Posted by: Diana Cassar-Uhl, MPH, IBCLC | June 15, 2012

Understanding oversupply


Oversupply, forceful let-down, foremilk/hindmilk imbalance … all of these strike fear in the heart of new mothers because they translate to an inconsolable, visibly uncomfortable, crying baby.  He may want to nurse all the time, because the sucking behavior soothes him when his tummy hurts, but the more he nurses, the more miserable he becomes.  There may be blood in his diapers, maybe he chokes when he starts breastfeeding, or he spits up a lot after every feeding.  You’re desperate for a solution that won’t threaten your milk production, because you really want to continue breastfeeding your baby – but your baby doesn’t seem to “like breastfeeding” and you’re feeling rejected and discouraged.  What causes this constellation of circumstances?  There is a lot of information out there about oversupply, overactive milk-ejection reflex (OAMER), and what has been called foremilk/hindmilk imbalance. I will do my best to help you understand WHY your breasts are so eager, WHY this is so irritating to your sweet baby, and offer you some resources for how to find the solution that works for you and your baby.

First, it is very important that you ensure your breastfeeding management is optimal and you are “watching baby, not the clock.”  Some mothers unintentionally create an overproduction of breastmilk when they, perhaps out of concern that they’ll make enough milk, or maybe to make bottles so grandma and daddy can feed the baby, pump or express more milk than their babies are actually taking.  Most mothers, if feeding on demand and not by a schedule, and not over-stimulating milk production, will make the milk their babies need.  Hormonal imbalances are another reason for overproduction of milk; if you have a history of PCOS, you may be susceptible to oversupply.  Postpartum thyroid issues can also have an effect on milk production.  Be sure to rule out medical causes of hyperlactation first.

You may have been told that your baby is fussy, has a skin rash, is gassy, spits up, has diaper rash, a red ring around his anus, or green poop because of something you’re eating, oversupply, or foremilk/hindmilk imbalance.  You may also be hearing that “gassy foods make gassy babies” when you’re breastfeeding, and you’re confused and concerned that you will have to somehow satisfy your ravenous appetite on salad and air.

A note about how you make milk:  your milk is synthesized from ingredients in your bloodstream, not in your digestive tract.  Gassy baby after that stir-fry?  It probably wasn’t the broccoli …  yet, you’ve read something or someone has told you that eliminating certain foods from your diet may be the answer to your crying, uncomfortable baby.  How can this be possible?

A healthy, mature digestive tract (or “gut”) is “sealed;” nutrients are absorbed and wastes are contained until they are eliminated.  This “sealing” takes place in a healthy, breastfed baby sometime around the middle of the first year (immunoglobulin from your milk helps to coat your baby’s small intestine in the meantime), which is why it is advised that we hold off on introducing solid foods until then; also, the first foods we introduce are hopefully less likely to be allergenic and irritating to your baby’s gut.  This is where the claims that breastfeeding protects babies from allergies and eczema come from, IF our own (maternal) gut is healthy.

For many of us, though, our gut is not healthy and sealed, and is known as a “leaky gut.”  Perhaps we were formula fed as babies, or we’ve been on antibiotics; maybe we have a food allergy or intolerance we don’t know about, or our diets are full of processed, irritating ingredients we’ve been led to believe are “foods” because we can buy them in the grocery store … whatever the reason, our bodies mistakenly allow proteins from foods we eat to pass into the bloodstream, where they can then pass into your milk.  So, if your gut is leaky or less healthy than ideal, irritating proteins are passing into your milk and being fed to your baby, creating many of the same symptoms commonly seen in babies fed cow’s milk or soy preparations: eczema, gas, diaper rashes, and later, reactions or sensitivity to allergenic foods.

A Google search or a Facebook page may tell you your baby’s problems are caused by foremilk/hindmilk imbalance.  This was once a commonly accepted explanation and “block feeding” (offering the same breast at every feed for a prescribed number of hours, then offering the other breast for the same number of hours, regardless of how many times the baby wants to feed in that time) was the preferred method for dialing down milk production and encouraging the baby to consume the fatty, satisfying “hindmilk.”  Now, however, the idea that a mother makes two different kinds of milk is being challenged and the practice of block nursing doesn’t seem so vital.  Nancy Mohrbacher, IBCLC, FILCA published this blog post on the foremilk/hindmilk misconception and what current research tells us.

Today, we are also thankful that the Academy of Breastfeeding Medicine Clinical Protocol #24 is available to us: Allergic Proctocolitis in the Exclusively Breastfed Infant.

From this, we learn that an exclusively breastfed baby can experience allergic symptoms as a result of maternal intake.  Cow’s milk is the primary offender cited, and this is consistent with my clinical experience.  All of the mothers I have worked with who had symptomatic babies reported some, if not complete, improvement after eliminating dairy products from their diet.  Other mothers needed to eliminate soy, eggs, and/or gluten to bring their babies to complete relief.  Some very detailed analyses of gut health, with some commentary on breastfeeding mothers and babies, can be found at this link.

Does this even relate to oversupply?  If so, how?  It’s clear that the symptoms in babies are similar.  Some professionals suspect a cause and effect relationship, that something about the mother’s gut health causes both oversupply AND allergic sensitivity in the breastfed baby.  There is no current, specific research linking maternal gut health to oversupply, but it has been my experience that most mothers with oversupply also have babies with allergic reactions to something in their milk. (Tongue tie in the baby is also very often present, but this goes beyond the scope of this post.) To me, this suggests that the mother’s digestive issues (which she may or may not be aware of – she may feel perfectly healthy and well), can result in a host of abnormal outcomes, among them oversupply and forceful let-down.  While not “evidence-based practice,” rather, “practice-based evidence,” I’ve noticed over the last 7 years that the mothers who eliminated one or more allergens from their diets were delighted not only with their happier babies and normalized milk production, but with how terrific they felt without the allergen!  Caring for a newborn and feeling terrific!  Years later, many of these mothers tell me they never went back to the offending ingredient, or introduced it in far reduced amounts once their babies got older and/or weaned.

Do you see yourself and your baby in this post, but feel discouraged because you just went through a pregnancy where you couldn’t drink alcohol or caffeine, eat sushi, soft cheeses, or deli sandwiches, or enjoy a medium rare steak?  It may feel unfair that now, you need to give up ice cream, cereal with milk, and your favorite candy bar (read the label, it has soy in it!).  Don’t worry!  There are so many wonderful foods you can eat!  I’ve written on my blog about delicious, wholesome, healthful, real foods that won’t make your baby cry in pain.

Of course, you may choose to try other measures to resolve oversupply before changing your diet.  If you’ve already ruled out possible medical reasons for hyperlactation, changing your breastfeeding position to one that makes the milk flow against gravity is one (side-lying and “laid-back” are two options) measure that is gaining popularity.  “Block feeding” is still commonly recommended, but some IBCLC’s report that the method is either incorrectly communicated or not well understood, and mothers can jeopardize their milk production capability if they are not closely monitored during the block feeding period.   If your IBCLC suggests block nursing, be sure to ask her to be specific about how long each block should be, and for how long you should continue the regimen.  Antihistamines, sage, and mint (for example, tea made from steeping fresh mint leaves) are also ways to reduce milk production.  These methods, however successful they may be, represent a resolution of the symptoms, not of the cause, therefore, even if the oversupply is corrected, sensitivities may still persist in your baby.

Breastfeeding your baby can be a pleasurable, memorable experience, definitely worthy of any adjustments you may make to ensure your baby’s health and comfort.  The best news:  there are resources for you, and you will find solutions that work for you and your baby.

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Responses

  1. I’ve been learning a lot about leaky gut lately (trying to get control over some of my own issues now) and in retrospect realizing that it probably contributed to some of our nursing issues. I did cut out many proteins and even gluten while nursing – some of it was behaviorial (red meats were utterly unappealing to me, so I just went back to being vegetarian) but some of it was because I noticed my baby was effected by certain foods – especially high gluten foods. i had a great support group, too, and although 10 years ago we weren’t talking about leaky gut, we did know which foods caused certain issues even if we didn’t know the cause.

    As always, great article. Doesn’t seem to matter if I’m done with having babies, I am still learning!!

  2. [...] You may be at that point in your breastfeeding journey where you’ve tried everything to temper an oversupply of milk, or you’re discouraged because your baby is showing signs of food allergy or sensitivity and [...]

  3. Can you provide more information/references on how PCOS and overactive letdown work?

    • Hi Hazel,

      I’m not sure there is a definitive study, but in the clinical experience of my colleagues and myself, some mothers with PCOS experience oversupply. Because PCOS is a syndrome with various markers, one woman’s constellation of symptoms and markers might be different from another woman’s. Some women with PCOS have too much circulating prolactin, and this could be the cause of oversupply for them. The oversupply I write about in my post is that which cannot be traced to hormonal levels (usually prolactin or thyroid hormones) or breastfeeding management (such as pumping too much or too often). I hope this helps and thank you for reading!

      –Diana

  4. Utterly fantastic post! Thank you so much–I will be sharing it with mothers I help with frequency.

  5. Hi,

    I have a quick question about your blog, do you think you could e-mail me?

    Jillian

  6. I had oversupply issues with both of my kiddos – worse with #2 because I was tandem nursing, but never allergic symptoms luckily. What I find most frustrating about oversupply is how our ability/willingness to deal with it is so tainted by the pervasive low-supply myths. I KNEW i had oversupply. I was constantly engorged and baby #2 was hideously uncomfortable. To boot, I’m a lactation counselor… but still I was too afraid to do anything to encourage my supply to correct. I waited it out until it settled off on its own. How ridiculous is that?! If it was a client I was supporting I would have told her with confidence that she could work on the problem without fear of mysteriously drying up overnight. But in my own postpartum haze that cultural fear took hold. It’s that insidious.

    Sorry, that was slightly off topic…

  7. I had over-supply with my last two. My son was born about a year ago and I suffered from over-supply. He had a PTT and LT that were released by Dr. Kotlow in NY. However, my 10-12 weeks my over-supply disappeared. I no longer have issue. He did have a red ring around his anus and frequent rash, however, that too has long since disappeared. He was never very fussy or gassy. Very easy baby. His latch still isn’t 100% but it works well enough for us and we are happily nursing. What could make over-supply calm down and all my son’s symptoms disappear? I’ve thought about thyroid as I’ve monitored it for a few years now. Even while pregnant it was about .47-.76 (TSH). I recently had it rechecked and it was 1.30. The “highest” it’s been in years. I sometimes wonder if my thyroid had anything to do with my over-supply….I’ve spoken with Jennifer Tow about TT but never about over-supply and a relationship to TT. This is all very interesting and I’d love more info…

    • Jennifer Tow and the other IBCLC on the tongue tie support group on Facebook have said that releasing a tongue tie will correct oversupply, in the same way it does under supply, by improving oral function in the baby. I’m guessing it is because there is such a delicate feedback system between you and the baby, how the baby nurses and how much milk you make. It was a new idea to me, and explains some past babies I have known.

      • Helen, for some reason I missed this reply from over a year ago. I’ve had over supply with all three children. It subsides by 6-10 weeks or so (all three have had ties – only one was revised). Is this article referring to over-supply that never corrects itself (I’ve seen moms struggling with it at 1-year) or any over-supply not related to over-stimulation?

  8. Thank you so much for your article. I have been suffering with over supply and a reflux baby.
    It fits my situation throughout! We both had antibiotics in hospital and i had a further course when i got mastitis. I told several doctors that i believed the antibiotics started it all and was literally laughed at!!!(especially my second course was ten days and my baby’s poop amelled horrible and i knew it was affecting his guts just like mine) We had his tongue tie cut at 5 weeks (he had a very thick posterior one). I have been dairy free since he was about 4 weeks (with a few incident including the pediatrician suggesting I could eat goat cheese which backfired!)
    I have been told countless of times that babies have immature guts and the crying, back arching, chocking, vomitting, grunting and whimpering in their sleep is normal. Yet I know that since I stopped dairy things have massively improved! I think there is still something I am eating that is upsetting him at times and planning on doing a diary. Not sure yet I can manage a full soya (bloody lecithin in everything), wheat/gluten free diet but I read your other post with interest and have been trying to limit processed food. (one doctor told me to avoid fruits… So been going a bit mental about what I CAN eat!)
    Anyway thank you for your article, it has confirmed a lot of things I believed in but was repeatedly told I was wrong and should go back to dairy or I would loose my teeth (I have been told that for real!) and that colic/reflux is unavoidable. I have not yet managed the perfect diet and we have good and bad days but at least I know I am not doing it all for nothing!

    • I had a similar experience years ago, with one of my babies. He was so much happier and much more comfortable when I went off dairy, and I stopped having colds that lasted for weeks and were so bad I had to breathe through my mouth. Surprise! I didn’t know I had any allergies.

  9. This is a very interesting article. I breastfeed my twins for 13 months. For the first few months I didn’t feel I had an oversupply and they slept and ate well, but didn’t gain weight as well as they could have. I was convinced it was to do with my milk quality so I went to see a Naturopath. After chatting with him he said that I should look at eliminating dairy and gluten from my diet based on my blood type and the fact that there was history of this intolerance in my family. Within months of commencing the diet, my son’s started to gain well and I lost 20kg!

  10. [...] http://dianaibclc.com/2012/06/15/understanding-oversupply/ [...]

  11. [...] of milk, which can be related to an endocrine/hormone issue like postpartum thyroiditis.  If you have oversupply, it might be worth it to have your hormones checked, since it’s fairly common for things to get a [...]

  12. Great work D.

  13. This site has changed my life. It wasn’t until my baby awoke from his sleepy 3month haze that I discovered that he probably has silent reflux, that I have overproduction and that we had thrush after taking antibiotics after delivery. He is now at 15weeks and is napping has become spotty, where he was a great sleeper, only up for a couple hours a day, which didn’t seem normal, but I wasn’t fitting it, given I have 3.5yr old. Everything you have written is us. You mentioned ruling out hormonal/medical reasons for overproduction…. what specific tests do you ask your dr to perform? I am day 2 into removing the major allergens and thank goodness, I discovered this prior to the full Total Elimination Diet. I would love a consult with someone that you would recommend to get me started on the right path, because I believe I have leaky gut. Note: I have been on a great probiotic by Progressive for 2months already, but will start giving my little guy a priobiotic (he didn’t like it the first time around).

  14. […] Understanding Oversupply by Diana Cassar-Uhl […]


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