Oversupply, OALD, with baby feeding on one breast at a time

[@llli*bear.mommy]

Hello! I'm a FTM of a 7-week-old EBF boy. We had a rocky, difficult start with breastfeeding--my milk did not come in right away, plus I felt so much excruciating pain from my son's powerful/bad latch and my nipples toughening up that I resorted to mostly (machine) pumping during the first month.

Finally it stopped hurting so badly when my son nursed, and I've been able to breastfeed and almost entirely avoid pumping for the past 1-2 weeks. Granted I still experience some terrible pain, but it's (a) limited to an aching, throbbing pain that comes and goes only in my left breast; and (b) neither I nor my OB can figure out what is causing it (not thrush, no symptoms of mastitis, not letdown pain which is something I experience separately, etc.).

My main problem now is overactive letdown and what I think is oversupply (at least in my "stud" left breast). My breasts never feel fully drained after my son feeds. Also, if I do pump, I get 3-4+ ounces in my left breast and 2-3 in my right breast. When I have given my son a bottle, however, he eats about 3 oz max.

The OALD is worse in my left (stud) breast--LO chokes, gasps, cries/screams from the fast and heavy flow. I try to lean back to help with the gravitational flow, and this seems to help a little. My son only feeds on one breast at each feeding, which seems fine as he has plenty of pee diapers and is gaining weight well/rapidly (he was 8 lbs. 11 oz at birth and just yesterday was weighed at 14 lbs. 4 oz). He also shows symptoms of reflux (crying after feedings, arched back, hates to lie on his back or his tummy, frequent spit-up, occasional vomiting), which I think is partly related to how quickly he gulps milk when feeding. I know people say breastfed babies can't be overfed, but I think the OALD might be forcing LO to take in milk so quickly that his body doesn't register the feeling of fullness quickly enough. Also, LO's pediatrician said he might be overeating.

My problems are this: Since my son only feeds off one breast a time, the unused breast gets painfully engorged, especially the first stretch of the night when my son sleeps the longest--I just calculated that my right breast went 8 hours without any stimulation (from pump or baby)! This seems too long, but I don't know how to deal.

I am terrified to pump, whether right after a feeding or to replace a feeding, because I'm worried it will exacerbate my oversupply. However, my midwife suggested that I pump once in the morning after a feeding, to start building a stash, and once at night so my husband can give the baby a bottle and give me an extra bit of sleep.

I try to manually express a little to deal with engorgement pain and have been getting 1-1.5 oz from my left breast and about 1/2-1 oz from my right breast. I'd like to express less, but when my breasts are engorged, they get lumpy, and I'm scared of plugged ducts/mastitis and so express until I don't feel the lumps anymore.

Despite my son feeding off only one breast for a while, my engorgement and OALD do not seem to be getting better.

- Is there something I am doing wrong? I am nervous about block feeding for longer stretches because I'm not 100% certain I have oversupply.

- If I pump 2x a day as my midwife suggests, will it worsen the oversupply?

- If I pump after a feeding, should I only pump from the unused breast? Won't this tell my body to create more milk and thus worsen OS, since I'm taking out more milk than my LO eats in a single feeding?

- If I pump at night so that my husband can give LO a bottle, should I only pump until I reach about 3 oz (which is how much LO will eat)?

One note: I do not have a job currently so I don't have a hard deadline of having to go back to work, but I would like to start building a small stash since I'd like to be able to get out of the house some and also am thinking of specific upcoming weekends where I will be away from my son. Also, I'd like LO to get accustomed to the bottle (so far, we have been lucky in avoiding nipple confusion but I'm not sure if he'll start to reject the bottle as he gets older).

So sorry for the long and rambling post! And my apologies if this has already been addressed elsewhere! I just don't know where to begin and would appreciate any advice you may have. Thank you in advance!

[@llli*maddieb]

Hi bear.mommy. I responded to your other post about the breast pain and I suggest check that out. It was not clear on that post how much over production (OP) you are having. So it sounds pretty bad, but take heart, OP is almost always a temporary problem. You are at the peak time for milk production right now. Even if you did nothing at this point, your milk production would almost certainly begin to reduce to a more manageable amount over the next several weeks.

Also, please do not worry about your baby overeating! Yes babies whose mom has OP gain rapidly at first. This is perfectly fine, it all evens out later.

Ok, so I will take the questions one at a time.

My problems are this: Since my son only feeds off one breast a time, the unused breast gets painfully engorged, especially the first stretch of the night when my son sleeps the longest--I just calculated that my right breast went 8 hours without any stimulation (from pump or baby)! This seems too long, but I don't know how to deal.

A baby nursing one side at time is fine. But no, you do not want to have one breast go more than a few hours without milk removal (unless you are intentionally block feeding, more on that below.) So, as I suggested in your other thread, can you encourage your baby to nurse more often? Baby nursing with high frequency will probably help and cannot hurt, because baby will not take in more overall, but rather, less at each meal.

Frequent nursing also helps reduce fast flow, so should help baby be a little happier and calmer overall.

- Is there something I am doing wrong? I am nervous about block feeding for longer stretches because I'm not 100% certain I have oversupply.

It sounds like you have OP, as you are reporting most of the symptoms including above average rate of weight gain. But that is still not a reason to block nurse necessarily. Again, given a little time, OP usually solves itself. Also, block nursing in this situation where there is clearly something going on with at least one breast might cause more issues.

- If I pump 2x a day as my midwife suggests, will it worsen the oversupply?

Yes, but sometimes some pumping is needed anyway if a mom is suffering from a milk stasis related issue and baby cannot or will not nurse more often or nurse more effectively. The question then is, why is midwife suggesting this and why specifically 2 times a day (rather than as needed?) and could encouraging baby to nurse more often be more helpful than pumping?

- If I pump after a feeding, should I only pump from the unused breast? Won't this tell my body to create more milk and thus worsen OS, since I'm taking out more milk than my LO eats in a single feeding?

Again, yes, pumping after babyt nurses just like pumping any other time is going to act to increase production. (In fact pumping after baby nurses to "empty" the breast is even more likely to increase production than pumping at another time. But, does midwife think this is needed to fix the breast pain issue or...? So again, it would help to know, what is the purpose of pumping after baby nurses?

- If I pump at night so that my husband can give LO a bottle, should I only pump until I reach about 3 oz (which is how much LO will eat)?

given the issues you are having, I would caution against doing any bottles, unless needed for a unavoidable separation from baby. But, yes, if you want to have baby get this bottle, only pump what is needed. Also make sure dad is using paced bottle feeding technique, it may be that baby does not even need 3 ounces.

The reason a bottle in particular may cause or exacerbate the issues, separate from the pumping, is that babies often take more in a bottle than they really need (and yes, even 3 ounces could be more than baby needs at that particular moment) and when baby does that, they nurse less often, and that increases all the issues related to OP and fast letdown.

Basically, when trying to get your body to stop over producing, you want your body getting a clear, simple message that it is making too much milk, and to please reduce. Your body gets this message most clearly when baby is encouraged to nurse frequently and the body is not confused by pumping and baby is not "confused" by getting bottles.

One note: I do not have a job currently so I don't have a hard deadline of having to go back to work, but I would like to start building a small stash since I'd like to be able to get out of the house some and also am thinking of specific upcoming weekends where I will be away from my son.

I think you should wait at least a couple weeks or until whatever is going on with the painful breast to be resolved before even thinking about building a stash. Really. Also, if you mean you have a weekend coming up soon where you plan to be away from your baby all weekend, I would suggest that is not a good idea given what is going on right now...short separations, you can easily pump what is needed in the day or two prior. if you do have a weekend getaway planned anytime soon, realize you will have to pump every 2-3 hours the whole time.

Also, I'd like LO to get accustomed to the bottle (so far, we have been lucky in avoiding nipple confusion but I'm not sure if he'll start to reject the bottle as he gets older).

If you want to be sure your baby will take a bottle, you can give baby practice bottles- meaning once or twice a week give baby a ounce or even a half ounce in the bottle. That will be enough to keep baby very used to bottles. Again, given the challenges you are having right now, pumping and bottles are probably best avoided or at least minimized.

Even babies who never got a bottle often take them just fine whenever they are introduced. Yes, some babies are reluctant to take bottles and it takes a little working with them to take them. This can happen at any age. But the idea there is some window of time a baby must start getting and continue to get bottles, or there will be bottle refusal, has been disproven when studied. Yes, very rarely, some babies out and out refuse bottles. But that could happen whenever the bottle is introduced.

What is much more common than a baby who will not take a bottle is the baby who starts to refuse to nurse after getting bottles, and that can be much harder a problem to fix. This is something that never happens immediately, rather, it happens maybe many weeks or months after bottles are introduced, and is more likely to happen the longer and the more often baby has bottles. THAT is what nipple confusion means- a baby who over time has become habituated to bottles and learns to no longer nurse. Again, this is much more common than a baby who cannot figure out how to take a bottle when that is the only way they can be fed. That is actually pretty uncommon.

Ok, here is a good article on block nursing. given the issues you are having with the breast pain, I would suggest approach block nursing with great caution. It may not be safe to take long blocks without any milk removal. Also be careful- even when block feeding you want baby nursing very frequently. Again the expertise of an IBCLC to guide you here is probably your best bet.
http://www.nancymohrbacher.com/artic...dos-donts.html

[@llli*bear.mommy]

Hi again, @llli*maddieb, again, thank you for your time and response! This is the most helpful and thorough response I've received to date--others I've consulted have simply recommended block feeding or other solutions, without looking at the entirety of symptoms/issues I'm experiencing.

The midwife wanted me to pump to build up a stash, and she suggested the morning because that's when I have the most milk. She also suggested a pump at night so that I could get a few more hours of sleep. When I mentioned the OS, she didn't really give it much mind and said the pumping will not exacerbate the OS (I disagree). The last IBCLC I met with also recommended that I start building a stash. I don't understand why they are encouraging this, as I didn't indicate an immediate need for a large freezer supply. I agree with you, I was more inclined to wait and see if my OS would resolve before getting back into pumping. I am going to hold off on pumping for a while and hope that my milk supply will regulate itself soon, as you mention. It's reassuring to know that I'm at peak milk production right now and that hopefully things will settle down soon!

"What is much more common than a baby who will not take a bottle is the baby who starts to refuse to nurse after getting bottles, and that can be much harder a problem to fix. This is something that never happens immediately, rather, it happens maybe many weeks or months after bottles are introduced, and is more likely to happen the longer and the more often baby has bottles." --- THIS is very good to know; I had no idea! I had only been focused on whether LO would accept bottles, which he has had no problem with. But I didn't think of LO developing resistance to nursing over time. Now I am even more dissuaded from pumping/bottles for the time being.

The lingering uncertainty in my mind is what to do if LO doesn't want to nurse more frequently, or if he does but the engorgement problem still persists. I'm thinking of hand expressing JUST to get out some of the lumps, though given what you say about milk stasis, I'm worried about leaving milk sitting too long in the breast. Right now, it seems like no matter how much LO takes in, my breasts still do not feel fully drained (the way they did when I was pumping several weeks ago). Sigh. I'm really hoping an IBCLC will be able to help--I've seen a few at Kaiser, and it seems they are all a bit too busy to take a deep look at my situation. But I'm not going to give up and will try again!

Thank you again!!

[@llli*maddieb]

I don't understand why they are encouraging this,

Wow, me neither! Why does your midwife or IBCLC care if you build up a stash? Wow. This is so not their job. If a mom needs to build up a stash for some reason and wants advice about how to do that safely, then they can and should offer that kind of advice if they are capable of doing so. But why are they assuming you need or want a stash...or the size or immediacy of it, or that to build one, you should pump every day? I just do not get it.

Of course, you are correct- pumping over and above baby nursing is going to increase milk production. And the more often you pump, or the more that you extract when you pump, the more it will increase production. This is the most basic and rudimentary fact about milk production- more demand = more production.

Right now, it seems like no matter how much LO takes in, my breasts still do not feel fully drained (the way they did when I was pumping several weeks ago). Sigh

In the normal course of nursing, babies rarely if ever "drain" the breast. If a mom is making more than enough milk, as is actually pretty common, then of course baby will not take all that is in there. Baby takes what baby needs. The milk that is left in the breast tells the body, "hey, this much was not needed, so please start to make less." At the same time, if baby is nursing frequently, then while mom is not empty she is also not so full she is uncomfortable while the body figures out what is enough but not too much.

This is why frequent nursing helps. Of course, some babies will not nurse enough and hand expression in that case is a good idea. However, most babies, if gently encouraged, will nurse more often. It may take several days, but baby nursing frequently with very little other milk extraction should help get things back on track.

Some moms have very serious hyperlactation, and in that case, under the care of a IBCLC, block nursing as well as other milk reduction strategies may indeed be needed. But it may make sense in your case to first reduce/eliminate the pumping, encourage the more frequent nursing (Still ok if baby nurses one side at a time) and see if that starts to help.

If you do have mastitis, you may need treatment for that, but you can continue to nurse baby this way while being treated.

[@llli*bear.mommy]

It's good to know I'm not the only one questioning why there's pressure to build a stash! I got the feeling this was the advice they give to all moms, which still doesn't explain why they encourage it in the first place...

I'm hoping more frequent nursing does help. In the meantime, I've set up another appt. with an IBCLC next week and hope to get to the root of the breast pain!

THANK YOU again!

[@llli*maddieb]

I got the feeling this was the advice they give to all moms, which still doesn't explain why they encourage it in the first place...

Actually I now recall this has been reported before. I think the culture of the particular institution may just be getting passed on by everyone connected with it. If the LC and midwife were from two different places, then I have no idea.

Unfortunately what seems like a benign suggestion can cause so many issues. The results of OP can range from a bit of a bother to a serious health issues (for mom) so telling a mom to pump to build a stash is potentially dangerous. Also it implies that all moms will not be able to nurse their babies long term and so need to stash tons of milk in the freezer! Of course this is not true and even moms who will need a stash because they are going back to work only need enough for the first day, plus a "cushion."