Can you make too much milk?
I suppose it depends on who you ask.
There is something called "oversupply" or "hyperlactation" or "overactive milk ejection" that can be a mixed blessing. You sure get to store up a bunch if you are pumping but if you don't remove the milk adequately, you can get recurrent plugged ducts and mastitis and other unpleasantness.
We don't know really why it happens (I have my theories though). The ability to produce breastmilk exists on a spectrum. On one end, we have moms who aren't able to produce enough milk. I can usually help with that, or at least attempt to explain it. On the opposite side of the spectrum are the moms who can't ever seem to be empty, leaking through clothes and bedding, pumping crazy amounts of milk even when their obviously full baby is done eating. Maybe it's from too much pumping (one theory). Maybe it's because there is something really cool about those moms we haven't figured out yet. Some people say that these women are "blessed." I bet the people who can still pump 8 ounces after the baby eats aren't very comfortable, and probably don't feel so blessed.
Mothers who overproduce breastmilk can have plugged ducts, recurrent mastitis, and breast abscesses. We need to slow milk production, use antibiotics if mastitis occurs, and anti-inflammatory medications like Ibuprofen for discomfort.
Infants of mothers with an oversupply of breastmilk (or more accurately, an aggressive milk ejection- and I think you have both oversupply and a powerful milk ejection or just one) will often choke and sputter at the breast, and pull off and reattach themselves to the breast as they attempt to control the flow of milk. This can happen even at the end of the feeding since the milk ejection reflex (“let-down”) occurs several times during a feeding. I've seen these kids actually use their hands to push away the breast. They sometimes bite to slow the flow and often get on the breast, suck a few times and then cry. They always sound "congested" because there is always food banging around the back of their nose. You can try to suck that noise out, but it's food, not snot.
These babies feed frequently, gain weight very quickly, are often “colicky” and have explosive watery bowel movements. Mothers of these children are often told to wean the baby since the child is “allergic” to the milk. Of course I wouldn't tell you that. These babies can be managed without having to wean. Plus, breastmilk allergy is extremely rare if it even occurs.
Overabundance of maternal milk should be distinguished from other reasons for breast fullness, such as engorgement, which may be related to a poor latch and poor milk transfer from the breast. Usually, the baby is gaining like crazy when the mom has breast fullness from overproduction. Breast fullness from engorgement should be managed with the help of someone experienced in assessing breastfeeding complications, like me or Karen or Jenny (687-3275.)
Before we try to fix the problem, you could try positioning the baby more upright, facing the breast, so at least they won't get a big spray of forcefully- released milk while they are lying on their back. I would suggest, if you can do it, latching the baby as you normally would and then reclining back so that you are almost laying down and so that the baby is coming at the breast from the top, taking away the effect of gravity. It takes some practice, but really helps decrease the amount of air the baby is taking in, thereby decreasing the burping and gas stuff. And put your feet up. One of my theories has to do with blood pressure, and nursing with your feet up or on your side while lying down raises your blood pressure and may slow the squirting. (My theory. Lots of clinical experience; no data yet, so don't quote me, at least for this part.)
It's the aggressive milk ejection reflex that makes them sputter. You would too if you got a big blast of something in the back of your throat. You might even make choking noises. You might throw up and perhaps burp loudly. This oversupply/aggressive milk ejection isn't any fun for the kids. Most breastfeed kids don't burp well or at all since they can control the rate of flow from the breast. These kids can't control the flow of milk and they will burp with the best of 'em.
We could fix the oversupply, if you want to, with a little "lactoengineering." You only make as much milk as is removed- “demand and supply” rather than “supply and demand” soooo demand less. Feed several times on one side and let the other side stay more full. Make sure that you don't let the other breast get so full that it's going to explode since that's what causes the plugged ducts and mastitis. Pump it until you're comfortable, but not to empty. Pumping to empty makes you make more milk.
A couple of things happen when you use just one side. First, we work on foremilk/hindmilk imbalances. We're not really supposed to be using these terms anymore, but I think they are helpful.
Foremilk is the thirst- quenching milk in your breast, ready to go at the beginning of the feeding and has lots of lactose but not much fat so it's low in calories. Lactose is very important. It helps with the intestinal absorption of calcium and iron. It helps promote the growth of good bacteria in the gut. And probably most importantly, it is a sugar that attaches to a lipid needed for brain development.
Hindmilk, at the end of a feeding, is higher in calories because it's higher in fat. The amount of fat slowly increases over a feeding, releasing a gut hormone called cholecystokinin (CCK) and CCK is one hormone that tells your brain you are full. If you don't get that fat, you don't get CCK, you keep eating. If you do several feedings on one breast, then there is less foremilk to get through and the baby might just feel full. You'll know when the baby gets to the hindmilk because they come off the breast looking verrrrry satisfied. This process works on opioid receptors, you know, like morphine. That state of enough-fat -contentment I call the "milk buzz." The baby who is blown off the breast by a squirt after a let-down is different than the one enjoying the milk buzz. The kids with the milk buzz are out, hard to arouse. Kids squirted off wake up right away, if they even slept. Those kids should go on the same breast until you see the buzz.
If mom has a lot of milk, the kids get lots of milk, and lots of lactose. Lactose is a sugar. Lots of sugar delivered to your stomach makes your stomach empty faster. Fat makes it empty slower. Lots of lactose leaves the stomach, heads to the intestine in a big blop and just can't all be digested because it's moving fast and there may not be enough enzyme to break it all down. This is often mistaken for a lactose intolerance which is really, really, really rare in infancy. The kids then get gassy, have explosive poops and get really irritable. Most moms blame something in their diet. It's probably that the baby doesn't know they are full. They gain weight like crazy and are always at the breast. We just need to make the baby know they are full.
I'm not a fan of nipple shields but this may be one time where, if position changes don't help, that it may work. Here's what it looks like (and I have them in the office) You can see that it might serve as a "breakwater" to slow things down a bit and make the feeding more pleasant. We could also use drugs, although this is a desperate measure. For example, while pseudoephedrine is compatible with breastfeeding, just one 60 mg capsule can suppress milk production. Estrogen-containing birth control pills may also help.
If this goes on without us realizing that the kids are getting blasted, they may start to refuse the breast. Wouldn't you? If you were getting squirted every time you ate something (even if it's something you really loved), wouldn't you try to avoid it? Maybe. Or the kids may "play" at the breast, latching on, pulling off, latching on, pulling off...you could get the idea that the child didn't like your milk, or that you ate something bad, or that you don't have any or enough milk when your child is actually developing defensive maneuvers to protect themselves from the big squirt. They may bite to slow the flow and that might be an important cause of nipple pain.
Of course we don't necessarily have to fix the oversupply. And not every kid is bugged by the fast flow. It may come in handy for later use, such as a return to the workplace. We could also consider donating it to our local milk bank, the Mother's Milk Association of Wisconsin in Madison.
updated January 22, 2009