, which means next time there will be even more milk there.
What symptoms will I see?
La Leche League have a brilliant guide to Oversupply and Lactose overload and they list the main symptoms as:
Very large weight gain (as much as 400g/14oz per week), moving upwards through centile lines
Explosive green, frothy poos
Struggling to control milk flow
Pain and excessive wind or ‘gas’
You may also notice the following:
Choking, coughing, spluttering at the breast
Fussing, arching and pulling on and off the breast
Clamping down or biting (to slow the flow of milk)
Frequent spitting up
Always appearing ravenous and unsatisfied despite large weight gain
Unwillingness to nurse to sleep or find the breast a restful and calming place
Breast refusal
Faltering weight gain (due to breast refusal)
Lots of wet and dirty nappies
General ‘colicky’ behaviour
A mother with oversupply may have the following symptoms:
Breasts that are rarely soft or comfortable
A forceful or ‘over-active’ letdown
A painful letdown
Profuse leaking
Painful nipples (from baby clamping and pulling on and off)
Recurring blocked ducts and/or mastitis (see here for more info)
Distress about your breasts not providing the calming place for your baby you had expected
The only situation you may not see large weight gain in a baby when there is over supply, is when the mum is also pumping frequently- the baby is probably not getting such a huge excess of milk that they are jumping up the centiles- but they may be struggling with the other symptoms because they are getting lactose overload from the milk they are feeding on.
Lactose overload is a side effect of the oversupply of milk and is caused by the baby drinking an imbalance of fatty milk and milk containing lactose.
A very full breast will contain more milk that is high in lactose. Emptier breasts contain fattier milk- which is less high in lactose, so if a breast is always very full, the baby takes in more low fat, high in lactose milk than higher fat milk and the following happens. Lactase- an enzyme in the gut, digests the lactose, but when there is too much lactose, the lactase is overwhelmed and the milk sugar in lactose begins to ferment, causing excessive wind and frothy green poo.
If your baby seems comfortable and has yellow stools, it's likely there's no problem with the amount of fat in your milk.
We need lactose for energy and to make our brains grow- true lactose intolerance in babies is extremely rare and is called galactosemia- it is picked up by 7 days because the baby becomes so ill. Lactose intolerance and lactose overload are often confused but it is really important to know that lactose overload is simply, too much lactose milk and not an intolerance.
Amount I would have probably expressed in 24 hours!
So, what can we do about oversupply??
Well, to start with, before you call in the IBCLC, there are some things you can do at home.
Check that your baby's attachment to the breast is good- if you have milk shooting out your breasts because of the very large volume, it may be tricky for your baby to feed.
Using laid back or upright positions. Anyone who comes to our group will know how much I flipping love a bean bag and laid back positioning. It really helps control the flow of milk and allows the baby to go on and off the breast to catch their breath.
If the breast is very engorged, reverse pressure softening can help to move fluids back from the nipple area, which can help your baby to latch more deeply. Read about it here.
Feed as often as your baby needs, this may be very frequently, but this is ok, it's likely your breast won't be super full if you feed more often, making it easier for baby to attach and remove milk more effectively. It also helps with the powerful spray from letdown.
Only offer the second breast if the baby really seems to want it after feeding on the first breast. Think of it as a little pudding.
Give your breasts a shake before feeding and use gentle massage whilst feeding to make sure any fatty milk that has collected is coming down the breast too.
If after this, your baby is gaining weight at a fast rate, you are still seeing lots of symptoms and you are concerned, talk to an IBCLC, breastfeeding counsellor or infant feeding specialist.
Ready for your email with my trusty cup of tea
I'm not going to talk about block feeding today, because it will mean you are sat here for about another hour reading this blog, but what I will say is that there is a lot of different information on block feeding on the internet and it can have a very quick effect on supply- this isn't always great. It can seem like a quick fix but it can cause a lot more problems if it's not done correctly.
As a rule-
If you have all the symptoms and your baby is gaining weight excessively- talk to a feeding professional about making a plan to reduce your supply.
If you have all the symptoms above and your baby is gaining weight normally and you are expressing and throwing milk or freezing, reduce the amount you are expressing.
If you have all the symptoms, except excessive weight gain and you are not expressing, DO NOT block feed. It's likely your problem is NOT because of oversupply, and by block feeding you risk having a huge impact on the health of your baby.
It is so important to talk to someone who is highly skilled in lactation before attempting block feeding.
So, that's my story of my mad milk supply. It wasn't easy, but, it did get better. I really think if I had some better help and support from the off, I would probably have never got to the stage of the green poo and projectile vomit, so seek help early, get the support you need and we will work together to get you where you want to be.
Kim x
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