Oversupply, foremilk/hindmilk imbalance and a fast let down - my experiences

[kumber]

Hi ladies, me again (god I'm boring myself with this now!). EDIT -- I thought I had put this in the bfing section, sorry!

I just wanted to post my experiences of my bfing struggles as I've noticed a few of mummies and babies are experiencing the same issues so wanted to pass on my research and the advice I was given in the hopes that we can support each other and it hopefully heops us to carry on bfing.

So, as the title says, I have oversupply, foremilk/hindmilk imbalance and a fast let down so a really lovely combination!

Oversupply, while easily corrected, leads to foremilk/hindmilk imbalance - that is when baby is getting too much of the thinner, lactose-rich milk and not enough of the thicker, fat-rich milk. Baby needs both of these for their needs - although they can thrive perfectly well on foremilk, it does come with its problems.

Symptoms of oversupply are mostly full or engorged breasts even after feeds. After a feed your breast should feel soft and drained.

Symptoms of foremilk/hindmilk imbalance are:

• your baby gains weight very rapidly
• your breasts always feel full and you are troubled by frequent leaking (oversupply)
• Your breasts seem to fill quickly
• Your breasts are often lumpy and tight, despite softening with a breastfeed.
• Your baby gags, gulps (especially at the start of a feed) and often will not take the second breast.
• Your baby may bring up quite a lot of milk at the end of the feed
• Your baby may be extra fussy between feeds, especially in the evening.
• You are changing lots of wet nappies (ie more than the usual 5 heavy wet disposable nappies or 6–8 heavy wet cloth nappies in 24 hours).
• Your baby generally has a bowel motion at each feed that is often green and frothy (and possibly also explosive).
• Baby clamps down on the nipple at let-down to slow the flow of milk
• Makes a clicking sound when nursing
• Spits up very often and/or tend to be very gassy
• Periodically refuses to nurse
• Dislikes comfort nursing in general
  Oversupply La Leche League, Australian Breastfeeding Society - Too Much Milk and KellyMom - Forceful Let Down

Oversupply and foremilk/hindmilk imbalance causes excess lactose in the stomach and gut of baby. Whilst babies are designed to break down more lactose than an adult, an overabundance of it means that it does not get broken down sufficiently. This leads to excessive and painful gas build up in the gut of baby - in our case it's caused a very distressed little guy in a lot of pain throughout the day. I was told by mws, hvs, and peer-to-peer bf people that this was normal. It is not. If you have been given similar advice, please don't be fobbed off. Trust your instincts!

Fixing these problems is simple but slightly long-term. I rang the NCT breastfeeding helping and was advised the following:

• Express before each feed only to the point where let down is stimulated - this will help slow the milk down so he's not gulping and taking in air
• Feed leaning back at a 45 degree angle so he is higher than my breast, again to slow the flow of milk
• Put baby back to the same breast in a 4 hour block so every feed in that 4 hour block is all on one breast. This has two results; firstly your full breast signals your body to stop milk production on that side, reducing the amount of milk you make and so reducing the oversupply, and secondly it allows baby to get the thicker, fatter milk over the course of the 4 hours, reducing the amount of lactose and helping reduce the painful gas
• When block feeding, pump off the full breast only enough to relieve the pressure but not drain the breast
• Don't offer both breasts per feed, remain on one for the full 4 hour block.

I was advised that if I don't see a difference in him in a week to move from 4 hours to 6 hours of blocks. Do, however, give the NCT or National Breastfeeding Helpline a call for yourself, as they will tailor their advice to suit the severity off your problem.

I was told to expect to continue in this way until at least 6 weeks, at which point I should expect to notice a difference in my supply in general. It can take up to 12 weeks to resolve.

Had I known all of this as a ftm with ds1, I would never have given up bfing. As it was I convinced myself it was all my fault and I couldn't see him in so much pain for 6 months. I don't think these issues get looked at or discussed enough, I was made to feel guilty for complaining when there are some mums who aren't able to make enough milk when my problems are just as isolating (I can't boob in public without help due to let down) and just as distressing for mum and baby. Hopefully this thread provides some support to ftms/first time bfers that, although it's horrid and draining (but not in the way it should be!), it is fixable and it isn't forever.

 

[Cakey]

Oh wow this kind of explains some of the problems I'm having with my little boy. I'm a bit angry that none of the many HVs I've seen have suggested this though! Thanks for posting. Xx

 

[kumber]

I don't know whether a lot of hvs don't know about it or just don't understand how difficult it can be - I mean why complain about having too much of something? I don't think people realise how difficult it is.

 

[Anna.Femm]

Thank you kumber, that was really helpful! I experienced the same problem, although it was only for a few weeks: oversupply and fast let down, and my poor son would literally choke on the excess milk and made the whole experience unpleasant for him so he ended up crying when I offered him food! Fortunately I was given advice to not press him at all and only offer when he asks, which effectively reduced the number of feeds, and in turn the milk supply, so we pulled through. It was a very frustrating time though, and like you say, there is not a lot of talk about this as most mums have the opposite problem.

 

[WTT_june 2014]

Hey Kumber, how you getting on? Thanks for sharing this info!
I have also been advised you can reset your milk supply by completely draining both breasts. Don't know if this link will work, hopefully it will which explains in more detail:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2075483/

 

[kumber]

That article is fab WTT, thank you! We will be trying this in a week or two if we don't see improvement