Over Supply

Just as low supply is a problem, oversupply too is a problem lying on the other end of the continuum.

Usually, the milk supply gets established and adjusted as per the baby’s needs in the first 6 weeks. This is a crucial time to ensure that the baby’s actual needs are communicated to the mother’s body and a balance between demand and supply is stricken. If the baby doesn’t nurse optimally at the breast, the supply takes a hit. Similarly, if breast milk requirement is communicated to the mother’s body in access, the supply increases more than the baby’s actual needs – resulting in oversupply.

Some common causes of oversupply:

1. Some women naturally produce breast milk in more volumes.
2. Artificial stimulation of nipples and breasts through pumping can cause oversupply. This is why it is recommended to avoid pumping in the first 6 weeks. Hand expressing to relief in case of engorgement, fast letdown, natural oversupply etc is better than pumping.
3. When galactagogues are consumed without the actual need for it, it can lead to oversupply.
4. While nursing, when a mother frequently switches breasts without letting them drain completely, the baby ends up drinking more of the foremilk (with less fat). This can make the baby hungry sooner. So the baby nurses more frequently and the breasts aren’t drained but yet stimulated more frequently, leading to oversupply.
5. Mothers of premature babies need to pump as their babies might be in NICU and/or are unable to latch. As there’s lack of direct communication between the mother and baby’s bodies, sometimes the mother pumps more often than needed which can lead to oversupply. Same is also possible for exclusively pumping moms.

How to determine if you have an oversupply? Signs to look out for:

1. Oversupply often goes hand in hand with a forceful or fast letdown. Oversupply manifests itself in various forms. Some can be interpreted wrongly as many of the signs of oversupply overlap with the signs of reflux, colic/gas, poor latch etc.
2. Baby gags, chokes, coughs, gasps while nursing.
3. Baby clamps down on the nipple to control the fast flow of milk. This can lead to sore and cracked nipples.
4. Baby pulls away from the breast and becomes very fussy.
5. Baby spits up the milk very often. The quantity too can be large.
6. Baby is gassy.
7. Mother’s breasts don’t feel empty and drained post nursing.
8. A baby may pass green stools.
9. Baby suffers from weight gain issues. In some cases, babies gain a lot of weight as they drink milk in abundance, whereas in some cases, babies don’t gain enough weight as they fill up on foremilk (which has less fat) and air while nursing, resulting in a good pee count but poor weight gain.

How to manage oversupply?

1. Enabling the baby to adjust with the oversupply of breastmilk.
2. The laid back position is very useful as the baby has to work against gravity to nurse. This position inhibits the fast flow so the baby doesn’t gag/choke.
3. Football position and Cradle hold are useful when the baby’s head is kept a little higher and not parallel to the body. The mother may also lean back a little to help the baby further.
4. The scissor hold (which is otherwise not recommended) can work as it slows down the flow while nursing the baby.
5. Nursing at early hunger cues and/or nursing when the baby is sleepy or relaxed makes the baby suckle at breast gently. This can control the flow.
6. The mother may wait till the letdown occurs, and when it does, she can remove the baby from the breast and once the flow slows down, put the baby to breast again.
7. Hand expressing a little before nursing the baby can also work.

Bringing the supply down to match the baby’s needs.

1. It should only be done after the first 6 weeks.
2. Nursing the baby from only one breast in each nursing session is a good idea when the baby is gaining weight well. However, in some cases, babies don’t gain enough weight even if the mother is having an oversupply (as the baby is unable to drain the breast and get the hindmilk which is rich in fats). In such cases, the focus should be more on helping the baby get to the hindmilk without getting full with the foremilk. (taking the baby off the breast when letdown occurs, and putting her back on the breast once the milk flow slows down is a useful technique here).
3. Block feeding is a popular technique to deal with oversupply. In this method, a duration of time is decided. E.g. 4 hours. During that time the baby is fed on demand but only from a particular side. So, basically, the baby is nursed as many times as needed, but only one breast is offered during that time frame. If and whenever the other breast becomes uncomfortable during that time, hand expressing to relief is all that is done. That breast is not drained. Additionally, cold compresses can be used to discourage blood flow and in turn reduce milk production.
4. Extra breast stimulation should be avoided. E.g. pumping without need, expressing in the shower etc.
5. Extreme measures like cabbage leaves compress and consuming foods and other herbs that inhibit supply should be avoided or used with professional guidance.

References :
https://www.llli.org/breastfeeding-info/oversupply/
https://kellymom.com/bf/got-milk/supply-worries/fast-letdown/
https://www.breastfeeding.asn.au/bf-info/common-concerns%E2%80%93mum/too-much-milk