Milk flow too fast for baby to feed

[@llli*jah73]

Hi, hoping someone can give me some advice! My baby is almost 5mnths, and from the start i have had oversupply and over active letdown. I am constantly engorged and when my baby tries to feed, she can't cope with the flow, leave alone the letdown. She coughs and chokes and is now screaming and refusing to feed. As soon as she latches, milk sprays down her throat. I have taken advice from numerous LC's and none of them have been able to help. I want to continue to BF and don't want to use a bottle or nipple shield. I am hoping for some advice on how to reduce milk supply and slow the flow. I am currently taking half teaspoon of sage 3 times a day and block feeding. I feed her (although times vary as she refuses to nurse so a feed can take 2hrs) 9am and 1200 same side, then swap for 3pm and 6pm same side, then swap 8pm, swap 10.30pm, 1st feed in morning on fullest (both are bursting by now) usually she feeds within a couple of hours so I use same side again and then swap at 9am and start all over again. I hand express the1st letdown when I swap sides after a long block of time as the flow is just so fast, but she can't even cope afterwards. I'm scared to express more as I don't want to increase supply even more but she chokes on every suck and must go on and off well over 50 times, if I can actually get her to feed. I have tried nursing lying back and lying flat, but it doesn't help. Also I try doing a scissor hold, but she finds it difficult to feed with my fingers there and it doesn't really seem to slow the flow. She really wants to fall asleep at the breast but just gets a face full of milk. Can anyone tell me, when you block feed, what happens at the beginning of a block, when you change sides, how is the baby supposed to feed off a breast that is bursting as it just sprays constantly? Am I meant to express off more and will that increase my supply? Am I better doing 1 feed on 1 side and the next on the other. I have tried all combinations. Has anyone had experience of what worked for them to reduce supply? My baby is putting on weight but feeding is taking up ALL of my time and taking over my life, I have no time to give my toddler and that can't be right! I would be so grateful for any advice as I am really not sure of the best course of action to resolve these problems. I have breast implants, but my surgeon assures me that they would not be causing these types of problems. Has anyone experienced what we are going through, and if so, what did you do?

[@llli*lllmeg]

Wow it sounds like you have serious oversupply/oald. Yikes.

In reading you post, I wonder why you are expressing at all-is it for your own comfort/to avoid engorgement, or in order to supplement baby? I understand baby is pulling on and off but as long as baby is gaining well this does not matter. When a mom has such a fast letdown baby usually gains VERY well. Is slow gain an issue? If you can avoid expressing, that is usually best when you have oversupply, except when you are using pumping as part of a milk reduction strategy, which I go over below.

As far as the spraying when you switch sides when block feeding, maybe you should try nursing even more often. I get it that feeding is taking up lots of time and the idea of feeding more often is probably not attractive, but my hope is that this will reduce the struggle each feeding has become and you can fall into a more manageable routine of frequent but short and effective nursing sessions. This won't happen overnight.

Block feeding does not mean to limit nursing frequency at all, it only means to nurse at one side for more than one feeding. When block feeding mom should still cue feed and in fact FREQUENT nursing helps with oald as there is less build up in between. Since you are having so much trouble with the spraying at the start of a block, I do wonder if you should back off block feeding entirely, nurse on one side at a time, and nurse very frequently for a while and see if that helps. Have you tried taking baby off when that initial big letdown occurs, letting it spray into a towel and then putting baby back on?

Also have you eliminated any hidden milk producers in your diet or supplements?

If nursing up hill or side lying has not helped, maybe if you can get the force to calm down a bit by nursing more frequently these measures will start to work better.

Have you ever tried a nipple shield? I understand not wanting to do that but if the only other alternative is pumping and bottles I would suggest trying a nipple shield first. It may or may not help, with that forceful a letdown I wonder if you would be able to keep a shield on, even. But I think any measure that keeps baby nursing at the breast is preferable to the alternative.

I looked up severe oversupply in Breastfeeding Answers Made Simple (Mohrbacher, 2010) and found these suggestions for SEVERE oversupply that does not respond to other measures. With this kind of techniques, baby should be gaining extremely rapidly-in other words, you should be very, very sure the issue is severe oversupply, and not just medium oversupply or just oald.

1) "full drainage and block feeding" method: This was done in a limited study (4 moms with oversupply) and for those moms it slowed milk production. The method is: using an effective breast pump to drain both breasts as fully as possible, then putting baby immediately to the breast. For the next three hours, baby is nursed at the same breast as often as baby cues. After three hours, mom offers the other breast at every cue. Depending on the severity of the overproduction, the time blocks were increased to 4, 5, 8, and, for one mom 12 hours! For some moms, no further draining with the pump was needed, for others, draining the breasts 1 or 2 more times helped.

2) Taking pseudoephedrine-in one study taking 60 mg a day was found to decrease milk production 24% over a placebo. It is important the original formula is used and not the 'PE" formula. Others suggest moms can either take one 60 mg. dose at bedtime or spread the total 60mg per day evenly over a day.

3) Taking combined oral contraceptives: a 4-7 day course of a low dose oral contraceptive with both estrogen and progesterone once a day.

4) Sage: Be careful to avoid the essential oil, as that form of sage is toxic. to use sage to slow milk production: steep 1 Tablespoon of Fresh whole leaf dried herb in 1 cup of boiling water for 10-15 minutes. Drink 3 to 6 cups per day until milk production becomes manageable for both baby and mom and then discontinue.

5) There is another block feeding/pumping technique described called a "right brained strategy" but it is too complicated to describe here. One of the LC's you spoke to should have this book and can go over all these techniques with you, they are on pages 427-430.

[@llli*mommal]

Wow, that sounds like some severe oversupply! I think lllMeg gave you excellent advice. I just want to suggest adding in some peppermint tea to your regimen- like sage, peppermint is supposed to reduce supply. It can't hurt, and might help.

[@llli*jah73]

Thanks for your ideas, I think I will try nursing more frequently but no sure how it will go as I am struggling to get her to nurse at all also she only seems to attempt with the flow if she is really hungry. I am a bit confused about how it will work as she sometimes sleeps 6hrs at night so if my boobs get used to feeding frequently during the day they will be bursting over night. Also wondering how swapping sides frequently will work, as if she is refusing she may take only a few mouthfuls over the course of several hours. I have never used a pump and only hand express if I am so engorged that I am about to get mastitis (which is quite often at the moment) or if I'm bursting at the beginning of a feed as she chokes and flatly refuses to nurse. On the advice of an LC, I did try offering both breasts at each feed and it was a disaster. The let downs and flow seemed better but my baby had stomach pain and symptoms of lactose overload, and my supply rocketed! I really am confused about the best way to deal with this as there is so much conflicting advice and nothing I try seems to work. My baby is very unhappy and so am I. I would be interested to here if anyone has had a similar experience and what worked for you.

[@llli*mommal]

I am a bit confused about how it will work as she sometimes sleeps 6hrs at night so if my boobs get used to feeding frequently during the day they will be bursting over night

Eventually your body should be able to learn to make the right amount of milk for a given time of day. More during the day, less at night.

The thing that works for most moms with oversupply... Is time. Time, patience, and persistence. If using both sides at a feeding made your supply go nuts, I think I'd probably avoid that and just concentrate on the block feeding. And since you're having such a difficult issue, I think I would try the pseudoephedrine remedy lllMeg suggested. If that doesn't work, then I'd graduate to the oral contraceptive route.

[@llli*jah73]

I'm. A bit scared to try pseudo ephedrine but am getting desperate. Does anyone know if it has any side effects fo baby and also, if it reduces supply too much, is it reversible? I am trying to nurse more frequently, but in a loose block pattern, so staying on one side until it feels really soft instead of going by the clock or by number of feeds, not sure if this is the best thing to do as the time that each side is used or not used, will vary so much? DD has been really unsettled all day, not sure of she is hungry, tired or uncomfortable. It is difficult to tell what she wants as most babies will feed when they are hungry and refuse when they are not but DD refuses also when she is hungry because the flow upsets her so much. I'll give it a few days and see what happens.

[@llli*mommal]

Pseudoephedrine:
- effects on baby- none that I know of
- if it reduces supply too much, it is definitely reversible. Just nurse more and increased stimulation and milk removal will promote increased supply.

Your current block feeding strategy sounds great. Much better to pay attention to your body than the clock. Your body doesn't do things according to the clock- it has its own internal idiosyncrasies. just like your baby does- some days the flow probably bothers her more than others. It's pretty common for babies whose moms have OALD to be reluctant nursers, but have you talked to your doc about the possibility that reflux is compounding her issues with the breast? When a baby refuses to nurse even when hungry, I have to wonder if there's not an additional puzzle piece in the mix.

Let us know how things go!

[@llli*lllmeg]

I just want to point out again, that the ideas in my pp are for when severe oversupply is present (indicated by breasts being full/engorged even when baby is nursing often and well AND unusually rapid weight gain in the exclusively breastfed baby, AND it has not been helped by more typical measures, like nursing on cue, with normal nursing frequency, block nursing, uphill nursing etc. As mommal points out, it takes time for the more typical measures to work. If you have been limiting nursing time/frequency in an attempt to control your oversupply, as some moms do, you may have instead made the oald worse and perhaps inhibited normal nursing behavior in baby. I suggest trying the reccomended ideas for at least a couple of weeks. Also nursing frequently in this case means to cue nurse and also offer the breast as you like, but if baby is not interested they are not interested. Things can backfire if you try to 'force' baby to nurse. Kellymom has a good article on how to gently encourage baby to nurse, it's called "Help My Baby Won't Nurse."

Mommal also has good thoughts on the block nursing. Go by how you feel rather than timing the blocks exactly. And remember, with block nursing, you want to get full enough for long enough to give your body the message to slow down milk supply, while not getting to the point you are facing painful, tight engorgement that could casue other issues.

For the long sleep break at night, if you fear engorgement, you could try hand expressing just to comfort until your body begins to slow down production. A 6 hour sleep break at night woud be perfectly normal for a healthy well fed 5 month old, (and yes some moms will experience fullness during that time, normally) and such long slep breaks are normally accompanied by baby nursing frequently at other times of the day. You want to aim for that normal type of a nursing pattern by letting baby take the lead.

[@llli*jah73]

I have fed baby frequently today and block nursed by the feel of my breasts, it has not gone well, I think she has ended up getting too much milk as she tries to comfort nurse but gets loads of milk, so tries to get through it so that she can comfort. She has been screaming and I think she has reflux symptoms from being too full. When she feeds less often she doesn't get this, so I'm confused. Any thoughts? Thanks for your time

[@llli*mommal]

Sorry today has been so hard, mama. I wish there was some sort of magic bullet for fixing oversupply and fast letdowns... But there isn't, unless you count time and patience. I know when I was block feeding I'd feel like I was taking 2 steps forward and then 1 step back. I'd feel like the oversupply was diminishing, and then wham! It would come back.

Look, I think that if you are willing to continue with the frequent feedings and block feeding by feel, you're eventually going to see good results. But the key word here is "eventually".

What reflux symptoms are you seeing? And how has baby's weight gain been, so far?