Oversupply: When there is too much of a good thing.

Overproduction Disrupts the Distribution of Fat & Lactose

When feeding directly at breast, the average 1-9 month old will take about 2.5-5 oz of breastmilk per feed. In the context of oversupply, a woman may have 6 or more ounces in one breast alone. If it has been several hours since the previous milk removal, the milk in the breast will have had time to separate, with the fat floating to the top of the milk glands. If you have ever bought milk fresh from a dairy farm or pumped and then left the bottle to sit, you've seen the same thing happen as the cream rises to the top of the non-homogenized milk (see bottle image). This separation has sometimes been referred to as hindmilk and foremilk, but these terms led to a lot of confusion as people thought it meant the breast produced two different types of milk. It doesn't. The breast makes one consistent type of milk but after a few hours of sitting the fat naturally floats to the top of the breast and sticks to the walls of the milk glands. So, what does this have to do with oversupply? A baby breastfeeding from an overfull breast will not be able to drink all of the milk present and will first be able to drain the lower portions of milk with a higher lactose content. Baby may not have room in his tummy to drink enough of the milk for the cream top to makes its way down and out the milk ducts. In some babies, this disrupted distribution of fat and lactose may cause tummy upset.1 The fat and lactose digested together work as partners, but with lactose in high quantities separate from the fat it can irritate a sensitive tummy, rush through the digestive track and come out with bile present as a green frothy diaper.1 If your baby is showing signs of lactose overload, keep reading to learn about simple solutions to resolve this issue.

Overproduction Causes Rapid Milk Flow

Another way overproduction can cause a baby discomfort is by creating an excessively rapid flow of milk. A very full breast leads to faster milk flow as the weight of milk pushes forward to find release, much like a pent up damn opening the floodgates. If you often hear your baby gulp rapidly only to choke, sputter and cough while your milk continues to flow then you've witnessed this torrent. It can be stressful for babies to try to manage rapid milk flow and may lead to increased air swallowing and gas. 

In mild cases, adjusting into a reclined position with baby face down on the breast (see picture) will help gravity to moderate the flow of milk and give baby more control over his suck-swallow-breathe rhythms. Also, please be aware that occasionally babies with tongue-tie will struggle with milk flow even when milk production is normal. This is not caused by rapid milk flow but rather by baby's difficulty controlling the movement of milk in his mouth, leading to accidentally allowing milk into the windpipe when baby tries to take a breath between swallows.

Usually babies are great at self-regulating their intake at breast and will switch to a comfort suck once they feel full. However, very fast milk flow can cause baby to transfer a full feed in 5 minutes, which is not long enough for the hormones that signal satiety to circulate and not long enough to meet a young baby's suckling needs. Baby may even switch to a comfort suck that typically would not draw milk (one of the beauties of breastfeeding!), but due to the excess milk production and torrential flow, even a light suck may draw milk. Occasionally this leads to excessive weight gain (over 2 ounces per day) or a frustrated baby who just wants to comfort nurse and is being unintentionally "force fed." If your baby seems uncomfortable during feeds, frustrated when he tries to comfort nurse, and is gaining over 2 ounces per day this may signal oversupply.

Overproduction Increases Mother's Discomfort

Overproduction is not only unpleasant for baby, it can also be uncomfortable for mothers. Many mothers with overproduction experience frequent engorgement and feel like they have to pump often for relief. Plugged ducts and mastitis are more common because the excessive fullness and can trigger inflammation; inflammation can lead to tissue swelling; tissue swelling can cause ducts to be pinched closed, leading to a build up of trapped milk in the lobules. This is often referred to as plugged ducts and untreated can turn into mastitis. As mothers pump frequently to try to relieve the pressure, the breasts are signaled that the extra milk is being used and needed, and it reinforces the oversupply and perpetuates the problem. This vicious cycle is hard to break, but there are some solutions.

Use Breast Massage to Mix it Up

If your baby is having green diapers every day, you can easily resolve the foremilk/hindmilk separation by briefly massaging and jiggling your breasts before latching. Studies have found combining massage with pumping or breastfeeding actually increases the fat content of the breastmilk.2,3 It works by mixing the milkfat back into milk, much like shaking a bottle redistributes the fat that clinged to the edges and floated to the top.  Breast massage and jiggle before latching is called "The Milkshake Technique" and it works wonders at instantly resolving foremilk/hindmilk imbalances. If used consistently, especially anytime a woman feels full and it has been several hours since the last feed, the Milkshake Technique should quickly eliminate the green stools, gas and accompanying discomfort. There is absolutely no need to overthink the process. I do not recommend forcing baby to stay on one breast or other complicated measures that overthink the issue. Simply give those girls a little shake to mix then latch - easy peezy!

Rule out Underlying Causes

In severe and persistent cases of hyperlactation, we recommend making an appointment with a breastfeeding medicine doctor or your OBGYN. They can perform bloodwork to see if a medical condition is causing extreme overproduction. In rare cases, hyperlactation can be due to hyperthyroidism, a pituitary tumor, or a side effect of a medication. Some lactation specialists speculate that systemic inflammation causes oversupply for some women, but this is not well understood yet. Think of it like your nasal passages - when they are inflamed they produce more secretions and feel swollen. Hypothetically, generalized inflammation could cause your breasts to produce more fluid and swelling. Again - not very well understood, but its food for thought! Women could try eating a Mediterranean Diet, exercise, omega 3 fatty acids, and turmeric (curcumin) if they would like to explore a natural approach to systemic inflammation, in conjunction with seeking medical evaluation.