An Awesome Tool

I have great friends, and many of them are breastfeeding or have breastfed in the past. Only one of them has had an oversupply of milk, but the breastfeeding ones have all heard about my challenges. (Some of them were very afraid of breastfeeding because they’d heard my story BEFORE they had actually had kids. I feel somewhat guilty about that, but it did mean that they got help with breastfeeding way earlier than others might!)

When I had baby #4, I got a call from one of my breastfeeding friends, who told me she was sending me something from Amazon. I looked it up: a Milk Saver from Milkies. I was intrigued, because one of the most annoying things about my early lactation is double let-down. I let down on both sides whenever letdown happens, no matter which side the baby nurses on. This leads to my entire outfit being covered in milk, or lots of use of burp cloths (one or two per feeding, at least), and difficulty in nursing anywhere but the comfort of my own home, since I sometimes cover whatever I’m seated in or on – and possibly the baby and other people around me, depending on my burp cloth placement – in milk. Awkward! Later in nursing, around 4-6 months, I can trust the nursing pads to keep things in line. By 9-12 months, dual letdown only happens when I don’t have my daytime breast coverage setup in place. (For normal moms, this might be a nursing bra. For me, it’s usually something that doesn’t exert much pressure, because I’ll get plugged ducts just from wearing a nursing bra.)

Back to Milk Savers! A Milk Saver is a flattened cup with a hole in the side that catches milk from the breast that the baby isn’t nursing on. It’s designed to fit over a woman’s nipple without compressing or changing the shape of the nipple, and then just catch the flow of milk. It fits right into a bra or tank top, and can hold slightly more than 4 ounces of liquid. It’s made of silicon, so that when it’s full, a mom can gently squeeze it into a spout shape and dump the milk into a freezer bag or other container for storing milk.

This tool changed my early nursing days dramatically. Two cons: I would forget and lean over while wearing it, which meant that I spilled the captured milk all over myself. And I sometimes wouldn’t get it on correctly – just on one side – and it would leak a bit on me. The first con really just meant that I should remember not to lean over, and the second was easily fixed with a strategically placed burp cloth.  I had the burp cloths anyway, and they weren’t getting nearly the amount of use they’d gotten before the Milk Saver showed up. The pros far outweighed the cons with this device.  I can’t tell you how much laundry I didn’t do because of this thing! It was so awesome, I couldn’t even begin to do it justice. AND I had a supply of milk in the freezer for the first time ever.

(I know that sounds strange, coming from someone with abundant milk, but I only pumped when absolutely necessary, because I didn’t want to increase my milk supply in any way, shape, or form that wasn’t completely obligatory.)

I didn’t constantly smell like old milk from the milk that had leaked on me. I could pack it into my purse and use it when out on the go.  Sometimes I’d pack bags for the milk, and sometimes the plants nearby would get a little extra protein boost that day.  One feels so much more confident nursing out and about when one is fairly sure that milk isn’t going to make a huge, leaky mess all over.  One morning, during my baby’s first daytime feeding, I caught 4 ounces of milk – the Milk Saver was full almost to overflowing. I couldn’t believe how much milk had been running into burp cloths before!  I could contemplate milk donation! (I didn’t actually get around to doing it, because I had a newborn and no plans in place, but maybe next time around.)

Once the baby got older and I didn’t have dual letdown – or, at least, not as much – I packed away the Milk Saver; if I have another baby, it will be one of the first things I dig out of storage. I can’t say enough about how much the Milk Saver helped me in those early months of breastfeeding. I highly recommend this product to anyone who notices dual letdown. (I’m not getting any kickbacks for this post – I’m just letting you know about a very helpful, useful product that changed my breastfeeding for the better.)

In Which I Encourage Moms to Get Help When They Need It

My first daughter was born to parents who had it all figured out – we’d read the books about parenting styles, natural childbirth, breastfeeding, Baby Sign, the list goes on and on. She took very little time to whip us into shape and teach us that we knew absolutely NOTHING about parenting, including, but not limited to parenting styles, natural childbirth, breastfeeding, etc. Baby Sign didn’t matter, because she wasn’t going to sign to us at age 3 days, no matter how much desperation drove us to pray that she would. IF SHE WOULD JUST TELL US WHAT SHE NEEDED! Hannah, the high-needs baby, wanted to nurse. She did NOT want to have a bottle. Ever. Ever. Ever. She wanted to nurse. We began pretty well in the hospital, but began hitting bumps when we got home. I couldn’t figure out how to latch her on really well, because that thing that I’d heard about how it wouldn’t hurt if they were latched on correctly turned out to be not as true as I’d hoped. And engorgement threw me for a loop – I had NO IDEA. I hit a fairly large bump about three days in. I, in my sleep-deprived, middle-of-the-night stupor, let her latch on improperly. I developed a crack in my nipple. It didn’t heal for over three months. Those three months contained pain for me every time my baby nursed. Every single time. Finally, I got the help I needed. And I realized that there had been warning signs in those first few days of small bumps in our breastfeeding road. Had I recognized that I didn’t have a clue and needed some serious help, my breastfeeding journey might  have been really different. Because of my determination to soldier on and not ask for help, I ended up having about 9 months of major breastfeeding problems. Hannah helpfully encouraged me to continue breastfeeding by not ever taking a bottle with any degree of success at all (until, at 6 months old, she figured that I wouldn’t switch over to pumping full-time if she occasionally took a bottle), but I know in my heart that, had she been willing to take a bottle, I would probably have given up the breastfeeding struggle. I often feel guilty about the friends who saw me during those days, because I’m convinced that I made breastfeeding a far more frightening experience than it needed to be for them. It turns out that most people don’t experience 9 or more months of major complications when they’re breastfeeding, starting with a crack at 3 days and mastitis at one week. When I feel tempted to wallow in guilt about all of that, though, I realize that perhaps I set them up for success by reinforcing the idea that they should get help as soon as possible with any breastfeeding problem. So maybe my pain has helped someone. And I hope it helps others, too. Get the help you need – early and often, if necessary. La Leche League is a fantastic resource. There are lactation consultants and all kinds of medical professionals who help women with breastfeeding. Dr. Jack Newman has a fantastic website with all kinds of helpful information.  Feel free to call out other helpful sites that you like, too.  Books abound! The trick is, nobody is going to come and demand to help you – they won’t know! You have to be proactive in this.  Please, for your own sake and the sake of your baby, ask for help! 

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.