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Thread: Trying to correct oversupply/tummy issues

  1. #1

    Question Trying to correct oversupply/tummy issues

    Hello everyone,

    The short version of my question is: I'm following the instructions on this page for reducing my milk supply in hopes of alleviating green poo, gas, distress and crankiness in my 8-week-old. I started yesterday and overnight, my breasts became so engorged that they're literally rock hard, all the way down to the nipples. Is this normal for this process? Will my LO ever possibly drink enough to alleviate the engorgement and get anything other than foremilk?

    Here's the long version:

    My LO is 8 weeks old; my first. I had intended to have immediate post-birth skin-to-skin and start breast feeding, but medical necessity intervened and it was nearly a week before I was able to attempt breast feeding, although I was pumping and giving by bottle before then.

    When my milk came in, I became very, very engorged. Pre-pregnancy I was an A cup at best, and my breasts became rock hard all the way down to the nipples. So engorged that the lactation consultant at the hospital gave me a nipple shield so that the baby could even latch a little bit, but advised me not to use it and instead to pump until there was some improvement in my nipple flexibility before attempting to breast feed.

    We continued using the nipple shield and pumping to feed with a bottle once or twice a day when home (what I had read about nipple shields recommended pumping after every feeding when using them, so I made sure both breasts were emptied one way or the other every feed). At about three weeks, my LO started having one greenish poo a day, which I realized was correlated with periods of extreme crankiness and tummy upset. My LO has been eating like a champ and growing huge and chubby.

    Then last week, at 7 weeks, poo turned exclusively green, ranging from grass green to a yellowish-but-still-green dark khaki and accompanied by extreme crankiness and gas that required straining to pass. After four days or so, it seemed to be escalating, not improving.

    At this point, I started Googling and realized I was probably dealing with a foremilk-hindmilk imbalance. In an attempt to stabilize things, I started pumping exclusively, to ensure LO was getting at least some fat with every meal. The amounts I pump range from 1-1/2 to 5-1/2 oz per breast (3 to 11 oz total) per session, depending on the time of day and length between sessions. A typical bottle feed for my LO is around 2-4 oz.

    Doing this, most of the bright green poo went away, and it started tending toward the darker, yellowish and the crankiness seemed to abate. Still, I never saw a good orange-yellow poo like what we used to have and things weren't back to normal entirely with the gas. I called the pediatrician, who was not terribly concerned, and suggested we burp more thoroughly, but didn't mention any possible issues with my milk.

    It seemed to me that I had confirmed I was overproducing (5-1/2 oz from each breast at times -- remember I'm an A cup normally, so that's a huge amount to store in there!) and that a foremilk-hindmilk issue was causing LO's issues (LO was responding well to getting exclusively pumped milk, which guaranteed at least a mid-level fat every meal, but didn't entirely correct things). So yesterday, I went back to exclusively breast feeding following the first-level protocol on the LLLI page about oversupply. I'm not sure if it's relevant, but we're still using the nipple shield because of a tongue tie that was just resolved with surgery last week.

    Overnight, my breasts have become more engorged than they've been since my milk first came in. They're literally like rocks all the way down to the nipples. I was able to get LO to feed using the nipple shield, but it hurt worse than anything I've ever felt, including birth. Feeding alleviates the engorgement a tiny bit, but LO isn't getting anything but foremilk (I can tell because I'm still dripping watery foremilk after the feeding) and there's barely any change at all in my breasts after each feeding.

    To compound my stress, I have to go back to work in two weeks, and so I have to be pumping enough to feed her all day while I'm gone by then. I'm concerned about being able to do that.

    Is this level of engorgement normal for this process? What should I be doing? I know I've caused my own problems, and I just need to know how to get out of this milky hole I've dug. I'm sorry if this all sounds neurotic and hysterical -- it's been a stressful few weeks.

    Thanks for any experience/advice you can share. We need it!

  2. #2
    Join Date
    May 2006
    Posts
    21,117

    Default Re: Trying to correct oversupply/tummy issues

    Welcome to the forum and congratulations on the new baby!

    The first thing to know about oversupply (a.k.a. foremilk/hindmilk imbalance) is that all milk- including the so-called foremilk- contains everything a baby needs to grow and develop, and that includes fat. A baby will grow well, sometimes extremely well, on a diet of "foremilk" alone, provided he gets enough of it. The only problem with milk produced by a mom with an oversupply is that it may give the baby green or in rare cases bloody poops, extra gassiness, and fussiness. These are more annoyance than they are health problems (and yes, that even includes situation where oversupply causes bloody poops). So please do not drive yourself crazy worrying about the fat vs. lactose content of your milk, or risking potentially derailing breastfeeding by exclusively pumping.

    It is normal for oversupply to come and go repeatedly. So the fact that you are experiencing engorgement again doesn't necessarily mean much. However, I am a little concerned about the engorgement because:
    1. You just transitioned baby back to the breast
    2. You are using a shield
    3. You're not feeling much change in fullness after the baby nurses
    4. You're so engorged that you feel "rock hard".
    Those 4 things, taken together, make me wonder if the baby is able to get much milk out right now. Rock-hard engorgement and shield use can reduce the baby's ability to drain the breast. And a baby who has just been transitioned back to the breast may not have all the suckling skills he needs to get milk from the breast, due to becoming used to the bottle.

    I am also concerned because you are in severe pain, which makes me worried about mastitis (bacterial breast infection). Mastitis is more common in women who are overproducing milk and who are having difficulty in draining the breast.

    So, in your shoes, I would want to do the following:
    1. Watch the baby's diaper output very carefully for the next few days. As long as the baby is peeing/pooping enough, he's getting enough to eat.
    2. If baby will nurse without the shield, stop using it. If the shield is the only way your baby will latch, continue to use it. It's more important to have the baby nursing at the breast than to worry about the impact of the shield.
    3. If baby is unable to latch due to extreme fullness, either hand-express (preferably) or pump a small amount of milk to soften the breast prior to latching your baby on. An ounce or two of milk removal should do the trick (hopefully).
    4. Use reverse pressure softening (http://kellymom.com/bf/concerns/moth...oft_cotterman/) to enable the baby to latch.
    5. Watch yourself very carefully for symptoms of mastitis, which include extreme breast tenderness or pain, hard lumps in the breast (these would be engorged ducts, indistinguishable from engorgement, so probably not a useful symptom for you at this point), red patches or streaks on the skin of the breast, fever and chills, and whole-body aches and pains. If you have some or all of these symptoms, please contact your health care provider, as you may need antibiotics, nurse as much as possible, and get out the pump and drain the affected breast or breasts as fully as possible. Using the pump and fully draining the breast/breasts will not help the oversupply situation, but in case of mastitis, oversupply becomes a secondary consideration.
    3. Use comfort measures, like ice packs or cold cracked cabbage leaves tucked into your bra (if you're wearing one).

    Please give yourself some time and be very patient with your body. I know your return to work is stressing you, but this is the time to focus on caring for yourself and on nursing the baby. Let's get that going right before we start worrying about pumping at the office. Okay?
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

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