20: Surprising Symptoms of Oversupply
We are rarely worried about oversupply in our culture because as we are trying to fill the freezer it seems like never enough. So rarely when a mom comes in for feeding issues does she suspect oversupply.
I once saw a mom and baby come into my office with concerns of feeding issues. Her baby had multiple symptoms including: reflux, signs of stomach discomfort, chronic diarrhea, quick feedings which she frequently came off the breast fussy. Now this mom had come to me specifically because I worked with the baby’s older sibling on severe picky eating due to food sensitivities and GI issues. At this time I thought there must be some sort of allergy related issue because it ran in the family and it was a common cause of many other patient’s feeding issues where I practiced at the time. I mean it certainly checked those boxes from a symptom perspective. Now, this was before I was a Lactation Counselor and this baby was exclusively breastfed. She also surprisingly had no weight issues. In fact, she had great baby rolls. So I reached out to our hospital's lactation team and reviewed the case to make sure there wasn’t anything I was missing from a dyad perspective (a dyad is the mother and baby, and when we consider feeding we really must consider both). And she pretty quickly told me, “It sounds like oversupply.”.
To put it simply the definition of oversupply is the production of milk that is beyond the required volume for your healthy infant. But it goes beyond just having excess, which in our culture of fearing low milk supply, we tend to encourage oversupply. And oversupply, or hyperlactation, can have negative consequences for you and your baby.
Signs you may have oversupply include your breasts feeling full, even after a full feeding or very quickly after. You may have copious amounts of milk leakage either between feedings or on the side not in use. (You with the large towel, changing shirts every feed, you know who you are.). And oversupply can also lead to chronic mastitis.
Your baby may be gulpy or cough and choke- especially during let down. Their feedings may be shorter even though they are gaining weight because they are taking in milk so quickly. They may have some belly pain after nursing or green loose stools. Some describe them as “foamy stools”. Babies nursing from breasts with oversupply may have excessive weight gain, this is tricky because when you bring up a concern others may say, “Your baby is gaining and so chubby, what are you talking about?!”. They may have reflux, excessive gas, and even refuse feedings eventually.
Babies are smart. They will find compensatory strategies where they can. Such as, clamping down on your nipple or using a shallow latch to slow the flow of milk. In fact a wide latch may be difficult to achieve even if they try on a very engorged breast- I mean it’d be like trying to mouth a hard basketball.
Now I want to point something out about all these symptoms. Don’t some of them sound familiar? But not from oversupply? Many of these symptoms (gulping, shallow latch, belly issues, mastitis, etc.) can absolutely be caused by other issues. This is why it’s a good idea to have someone on your team that can suss things out and save you time. I mean imagine giving up cheese, only to find out, it helps not at all and you're still experiencing the same issues.
Now let’s talk about common causes. Oversupply is commonly caused by over pumping, and mothers who are breastfeeding and pumping to stash additional milk, especially from the beginning, are more prone. Think about it, frequent breastfeeding, nipple stimulation, and milk removal in the early days after your baby is born is how your body gets the message to ramp up production.
According to the Academy of Breastfeeding Medicine, there are three types of sources or causes of oversupply:
Self induced (this is where you take it upon yourself to over pump, or by taking herbs or prescriptions to turbo boost things.)
Iatrogenic (this is when a health professional advises a mother and steers her into hyperlactation. Again, it could be due to poor milk expression advice or inappropriate pumping schedules. Or, due to recommending galactogogues (which is something you ingest to support lactation). Any recommendations by professionals should be followed up on and monitored closely- not just thrown to you never to be adjusted or checked on like oh here’s this thing that may or may not impact an intricate balanced hormonal system in your body and it probably will work perfectly and yeah never need to be adjusted…
The last type is idiopathic hyperlactation which basically means we don’t know the reason- you just have oversupply beyond the normal period of expected breast fullness postpartum and it doesn’t really seem to be caused by schedule or behavioral reasons.
Well who knew that having too much milk would be a problem. But don’t worry, there are great management strategies. They include first and foremost, to gradually stop over pumping if that was your cause. It takes a few days for the body to respond to the new message and since mothers with oversupply are at risk for mastitis- this should be done carefully and very gradually. A Lactation Consultant can create a specific step down approach and help you monitor and make adjustments on this. They may also recommend other specific protocols such as block feeding, offering only one or predominately one breast per feed, hand expressing or pumping only as needed for comfort, reverse pressure softening before nursing, and in extreme cases they may recommend certain foods or herbs to help slow the production. I do not recommend creating your own plan, since going too fast can cause mastitis related issues and of course it would be detrimental to accidentally create a low supply by throwing the kitchen sink at a problem like this.
But here are a couple things that you can do. First, if you know you are over pumping (meaning you have a large supply that is quickly filling the freezer AND your baby is gaining and growing very well so there’s no intake concerns) then very VERY gradually slow down that extra pumping. This will be very specific to each mom. Some moms do have personal reasons to be pumping extra milk. However I find, most of us don’t actually need it and are operating primarily on anxiety of not having enough. Next, you can try laid back feeding. This is a position in which you are more laid back and your baby is more on top of you. You can do this at varying degrees, but the idea is to have gravity help slow the flow. Your baby will still be in good alignment, and supported on your body. And you should be comfortable, so use pillows and a good space to support your body. Some mothers find it easier to get into position and then allow their baby to latch, others find it easier to let their baby latch and very carefully lean back. If you try and it feels frustrating, consider the possibility that it may be helpful to have hands on help since we know there are multiple possible feeding issues that can stem from oversupply and make simply strategy more difficult. If you have excess milk, but you and your baby are having no issues- then you can weigh your options on whether or not you want to make adjustments.
Now that you know more about oversupply and what it can look like, this back to the baby I described who came into my office with oversupply related issues. You can see how if someone doesn’t have a robust understanding of the big picture and a good network of clinicians, this could easily have been missed. That mom likely would have gone to multiple doctors, maybe it would have been caught, or they may have been dismissed because her baby was gaining plenty of weight. Mom may have been recommended a difficult diet change or her baby prescribed reflux medication which wouldn’t have even addressed any underlying issues for them.
Your knowledge and your network are priceless when it comes to saving you time, money, and stress and I hope today you learned something helpful today to boost your knowledge. If so, please rate the show, and I’ll be here next week!
Articles mentioned and utilized in this episode: ABM Clinical Protocol #32