Overproduction of breast milk pumping

Breast Milk Oversupply | Advice for New Parents

Many women naturally make more milk than their infant needs. Sometimes an oversupply is created by over stimulating the breasts doing both breastfeeding and pumping. Having an oversupply of breast milk can be uncomfortable for both mother and her infant.

Signs of Oversupply - Mom

The following are signs of oversupply in the mom:

Leaking a lot of milk
Breast pain from feeling overly full
Nipple pain usually from infant biting, chewing or clenching down to slow a very fast let down
Recurring plugged ducts or mastitis

Signs of Oversupply - Infant

The following are signs of oversupply in the infant:

Gulping, coughing, choking or sputtering during feedings
Frequently detaching from the breast during feedings
Fussiness between feedings and/or cuing to feed all the time (even after drinking plenty of milk)
Frequently spitting up
Passing lots of gas
Explosive, green, frothy or watery stools; maybe even mucus or blood in the stool
Overly fast weight gain
May be diagnosed with “reflux”, “colic”, “lactose intolerance”, or even “failure to thrive”

Since most mothers and infants have symptoms, treatment is often a two-step process.

Feedings at the breast must be more comfortable for mother and infant.
A small decrease in milk production will make feedings more enjoyable for mother and infant.

Suggestions for making a little less milk

The following are suggestions on how to make less milk:

Use only one side for a three hour block of time, returning to the same breast if your infant cues to feed again in that time frame. Express a minimum amount from the other breast only as needed for comfort, until the next three hour block.
Gradually increase the time blocks up to 12 hours per breast, as needed.
There are medications and herbs that can be used if these strategies do not work for you. Call your lactation consultant or The Center for Breastfeeding Medicine at 513-636-2326 for guidance.

Stop these strategies as you decrease your milk supply and feeds become more comfortable.

Suggestions for managing feedings with a very fast milk flow

Here are suggestions for managing feedings with a very fast milk flow:

Try feeding when your infant is drowsy
Offer the breast before it gets overly full
If your breast is overfull, hand express or pump just the initial fast flow of milk and then latch your infant
Try feeding positions that use gravity to slow the flow of milk, such as a laid back nursing position
Burp frequently and give your infant breaks to pace him/herself
Firmly press the pinky side of your hand into your breast (like a karate chop) during the initial fast let down to slow the flow of milk. As your infants sucking slows down, release your hand to allow milk flow.

Last Updated 03/2020

Reviewed By Barb Chaney, MSN, RN, IBCLC

Too much breast milk? How to reduce oversupply

Sometimes you may feel like you’re producing too much breast milk, especially in the first few weeks of breastfeeding. Read on to find out if you really have an oversupply of milk, and what you can do about it

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Breast milk is amazing, so having lots is a good thing, right? Well, not always... Some babies struggle with the fast flow that usually accompanies an overabundant milk supply. And mums with oversupply can often feel very uncomfortable, with frequently or constantly leaking breasts, and may be more likely to suffer from recurrent mastitis.

Fortunately, there are a number of strategies that can help. But before you try any of these, ask yourself two key questions:

Do I really have too much breast milk?

Some symptoms of oversupply (outlined below) may have a number of other possible causes. It’s unwise to try to decrease your milk supply until you’re sure that oversupply is the underlying problem. Otherwise you could end up with less breast milk than your baby needs, particularly in the crucial first month when you’re trying to establish your supply.

Is oversupply a problem for me or my baby?

If you’re sure you have an oversupply of breast milk, but you and your baby are happy, there’s no need to do anything. Most cases settle down after the first few months. And as your baby grows, he’ll get better at dealing with a fast flow, and may come to enjoy it!

Leaking doesn’t always mean too much breast milk

During the first four to six weeks after your baby is born, your levels of the milk-making hormone prolactin will be increasing each time milk is removed from your breasts. In these early weeks, your breasts are learning how much breast milk your baby needs and how much to make every hour. As a result, excessive leaking and breasts that fill quickly – and even spray milk during let down – are common and normal.¹

At the same time, your newborn is also learning to coordinate the way he sucks and swallows, so some coughing and spluttering at the breast is also to be expected.

After around four to six weeks, surges in your prolactin will gradually decrease, and your milk production should start to follow a more straightforward ‘supply and demand’ process based on your baby’s needs.² But with so many hormonal changes happening in your body as a new mum, it’s not surprising that it can take time to adjust. Some mums find that their milk supply settles down quickly, while for others it may take a little longer.

Signs of breast milk oversupply in your baby

Overabundant milk supply seems to go hand-in-hand with a fast flow, especially during the first let down. Your baby may respond by coughing and spluttering near the start of a feed, clamping or biting down, or holding the breast very loosely in his mouth. He may come off the breast because the fast flow is a bit of a shock to him, and then cry because his feed has been interrupted. He’ll probably take in large volumes of milk, along with lots of air, and might spit up a lot and need frequent burping as a result. Be as gentle as possible if you’re burping him – jerky movements combined with a quickly filled belly can cause vomiting and upset some babies.

At the start of a breastfeed, the milk your baby is getting is relatively low in fat and consists mostly of lactose (sugar) and protein. As the feed progresses and your breast empties, the fat content of your milk steadily increases. In cases of oversupply, your baby may become full before he has completely drained your breast. This means that he is getting plenty of lactose-rich breast milk, but not as much of the high-fat milk that comes towards the end of a feed. Too much lactose, instead of a balanced meal, can be hard for babies to digest, resulting in explosive, frothy, green poos.

Paradoxically, in this situation your baby may want to feed constantly and be fussy in between feeds – although he’s taking in lots of calories, the low fat content of the milk means he never feels fully satisfied. This is because it’s the fat in food that makes us feel full. Think of the difference between eating dozens of rice crackers, and eating some cheese and biscuits – the cheese will make you feel more satisfied as it’s higher in fat.

However, all of the above symptoms can be caused by other things, such as reflux, allergies or even, conversely, a low milk supply. Only if they are combined with excessive weight gain is breast milk oversupply likely to be the cause. Babies are expected to gain around 900 g (2 lb) per month, but in cases of oversupply, they will put on much more – often around double that.¹ If your baby appears to have symptoms of oversupply but is gaining an average amount of weight, see a lactation consultant or breastfeeding specialist for advice.

Oversupply symptoms you may experience

Mums with too much breast milk often experience uncomfortable feelings of engorgement and tension and constantly feel overfull.³ As we have seen, leaking breast milk is normal in the first six weeks or so, and not usually a sign of oversupply. But if you’re still getting soaked every time your baby feeds after this period, it may be an issue.

Because a baby can’t always drain a very full breast, it’s also common to experience blocked ducts or repeated bouts of mastitis as a result of oversupply. However, these problems may also have other causes.

How to decrease milk supply

If you’ve established that you have too much breast milk and it’s a problem, here are a few simple measures that may help. For some mums these are sufficient:

Try laid-back breastfeeding. Feeding in a reclined position, or lying down, can be helpful because it gives your baby more control. He can set the pace and lift his head for a break if your flow is too fast for him. Remember to place a towel underneath you to catch any excess milk!
Relieve pressure. If your breasts are very uncomfortable you can hand express or pump a little milk to relieve them – but try to express the smallest amount possible. Each time you remove milk, you’re sending your breasts a message to produce more. So, while expressing can bring temporary relief, in the long run it could make the problem worse. If you need to express and store milk for times when you’re apart from your baby, it’s best to wait until you’ve addressed your oversupply.
Try nursing pads. If you're leaking milk, popping disposable nursing pads super or milk collection shells inside your bra could help you stay dry. If your leakage is only light to moderate or you have leaking breasts during pregnancy, Ultra thin disposable nursing pads will help you feel confident in a discreet way.
Avoid lactation teas and supplements. If you’ve been drinking mother’s milk teas, eating lactation cookies or taking herbal supplements to encourage breast milk production in the early days, make sure you stop – these could now be part of the problem.

Block feeding to reduce milk supply

If you’ve tried the above and you or your baby are still having problems, a technique called block feeding could get your supply to a more manageable level. But get advice from a lactation consultant or breastfeeding specialist before trying this method.

With block feeding, you breastfeed your baby whenever he wants for a period of four hours, but from one breast only. Your other breast will become very full of milk. As your breast milk contains something called ‘feedback inhibitor of lactation’ (FIL), the excessive fullness signals that breast to slow down milk production. It’s your body’s way of ensuring that your breasts don’t fill up endlessly.

Try this technique for 24 hours, alternating breasts every four hours. If there’s no improvement, you can increase the length of the blocks to six hours.

Full drainage and block feeding technique

If there’s still no improvement after another 24 hours, there’s another version of this technique that can be suitable for mums with more extreme oversupply, called ‘full drainage and block feeding’. ³

With this method, you use an electric breast pump to fully drain your breasts at the start of the day, then feed your baby immediately afterwards. The flow will be slower, which means your baby should be able to cope better. He’ll also get more of the higher-fat milk that comes at the end of a feed, so will feel more satisfied.

You can then begin block feeding for four hours at a time, as above. If this isn’t effective, switch to blocks of six, eight or 12 hours the next day, depending on how severe the oversupply problem is. Talk to a healthcare professional before attempting this technique.

You may not need to fully drain your breasts again after the first instance, but some mums need to do it once or twice more. Some mums notice an improvement within one or two days, or a little longer, but block feeding should not be continued for more than five days.

References

1 Morbacher N. Breastfeeding answers made simple. Amarillo TX, USA: Hale Publishing; 2010.

2 Cox DB et al. Blood and milk prolactin and the rate of milk synthesis in women. Exp Physiol. 1996;81(6):1007-1020.

3 van Veldhuizen-Staas CG. Overabundant milk supply: an alternative way to intervene by full drainage and block feeding. Int Breastfeed J. 2007;2(1):11.

Expressing, storing and thawing breast milk

Unlike breastfeeding, which is a natural process, pumping works a little differently. That is why efforts should be made to keep the milk flowing during pumping. Here are some ways that can make pumping easier:

Calm and pleasant environment
Optimistic attitude
Self-confidence and support of others
Confidence in an emotional connection with the infant
Having the baby present during pumping (if this is not possible, sometimes looking at his picture or smelling his clothes is enough)
Soothing warm drink (not coffee)
Hot shower or hot compresses before pumping
Gently massage the nipples
Gently stroke the areola and nipples with the fingertips
Gently massage with clenched fists over the breast towards the nipple
Massage the back between the shoulder blades along the spine with circular movements of the thumbs for several minutes

How to express milk?

First of all, wash your hands with soap and water. It is not necessary to wash the nipple specifically.

Principle of pumping:

In the first 3 days after birth, pump 5 minutes on each side, 3 times on each breast. From the fourth day (when milk already appears), you should express until the milk stops flowing and then switch to the second breast. A double-ended pump can express for at least 10 minutes. It should be pumped 8 times a day: once before bedtime, once after sleep and 6 more times during the day. There should be no more than 6 hours between evening and morning pumping, otherwise it may make pumping difficult.

You can massage your nipples with breast milk after every pumping.

If the mother is interested in breastfeeding in the future, this method is very important especially in the first weeks after childbirth, as it stimulates the production of milk in an amount sufficient for the child.

For your information: pumping is a temporary option. Once your baby is able to latch on (each baby has a different developmental rhythm), you can gradually transition to breastfeeding

In the skin-to-skin position, you can let it slide a little lower towards the chest to get used to the position, sniff and lick the nipple

It is advisable to give the baby fresh milk
If you bring fresh milk in the morning or in the evening, they will prefer to use it first, and only then the frozen leftovers
At a certain stage, the infant will begin to receive a breast milk supplement - HMF (Human Milk Fortifier), a fortifying supplement containing protein, calcium and phosphorus, which are not supplied to premature babies in sufficient quantities

Rules of behavior in the pumping room

Wash hands before using the pumping device
Only breastfeeding mothers are allowed to enter the pumping room, fathers are not allowed to enter so as not to cause discomfort to other women
You can’t eat in the pumping room, you can and should drink
Cleanliness and order should be observed
After pumping, disassemble the bottles into parts and wash them in a specially designed machine

Storage of mother’s milk

Mother’s milk is stored in plastic sealed container, which can be obtained from a nurse. The label on the container will include your name, the date and time you pumped, and a sticker with your baby's details.

For premature babies and newborns, store milk in the refrigerator compartment for up to 24 hours, in the freezer for up to 4 months.

At home, you can store your expressed milk in the refrigerator for up to 4 days and in the freezer (not in the door) for up to 4 months.

In a cold place, breast milk separates into a more watery and fatty layer, you can shake it a little before drinking.

Again, freshly expressed milk is most preferred by the infant. If you are going to bring expressed milk from home, you must arrive at the office before 9in the morning so that fresh milk can be used on the same day, since the daily portions are prepared only in the morning.

Milk should be brought fresh or frozen in a container with ice.

Thawing breast milk

Thawing breast milk is done at room temperature
Thawed milk can be stored in the refrigerator for up to 24 hours
Do not refreeze thawed milk
Fresh milk is always preferred, but when the baby first starts eating it will be before total frozen colostrum used, in date and hour order (within the first 4 days of pumping).
Heating breast milk after being in the refrigerator will only be heated in a special device by the ward nurse. Parents are not allowed to touch it. Heating milk in a microwave oven is not recommended, as the radiation destroys some of the ingredients.

Pumping: when and how? | Articles by doctors of the EMC clinic about diseases, diagnosis and treatment

In the life of a mother and baby, there are moments when breastfeeding is impossible or difficult for some reason. For example, a child has to be left without a mother for several hours - which means that a supply of milk is needed for him. Or in the case when the baby sucks badly at the breast, but eats well from the bottle, and pumping is the only way to feed him.

This can happen if the baby is born prematurely, and the very process of sucking the mother's breast turns out to be hard physical work for him - such an infant can also be offered expressed milk.

The same applies to the situation when the baby is ill and feeling unwell prevents him from fully sucking, as he is too weak to make the efforts necessary to "extract" breast milk. In this case, it should be expressed for 2 reasons: firstly, to provide the child with complete and optimal nutrition for him, and secondly, to maintain lactation.

Situations are different, so it is important to understand why pumping is necessary, how to do it correctly and what are the conditions for storing breast milk.

When and why to express?

Pumping is the process by which a nursing mother manually or with the help of a breast pump extracts milk from her breast.

This is not a mandatory procedure for everyone, and it does not need to be carried out after each feeding, since the milk in the female breast is formed exactly as much as is needed to saturate the baby at a certain age. Those. how much milk the baby ate in one feeding - so much will appear in the breast by the next.

But if, after applying, you also express the rest of the milk, then by the upcoming feeding it will be produced more than the child can eat - and this often leads to stagnation of milk (lactostasis).

Milk should be expressed when:

Having to bottle feed or supplement a baby for one reason or another. If at the same time the pediatrician did not forbid the baby to eat breast milk, then the mother needs to feed the baby expressed.
The baby is left without a mother for a long time. There are times when a woman needs to go away, and she cannot take the child with her. In this case, you can leave a supply of milk for several hours, after decanting it.
Mom is sick. It happens that during lactation a woman becomes seriously ill and is forced to take medications that penetrate into breast milk, which is strictly forbidden to give to a child. Medicines contained in milk, once in the child's body, can have an adverse effect on it. To prevent this from happening, the pediatrician will help you choose the milk formula that you need to feed the baby during the mother’s illness. Pumping in such a situation will help a woman maintain lactation until recovery.
Mom goes to work. A mother's return to work before the end of lactation can put her before a choice: transfer the baby to formula milk or feed it with expressed milk. Recently, more and more parents are choosing the latter option, since breast milk is much healthier than artificial nutrition.
Injured nipples. With improper care and attachment of the child to the breast, cracks may appear on the nipples. Feeding in this condition of the nipples becomes very painful for the mother, and then the baby should be briefly transferred to expressed milk from a bottle. This is useful because the nipples are less likely to get irritated when they are expressed than when they are sucked by an infant. In a few days, the nipples will heal, and it will be possible to resume feeding the crumbs directly from the breast.
There is a risk of lactostasis. A child, especially in the first days after birth, is not always able to suck out all the milk. To avoid lactostasis, mom needs to express excess milk. If this is not done in a timely manner, stagnation of milk can lead to inflammation of the mammary gland - mastitis. However, you must follow all the rules of pumping and do not resort to it after each feeding: this will only increase the flow of milk.
Not enough milk is produced. Pumping will help normalize lactation, as it leads to an increase in the production of milk in the breast, which can be useful during a lactation crisis.

5 pumping inhibitions

In order not to harm herself and not leave the baby without breast milk, the mother must know and be sure to follow the basic rules of pumping:

Do not express more than 3 times a day if pumping is combined with breastfeeding because this will lead to excess milk production. If the mother is sick and the baby is not applied to the breast, it is necessary to express with a frequency approximately equal to the number of feedings (on average, once every 3 hours - 8 times a day).
Do not express immediately after feeding, as this may lead to hyperlactation, ie. increased milk production.
Do not express "to the last drop". The main indicator by the end of pumping should be a feeling of relief in the chest. The female body regards the emptying of the breast without a trace as an increased need for milk by the child - and begins to produce more milk, which the baby cannot eat, therefore, there will be a threat of milk stagnation.
Do not express during the night, as this may also lead to the formation of excess milk. The main hormone responsible for milk production - prolactin - has a daily rhythm of formation, most of all it is produced at night, in response to the baby sucking or pumping.
Do not express on the first day after the arrival of milk. Usually, when lactation begins, more milk is produced than the newborn needs, and it is necessary to get rid of its excess. Therefore, just at the time of the arrival of milk, you can not express everything without a trace. If the breast is very dense, then it is recommended to express only a small amount of milk so that it becomes softer and the baby can fully capture and eat it.

Substances that signal that milk is being produced in excess appear in the filled breast after about 1 day. If you express all the milk accumulated in the chest earlier than in a day, then it will be produced in the same amount.

Hand Expression Technique

There are two ways to express - manually and with a breast pump. Usually, each mother chooses the most convenient option for her. It is better to do it manually at home, when a woman has enough time, since the whole process will take some time. Breast pumps will help a working mother, which greatly facilitate the pumping process.

Rules for hand pumping

It is best to express milk 10-15 minutes after the end of feeding the baby. Wash your hands thoroughly beforehand. If you use any breast cream, wipe the skin and nipples with a cotton swab or pad soaked in breast milk. Prepare a wide-mouth milk container by first washing it under running water and then sterilizing it (by boiling, in a steam sterilizer or in a dishwasher).

Sit comfortably, keeping your back straight, because pumping can take some time, and an uncomfortable position can cause back pain.

Gently grasp the chest: the little finger is under the chest at the ribs, the remaining fingers are positioned so as to support the chest from below. The thumb lies on top, about 3-4 cm from the nipple. In this case, the thumb and forefinger are located opposite each other, forming the letter "C".

Use your thumb and forefinger to gently press down on your chest and hold this position for a few seconds. In no case do not bring your fingers together, they should remain in the same position, the letter "C".

Repeat pressing, moving the palm in a circle - this way you will use all the ducts of the mammary gland.

Be patient, milk may not come out immediately, but only after a while. If you are pumping for the first time, check with your doctor or lactation consultant beforehand to show you how to proceed.

Manual pumping errors

Do not squeeze the nipple: this way you will only hurt yourself and injure the breast, and you will not express milk fully.

Do not press the palm too tightly against the skin, moving the hand across the chest so that there is no irritation and microtrauma.

Do not give up at the first unsuccessful attempts, be patient.

Breast pumps

Breast pumps make pumping much easier, as they are designed to fit all the anatomical features of the female breast.

Which one to choose? Breast pumps are divided into mechanical and electrical. In the first case, the pumping process is carried out manually: by squeezing the “pear”, the woman starts the suction mechanism. Electric models are good because they work independently: from the mains or from batteries (batteries, accumulators) and do not require additional effort on the part of the woman.

Mom usually chooses a breast pump model according to her taste and financial capabilities. It should be borne in mind that devices powered by batteries lose power faster than devices powered by the mains.

Many women are confused by the fact that electric breast pumps are loud enough. To date, there are a large number of silent devices, which is recommended to pay attention to when buying. The most effective are electric breast pumps that express both breasts at the same time and have the option of adjusting the thrust force and suction speed.

When choosing a breast pump, pay attention to the presence of the “boil and sterilize” marking. There must be the possibility of such heat treatment of parts of the apparatus. If the model cannot be boiled and sterilized, it is better to refuse to purchase it and look for another one.

Rules for expressing with a breast pump

Before pumping for the first time, carefully read the instructions for the device. Check that it is properly assembled.

Sterilize the funnel and sump (boil or use a sterilizer).

Position the funnel so that the nipple is in the center of the funnel.

The draw should be the lowest, especially at first, until the breast is accustomed to expressing with a breast pump. Each breast must be pumped until a feeling of relief, add 2 minutes to this time. On average, the process will take about 15 minutes.

Pumping, like manual pumping, should be carried out some time after feeding.

Basic mistakes when expressing with a breast pump

Incorrect position of the funnel of the breast pump can cause pain to the woman. Remember: the nipple should be located strictly in the center of the funnel of the device.

Very long pumping. Do not exceed the time required to collect milk, this can lead to hyperlactation (production of excess milk).

Very strong traction. If your breast pump has a selectable thrust function, you should use the smallest one so as not to hurt your breasts.

Care of the breast pump. A breast pump, like any machine, needs proper care. It must not be clogged so as not to contaminate the milk.

Each model has a care instruction, which you should definitely read before using the device.

When washing, always disassemble the pump completely, removing even the smallest parts. This will prevent stagnation of milk residues in them.

Before each use, sterilize all parts of the machine that come into contact with milk. This can be done with a sterilizer.

Milk defrosting

Never thaw or heat breast milk in a microwave oven. When heated in the microwave, the milk warms up unevenly, while feeding the baby can burn. Also, due to the rapid heating of frozen milk when using a microwave, most of the useful properties of this invaluable product are lost.

To defrost breast milk, place it on the refrigerator shelf, and when it becomes liquid, heat it up. To do this, lower the milk bottle into hot water or put it under hot water.