We're not alone!

Personally, I have come across very few people, including medical professionals and lactation experts, who know a lot about overproduction, or what to do with it.  Non-professionals haven't heare too much about it, either, and it can be a lonely road when you feel as if no one understands what you're experiencing, much less offers help!  So when I read this article,  in the International Breastfeeding Journal, by Caroline GA van Veldhuizen-Staas, I felt a sense of relief -- this woman gets it!  Even rereading it today, I feel a certain relief at the thought that she understands the things that I struggle with as I breastfeed.

Methods to treat real or perceived low milk supply are well referenced in the literature      Overabundant milk supply or hyperlactation on the other hand is not discussed in depth in the literature. There is no consensus on treatment or terminology. However, overabundant milk supply can be as devastating for the continuance of breastfeeding as underproduction.

So I'm not the only one who couldn't find much help for overabundant supply.

The hyperlactating woman will often experience a constant feeling of (over-) fullness, engorgement and tension. She may leak milk in between feedings, or leak copiously from the opposite breast during feedings, and has an increased risk for mastitis. 

When I say that she gets it, I mean it.  And she understands the baby's problems with the problem, too:

The infant may appear to be a greedy feeder, struggling not to choke or aspirate milk. He or she may often spit up after feedings and/or have reflux-like symptoms, and suffer from intestinal gas, colic and explosive, often green and foamy stools. The baby may show either a very low or a very high weight gain. The baby's struggle to cope with rapid flow may result in restless nursing behaviour, or even aversive behaviour, such as breast refusal or shortened feeds. Fussiness, crying and possible low weight gain can lead the mother to think that her milk is insufficient in quantity and/or quality.  

...A common secondary symptom in hyperlactation syndrome is a sub-optimal nursing technique in the infant. This may be the result of the child's attempts to cope with an overabundant milk flow, sometimes slipping from an optimum latch in order to clamp down on the nipple to slow the flow, often traumatizing the mother's nipple in the process. Or the infant may develop a conditioned habit of drinking but passively suckling at a breast that will give milk without any effort by the infant itself. This has the potential to lead to supply problems after 4–6 weeks when supply stimulation patterns transition from primarily hormonal stimulation to feedback inhibition mechanisms.  

After many, many months of having to piece together small bits of information here and there about overabundance and its resulting problems, I rejoiced to find an entire article -- scholarly, at that -- that discusses in detail these difficulties.

She talks about some of the physiological mechanisms that regulate milk production, as well as some of the common treatments, including block feeding, which I've found to be extremely effective in my own attempts to regulate supply. 

She then offers a new technique that she's developed, and describes some case studies that have used the technique.

 The treatment sequence starts with an as-complete-as-possible mechanical drainage of both breasts. ...The infant will latch on immediately after drainage and will be offered both "empty" breasts to satisfaction. ...Subsequently the rest of the day is divided into equal time blocks starting with about three hours, initially. Every time the infant shows hunger cues or other signs of interest in the breast the same breast will be offered without any restriction in either frequency or duration of feeds. At the end of such a time block, or after a multi-hour period of sleep, baby will be offered the other breast for all feeds within the next time block. ...Depending on the seriousness of the symptoms time blocks may gradually be increased to 4, 6, 8 or even 12 hours. For less complex situations one-time mechanical drainage will suffice; for others occasional repetition may be necessary. Intervals between drainage will gradually increase as the symptoms lessen.

When I found the article, I was already well into my breastfeeding relationship with my youngest, so I haven't tried this technique.  However, if I have more children, I will definitely try this method.  I would probably even try it now (my nursling is almost 20 months), except that with other babies, I experienced a huge decrease in the effectiveness of pumping after 12 months -- my breasts just don't react to the pump as they do to the baby after that time.

I highly encourage you to follow the above link and read the entire article -- it's fascinating and not too technical, and can make overproducing moms feel a bit more understood. 

She concludes her article with this statement:

 More research will need to be done to understand why some women will easily produce much more milk than needed and why for some it is so hard to regulate milk production to meet the needs of their children.

I totally agree.

International Breastfeeding Journal 2007, 2:11 

How it all began

I first learned that I had overabundant milk supply and overactive letdown when I was trying to nurse my first baby.  Boy, can first babies be humbling!  I learned a lot from Hannah -- and a lot of it was how little I actually knew. 

Breastfeeding classes encouraged me to nurse my baby fully on both sides -- 15 minutes, 10 at the very least.  Have her empty both sides. 

Hannah would nurse for 3 minutes or so and be done.  I'd encourage her to get back on, and she would scream and tense and scream some more.  I felt terrible, as if my baby was going to die of malnutrition because she wasn't getting enough milk. Never mind that she was back up at birthweight by her 3 day checkup and never looked back.  I'd been told how much she needed to nurse to get enough. Seeing the scale go up didn't get through to me.  I attribute this to lack of sleep and abundance of hormones, besides being entrusted with a new baby.

See the Lansinoh in the background? 

I would spend the first minutes of our nursing time praying that she'd fall asleep before letdown, because if she did, she'd nurse fully and well.  If she didn't, she'd pop off and scream.  I'd latch her on and anxiously wait to see her eyelashes slowly lowering...darn, letdown came too fast. 

By three months old, besides all of the other breastfeeding problems we endured, Hannah had enough.  She refused to nurse.  She wouldn't take a bottle.  She was unconcerned about the idea of malnutrition, she just didn't want to deal with the huge quantities of milk shot at her whenever she ate.  So began our 6 months of getting her to sleep and then nursing her.  Humbling doesn't begin to describe this experience.

I can't remember exactly when I learned about overabundant milk supply and overactive letdown, but I do remember the sense of relief -- I finally knew what was happening.  Of course, I could find almost no information about it anywhere -- my health care professionals didn't know much, nor did anyone else I approached.  There was lots of information about too little milk, but not a lot about too much.  It was a lonely, lonely time.

I have scratched the surface of our nursing problems in those early days. I'll talk about mastitis, plugged ducts, enormous cracks in the nipple, and thrush in other posts. Looking back, I think how miraculous it is that I didn't give up.  I'd like to share some of my hard-won knowledge about this with others so that we don't all have to reinvent the wheel, and so that others know that they're not alone with this difficulty. 

Daily maintenance

...for women with high supply or frequent plugged ducts 

**I'll have follow-up posts to talk more about the things that need to be more fleshed out here, but this is the general list.  Of course, as you read through this, remember the Disclaimers!



Things that I do daily to maintain good lactation:

1.        Check for sore spots.  I use this throughout the day to make sure that I am not developing a plug.  It’s a bit like a monthly breast exam, only a more general.  I use the heel of my hand and feel around to see if there are sore spots.  If there are, I check again after I’ve nursed the baby on that side.   If it’s still there, I go into full Plugged Duct Eradication mode.  (More on that in another post.)

2.       Check for plugs in the nipple.  This I do in the shower.  Just a quick squeeze to be sure that the milk is running where it should be.   I’ve become very familiar with many of the outlets on the nipple, especially the ones that tend to plug.  I’ve had countless times that I’ve gotten a bit of a plug out in the shower before it starts trouble. 

3.       Drink lots of water.  Lots.

4.       Nurse the baby.  Lots.

5.       Utilize cabbage to avoid oversupply issues. 

6.       Eat healthily.  Avoid eating lots of sugar.  I eat a small amount occasionally, and some seems to be okay, but if I go overboard, I pay a high price, so I am careful.  Also, I never, ever, ever eat sugar without something to balance it.  Ice cream is good because there’s a lot of fat to balance the sugar.  But ice cream actually doesn’t work for me because dairy also tends to add to plugged ducts for me.  So watch your diet and see if you have foods that trigger plugs. 

 

See how I'm in bed?  Rest!  Don't bother making your bed if you have a new baby -- you need to be IN that bed!  And really, if you're a plugged duct kind of person, you may not make your bed for months, even years, depending on how long you nurse.

 

7.       Rest.  If you are prone to plugged ducts and mastitis, please accept right now that while you’re breastfeeding, especially in the early months, you will have to have a much slower pace of life than you used to.  OR you will have a hectic pace followed by a slower pace that is forced on you because you have mastitis.  This is not a fun way to slow down. 

8.       Exercise, but in a sane way.  And only after your healthcare providers give you the okay.  Exercise will definitely help you to build up your strength and be more able to do activities, but you have to work up slowly.  Don’t expect to have your baby and start right back in where you left off, if you were exercising.  Start off slowly, or you’ll give yourself plugs or mastitis just by exercising.

9.       Take vitamin C.  And other vitamins as you need to stay healthy. 

10.   If you feel worn thin, tired, or overstretched, call a halt and get some rest!

 

I like this photo, because although I look tired, I'm sitting, holding the baby.  Listen to your body and rest when it's time.

The continuing difficulties of chronic plugged ducts



I have never had the terrible difficulty of low milk supply.  I've seen friends struggle with it and have not wanted to change places with them in the least.  I don't think this means, though, that the struggles of overabundant supply are insignificant in comparison.  The truth is, we all need help and support no matter what our difficulty with breastfeeding is, and although the grass may look greener on the other side of the fence, if we actually go to the other side of the fence, we'll see the weeds, bare spots, and piles of poo that exist in any field.

One of the surprising difficulties of abundant supply is the fact that, even though I'm nursing a 19-month-old, I still have to be extremely vigilant about plugged ducts.  In the last month, I've had two serious ones (one had probably developed into mastitis) that meant that I had to spend a day  in bed and several days taking it easy to recover -- no small task with four kids.

This morning, as my 19-month-old struggles with a cough and stuffy nose, she doesn't want to nurse.  She's cranky and feels terrible and nursing is harder than usual because of all the mucus, and she doesn't want to put in the effort.  Because of my history, I am worrying on many fronts this morning: first, the baby front:  will the baby get dehydrated from not nursing?  How can I get her to nurse?  Maybe she'll drink some water?  Is she developing another infection?  Then, the nursing front:  should I be pumping?  How am I going to take care of a sick baby (and three older kids) if I get a plugged duct? 

Over my breastfeeding career, I've figured out tricks for dealing with the difficulties that accompany the abundant supply, and I'll talk about those in another post.  My baby and I will work our way through this particular bout of trouble, too. 

I have had to accept, though, that as long as I'm nursing, I will have these challenges -- I remain vigilant at all times.

Disclaimers

I'm not a medical professional.  I'm a mother of four who has had almost 10 years of breastfeeding experience.  In this blog, I'm planning on telling about things that worked for me, but I'm not planning on prescribing for other people -- these will be ideas for you to consider and use as you and your medical professionals see fit. 



Some things that work for me won't work for others, and some things that have worked for others don't work for me.  I can only pass on the knowledge that I've accumulated and hope that it helps someone, but please be wise and consult with a medical professional, because I'm not one. 

Why "more like a firehose than a faucet"?



When I had my first baby, I was clueless about a lot of things.  (I'm still clueless about a lot of things, but I've gotten a few clues about some things along the way.)  Breastfeeding -- that mysterious, wonderful, rewarding, beautiful, frustrating, hair-raising, tiring, glorious, painful experience -- was one of them.  And I happen to be a person who has overabundant milk supply, as well as overactive letdown.  Okay, I haven't been officially diagnosed, but I have read the descriptions and nursed 4 babies, and I have an idea about this now. 

I tried to explain the difficulties my baby and I experienced day and night for ages to a man who was not familiar with breastfeeding -- at least, he knew about breastfeeding, but he didn't know about breastfeeding.

**As an aside, why try to explain my breastfeeding difficulties to someone -- a male acquaintance, no less -- who didn't know anything about breastfeeding?  The answer to this question remains lost in the haze that (perhaps blessedly) surrounds postpartum times and tough breastfeeding times.**



As I described (hopefully in not too much detail, but I don't remember what I said to him -- again, this might be a blessing) the ordeals we faced at each feeding, he had a lightbulb moment, "Oh!" he said, looking pleased, "so it's more like a firehose than a faucet!" 

I owe a debt of gratitude to him for explaining in a short sentence what the heck what was going on.  Too bad I can't remember who it was so that I can thank him.