Abundant Milk Supply

Excess Foremilk (Skim) -->   Lactose Overload  -->   Fussy Baby

• Excess milk puts your breasts at risk for plugged ducts , mastitis , and breast pain. 
• If you produce a lot more milk than your baby needs, your breast will be so full that your baby can’t empty the breast during a nursing session. She will consume too much foremilk and not enough hind milk.
• This foremilk is low in fat (it is skim milk) so it passes through the stomach quickly and the large volume dumps into the small intestine.
• This foremilk is also high in lactose (milk sugar), and the large volume of it is too much for the lactase digestive enzyme to handle.
• Thus, your baby develops symptoms of a “ relative lactose intolerance ” or “ lactose overload."
  • Fussiness  
  • Gassiness 
  • Mucousy and/or explosive green watery stools. Sometimes blood.
  • Your baby acts hungry all the time because the skim milk is like eating lettuce all day – she eats a lot but doesn't feel full. Consuming more high fat, high calorie hind milk, will make her feel full, as if she ate cheese cake!

How to prevent abundant milk supply issues.

• Before milk comes in, nurse both breasts equally at each session, around 10-15 minutes per breast. 
• When milk starts coming in, babies often cluster feed very frequently. 
• Once milk is in, completely empty the first breast before switching to the second.
  • Foremilk (skim) comes out first, then whole milk, and lastly creamy hind milk.
  • Most babies take 15-20 minutes to empty the first breast and take the second side for 5-10 minutes. Some empty a breast in 5 minutes, but others take 30-40 minutes.
  • Most babies nurse 1½ breasts per session. Some need just one breast per feeding, and others empty both breasts.

       Important points once your milk is in 

• If you switch to the 2nd breast automatically after just 10 minutes, like you did before your milk came in, your baby will get just the foremilk from each breast. 
• Instead, stay on the first breast until breast compressions no longer result in swallowing sounds. No more swallows means the breast is empty. If your baby wants to nurse again within an hour or so, consider this a continuation of the last feeding and go back to the same breast again, to be sure it gets empty.
• If your baby nurses just one breast per session, do not pump the other breast, but rather leave it for the next feeding. Pumping it to empty will demand even more than what your baby needs and your production will ramp up. However, if that breast is uncomfortably full, hand express just enough to be comfortable again.
• Click here to read how collecting milk in a Haakaa can ramp up your milk supply.

Managing an abundant milk supply and associated symptoms

• When you feel overly full of milk, a common mistake is to frequently pump after nursing to relieve the fullness. As noted above, it's OK to do this when necessary, but just until you're comfortable. Emptying your breasts these extra times will further ramp up your supply. 
• If you think you have over-supply issues, confirm this with someone who will assess the entire feeding regimen. Follow the instructions above to prevent progression of an over-supply. 
• If the issue has already progressed and causes symptoms for you and/or your baby (see above), the following feeding regimen will control your supply and resolve symptoms. 
  • This regimen does not restrict the number of feedings, but rather dictates when and which breast to offer at feedings.  
  •  The goals are to
    • drain a breast completely to increase your baby’s intake of fat and calories
    • limit the overall milk production to meet your baby’s demand rather than exceed it excessively. You'll still be able to store some milk for return to work. 
    • avoid plugged ducts while milk supply backs off. 

Feeding instructions to control an abundant milk supply (sometimes called “block feeding”)

• This completely cleans out your milk ducts once per day, which will help prevent plugged ducts as the new feeding plan controls your supply.
• In addition, this extra milk can stock the freezer to prepare for return to work. Don’t worry that the milk that goes in the freezer is mostly skim milk.  

• During the 3 hours, she’ll work her way through to the creamy milk.
• She may take 1, 2 or even 3 feedings in those 3 hours. 
• When the 3 hours are up, wait for her to demand the next feeding and start on the other breast. For the next 3 hours, offer only this breast. 
• If the “resting” breast gets too full and uncomfortable, pump off just enough to get comfortable (not to empty).
• Over time, the “resting” full breast will dial down its production.  

• Weight checks are needed during this adjustment phase, to make sure your supply doesn’t drop too much .

Things to consume that help down-regulate milk supply

• Altoids. Take ~ 5 per day.
• Peppermint tea 1 cup three times per day.
• Birth control pills with estrogen for 1 week. 
• Pseudoephedrine 30mg. Take 1 dose. Monitor effect and repeat every 12 hours if needed.
• Antihistamines