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我的乳汁太多吗?Am I Making Too Much Milk?


我的乳汁太多吗?Am I Making Too Much Milk?

我的乳汁太多吗?

 

有时妈妈会产生比宝宝需要量多的乳汁。尽管乳汁多看上去似乎是一个好的麻烦[A1] ,但是从涨满的乳房流出的急速的乳汁会使妈妈和宝宝对哺乳感到紧张和不适。宝宝在两次哺乳之间也会因为奶量太多而显得烦躁。

 

多数妈妈乳汁多的宝宝体重增加得比正常宝宝快,每天需要更换更多尿布。 (参考 如何知道我的宝宝吃到了足够的母乳?  来获得正常体重增长和尿量信息)只要宝宝愉快、容易哺乳,体重增长比正常宝宝快对于纯母乳喂养的宝宝来说没有任何问题。只有当宝宝或妈妈因为乳汁过多而遭遇哺乳困难时这才被看做是个问题。

 

一些妈妈乳汁过多的宝宝其实并没有得到足够的乳汁,因为他们很难控制流量过大的乳汁,所以很难哺乳。这些宝宝需要补充喂养(最好是他们妈妈的挤出来[A2] 乳汁),直到妈妈们的乳汁分泌量调节到适合他们的所需。

 

如果妈妈的乳汁多到宝宝难以控制,通常会有以下表现:

 

·         宝宝容易哭闹,经常易激惹和/或不安

·         哺乳时宝宝有时可能会噎住、窒息、来不及下咽或咳嗽

·         哺乳时宝宝可能会咬或抓乳头

·         宝宝离开时乳汁[A3] 喷射,尤其是在刚开始哺乳时[A4] 

·         妈妈可能会有乳头疼痛

·         宝宝可能会蜷紧身体,有时尖叫

·         宝宝断断续续地吃奶,哺乳常常像是在打仗[A5] 

·         哺乳时间短,仅仅持续5-10分钟

·         宝宝显得对乳房“爱恨交加”

·         两次哺乳之间宝宝可能会经常打嗝或嗳气,吐奶多

·         宝宝可能会有绿色水样或泡沫样喷射而出的大便

·         多数时间妈妈的乳房感到涨满

·         妈妈可能会有频繁乳管阻塞,有时会导致乳腺炎(乳房感染)

 

如果你有过其中的很多表现,可能就是由于你的乳汁过多,这可能会导致强烈喷乳(有时指的是过强喷乳反射),和/或前奶后奶失衡。[1][2]上述婴儿的表现是由这些原因引起的,但常常被误认为是肠绞痛、乳糖不耐受、乳蛋白过敏、返流或肌张力增加 (肌肉紧张)

 

如果你有乳汁过多、喷乳或前后奶不平衡,以下方法可能会改善你的哺乳状况。幸运的是,很多妈妈到宝宝满三个月时发现乳汁过多会自然调整到可控的水平了。

 

为什么会发生乳汁过多?

 

妈妈泌乳过多的原因有几个。一些妈妈的身体反应强烈,她们从一开始就分泌很多乳汁。另一些人可能是由于听从了一些母乳喂养的建议而无意中增加了乳汁分泌。如果妈妈在哺乳前为了使哺乳更容易而常规使用吸奶器吸出大量乳汁来降低乳汁流量,这种做法尤其会导致产奶过多。。她可能暂时达到了目的,但最终导致了长期的问题。另一个原因可能是在宝宝吃空一侧乳房前频繁两侧乳房交替哺乳。这通常会发生在妈妈每侧乳房只喂了一段时间或者她们在试图寻找在哪一侧哺乳会让宝宝不烦躁。有些妈妈的乳房对刺激非常敏感,两侧交替而不把一侧完全吃空会导致两侧乳房分泌乳汁过多。

乳汁过多[A6] 问题的产生通常是由于妈妈们从书本、网络或善意的朋友、家人或医护人员那里得到该如何母乳喂养的错误建议。妈妈可能会被告知她必须每一侧乳房喂多长时间或者宝宝必须每次吃奶都要吃两侧乳房。然而,对于乳汁丰富的妈妈,宝宝可能吃一侧乳房就会很快吃饱,以至于她要早点中止一侧哺乳来让宝宝能够接受继续吃另一侧。宝宝被中断了吃后奶而继续吃另一侧的前奶。大量吃热量较低的前奶会导致一种自我持续的循环[A7] :宝宝的胃由于哺乳而觉得饱胀不适,但他仍然感到饥饿,因为他没有得到足够的乳脂肪来满足他。所以宝宝哭闹着要再次吃奶,于是因为宝宝看上去永不满足,妈妈就认为他没有吃到足够的乳汁。

 

这种无意中的处理不当可能会进一步导致另外一个问题。前奶乳糖含量高,大量含有正常必要的乳糖的前乳[A8] 会引起胀气不适,常伴有绿色、水样或泡沫样大便。一段时间以后,不消化的乳糖会刺激肠粘膜,引起短暂性继发乳糖不耐受并可能引起少量便血,这可能会被误诊为食物过敏。调整哺乳来增加宝宝进食的脂肪量(吃空一侧乳房再换另一侧)通常能纠正这些问题。更多关于前奶、后奶以及乳糖的讨论见 Foremilk, Hindmilk, and Lactose FAQ.前奶,后奶和乳糖的常见问题。

 

降低乳汁分泌的方法

 

改变哺乳方法能够降低总奶量和宝宝获得的乳糖量,同时增加脂肪摄入。由于乳汁过多的妈妈通常每侧乳房都能产生足够的乳汁,一个有效的方法是每次只用一侧哺乳。如果宝宝在两小时内想要再吃,看看再给他喂同一侧时他的反应如何。两个小时后只喂另外一侧。乳房会由于未被频繁吃空而逐渐降低乳汁分泌速度。这样会下调乳汁分泌速度来配合宝宝的真实需要,同时降低宝宝摄入的前奶量和乳糖量。 [3] 当你让宝宝在一侧乳房吃更长时间时,能够保证他完全吃空乳房并获得更多高热量的后奶。

 

如果在再次哺乳前你感觉没有哺乳的一侧乳房不舒服,你可以用短时间手挤或用吸奶器(20-30秒或更短),仅仅缓解不适即可。不要吸出太多乳汁,否则你会刺激乳房产生更多乳汁。乳汁里有一种称为“哺乳反馈抑制素”(FIL)的乳清蛋白,如果有一段时间乳汁未被排出,它就会开始产生并聚集。这种蛋白质需要足够多来启动乳房切断乳汁分泌。仅排出少量乳汁来缓解不适仍然能够保证乳房足够胀满,触发“切断乳汁分泌”的信息,大多数妈妈能够降低乳汁分泌而没有乳管阻塞或乳房感染的危险。很多妈妈发现冷敷——新鲜的卷心菜叶或一袋冻豌豆——能够缓解过度充盈造成的不适和肿胀。

 

当宝宝变得在两次哺乳之间不那么烦躁,而是更加满足,大便不太稀而且更黄时,你会发现持续一段时间只用一侧哺乳的方法奏效了。由于乳汁流速不那么快了,哺乳时宝宝的噎住、窒息和喷溅也会减少。

 

如果47天单侧哺乳后宝宝仍然有困难,你可能需要更长时间的单侧哺乳(连续两三次或更长)来进一步降低你的乳汁分泌量。有些乳汁特别多的妈妈可能需要同一侧哺乳达12小时。最好慢慢地、小心地延长仅用一侧哺乳的时间,只有当乳汁分泌量没有下降时才持续更长时间。过长时间的单侧哺乳可能导致乳汁分泌下降过多。(多数乳汁过多的妈妈发现通过一些额外的吸奶可以很容易恢复足够的乳汁分泌。)

 

如果你的乳汁分泌实在太旺盛,持续一段时间的每次只喂一侧的方法仍然不能降低乳量,你可能需要尝试一种更极其有组织的方法,它在开始的时候需要吸奶。在开始哺乳前约1小时把两侧的乳房彻底吸空,让他们变软。然后持续几次哺乳都用同一侧乳房,直到该侧乳房完全柔软舒适而另一侧乳房开始感到无法忍受的胀满。当你感 觉胀到无法忍受,换到另一侧乳房哺乳,直到感到之前一侧乳房胀得无法忍受。一天中可能需要第二次把两侧的乳汁吸出,既为舒适也为避免乳管阻塞。之后的几天里,继续用同一次乳房哺乳,直到另一侧胀满。这会让宝宝在换到另一侧乳房前几个小时内都吃一侧乳房。当你的身体产生了“乳汁太多”的信息,它就会降低乳汁分泌的速度,就逐渐不需要吸奶了。

 

如果做了这些尝试后,哺乳状况还是没有明显改善,那可能就需要采取更有力的调整乳汁分泌的办法了。国际母乳会的指导会跟你和你的医生分享药物或草药信息来帮助你解决乳汁过多的问题。有时候47天的含有雌激素和孕激素的低剂量口服避孕药可能会被用于把乳汁量降到一个更合适的水平。鼠尾草茶帮一些妈妈减少了乳汁,就像传统用的伪麻黄碱(Sudafed, Halofed, Novafed)[A9] 一样。有些妈妈还发现薄荷及含有薄荷、薄荷茶、鼠尾草和百里香的止咳药有助于减少乳汁产量,虽然对于问题比较严重的妈妈来说可能会服用大量的止咳药。

 

减少喷乳的方法

 

当一个妈妈分泌大量的乳汁时,她的喷乳反射比较强烈。所有涌出的乳汁可能令宝宝难以招架。这就好像试图躺着从一个开到最大的水龙头连接的橡胶软管喝水一样。当乳汁涌出时,除了窒息、呕吐、咳嗽以外,宝宝可能还会通过拉扯乳头和浅衔接来控制乳汁流量。浅衔接对于妈妈来说可能非常疼痛。或者宝宝可能只是为了减慢流量而夹住乳头,产生“咬”的感觉。宝宝还可能尖叫和挺直后背来让你知道需要改变什么。

 

有时会建议乳汁过多或喷乳强烈(射乳反射)的妈妈在哺乳前手工挤出或吸出一盎司左右的乳汁来减慢乳汁流速。然而,这种办法常常达不到目的,因为排出这些乳汁会刺激乳汁分泌的增加,从而更增加乳汁的流量。

 

很多办法可以对付强烈喷乳而不增加乳汁分泌。把宝宝置于更竖直的位置,这样他的头部高于乳房,会使他在哺乳是更容易控制。或者调整你自己的姿势使自己向后斜靠,这样宝宝在衔接后几乎是在你的上面。这种姿势是乳汁不得不“向上”流,可以降低喷乳的强度。

 

有些妈妈发现“剪刀式”持住乳晕,让乳头置于食指和中指之间,可以帮助限制乳汁流出。另一个办法是用手掌根部压住乳房侧面。(试着改变手的位置以避压迫乳管而不小心引起阻塞。)你也许还发现在宝宝刚睡醒时哺乳比较有效。他困的时候吸吮力比较弱。

 

如果宝宝窒息/呕吐,让他放开乳头并让过多的乳汁喷到毛巾或者布[A10] 上。当喷乳强度下降后再让他重新衔乳[A11] 

 

许多乳汁过多的妈妈发现侧卧的姿势有利于顺利哺乳,因为乳汁水平地从乳房流出而没有重力的作用,宝宝可以让过多的乳汁从口中流出而不需要被迫咽下。(在你和宝宝身下垫个毛巾吸收多余的乳汁。)把一个卷起来的毯子放在宝宝背后让他不会从你旁边滚走。如果下次哺乳时你们仍然躺在一起并准备好了喂另一侧乳房,你可以把宝宝转到你身体的另一侧,这样另一个乳房挨着床,乳汁不会向下流而增加压力。

 

你可能发现侧卧位有一点难以控制,躺下时也不容易衔乳。有时把乳头对着宝宝的鼻子会帮助他伸直脖子,在衔乳时他向上看着乳房。有些妈妈坐着时让宝宝衔乳,然后抱住正在吃奶的宝宝慢慢躺下侧卧。学会卧位哺乳的一个很大好处是在宝宝吃奶时你可以入睡。不要担心宝宝会呼吸困难;宝宝会选择需要空气更胜于食物。只要他的头附近没有枕头或毯子,他就会在吃完奶后自由移动头部。他会把头靠在你的乳房上,好像它是一个枕头。(有过大、像枕头一样乳房的妈妈要格外注意宝宝是否有足够空间移动头部。)更多关于侧卧哺乳信息查看 (forthcoming) Side-Lying FAQ。(即将出版)侧卧常见问题。

 

有些宝宝用一次只吃一点、频繁开始和停止吃奶来对付妈妈的强烈喷乳。就像他们在慢慢享受一顿饭的几道菜一样。这样绝对可以;允许他们按照需求接近或离开乳房,保证宝宝每次吃同一侧乳房,这样他们才有机会吃到后奶。

 

虽然乳头疼痛时很想拉长哺乳间隔,但在宝宝非常饥饿前哺乳可以防止他过于强烈的吸吮,这种吸吮不仅使乳头更痛,还会引起更严重的乳头损伤。过度强力的吸吮还会引起更强的喷乳,使哺乳更加困难。

 

其他乳汁过多的问题

 

乳汁过多会引起漏奶。如果你的乳房不合时宜地漏奶,用胳膊或手掌根部压住乳头几分钟。有些妈妈发现每隔三四个小时在乳头上喷洒冷水或用冰块轻擦乳头可以减轻漏奶。多数妈妈发现最初几个月过去后漏奶会明显减轻。

 

虽然多数母乳喂养的宝宝无需太多拍嗝,但乳汁多的妈妈发现宝宝吃奶时吃进很多空气,也会由于过多的乳糖而容易产气。经常拍嗝会减少吞咽空气带来的问题。记得拍嗝后把宝宝放回最初那一侧的乳房而不是换到另一侧。

 

当你正设法解决乳汁过多的问题,你可以联系国际母乳会的哺乳辅导,来寻求帮助,从而解决这个令人困扰但不是不常见的哺乳问题。

 

减少乳汁分泌和喷乳的方法小结

 

·         每次哺乳只喂一侧乳房,之后两个小时内继续喂同一侧乳房,直到下一次完整哺乳

·              如果必要,逐渐延长同一侧哺乳时间

·              如果这个方法无效,尝试充分吸空乳房然后用一侧乳房哺乳,直到另一侧胀得无法忍受(详述见上文)

·         如果另一侧乳房在你准备哺乳前胀得无法忍受,吸出或手工挤出乳汁一小会儿来缓解压力

·              用冷的新鲜卷心菜叶或一袋冻豌豆缓解不适和肿胀

     更多建议见Engorgement FAQ 涨奶常见问题 

·         在宝宝过度饥饿前哺乳来减轻过强吸吮

·         尝试改变哺乳姿势

·            妈妈尽量向后斜靠

·            侧卧(让乳汁细流出)

·         剪刀式夹住或手的一侧压住乳管来减弱喷乳强度

·         如果宝宝窒息或喷溅乳汁,让他松开乳头,让过多的乳汁喷到毛巾或者布[A12] 

·         允许宝宝自由地接近或离开乳房

·         如果宝宝胀气则经常拍嗝

·         正确使用某些草药或药物可能会帮助减少乳汁

by Diana West, BA, IBCLC, co-author with Lisa Marasco of The Breastfeeding Mother‘‘s Guide to Making More Milk (McGraw-Hill, December 2008) and Elliot Hirsch of Breastfeeding After Breast and Nipple Procedures (Hale Publishing, July 2008), and author of The Clinician‘‘s Breastfeeding Triage Tool(International Lactation Consultants Association, 2006) and DEFINING YOUR OWN SUCCESS: BREASTFEEDING AFTER BREAST REDUCTION SURGERY (LLLI, 2001).

References

[1] Livingstone, V. Too much of a good thing. Maternal and infant hyperlactation syndromes. Can Fam Physician 1996 Jan; 42:89-99.

[2] Smillie, C., Campbell, S., Iwinski, S. Hyperlactation: How left-brained "rules" for breastfeeding can wreak havoc with a natural process. Newborn Infant Nursing Rev 2005; 5(1):49-58.

[3] Newton, M. and Newton, N. The let-down reflex in human lactation. Pediatrics 1948; 33:69-87.

 


 [A1]甜蜜的烦恼

 [A2]挤出的

 [A3]乳头时乳汁喷射现象

 [A4]哺乳开始时

 [A5]哺乳常常象战斗

 [A6]

 [A7]自身不断发展的

 [A8]乳糖过量

 [A9]同样保守的方法是使用伪麻黄碱(Sudafed, Halofed, Novafed)也能起作用。

 [A10]毛巾或布

 [A11]衔乳

 [A12]毛巾

 

Am I making too much milk?

Sometimes a mother can make more milk than her baby needs. While having too much milk may seem like a good problem to have, the rush of milk from an overfull breast can make feedings stressful and uncomfortable for both mother and baby. Babies can also be very fussy in between feedings when there is too much milk.

Most babies whose mothers have too much milk gain weight much faster than normal and have many more wet and soiled diapers than normal each day. (See How can I tell if my baby is getting enough milk? for information on normal weight gain and diaper output.) Higher than normal weight gain is absolutely fine for an exclusively breastfed baby as long as he is generally happy and feeding easily. It is only a problem when either the baby or his mother experiences difficulties as a result of having too much milk.

Some babies whose mothers have too much milk actually do not get enough milk because they have trouble handling the strong flow and can‘‘t breastfeed easily. These babies need supplementary feedings (preferably with their mothers‘‘ expressed milk) until their mothers‘‘ milk supply can be adjusted to better meet their needs.

When a mother has more milk than her baby can handle, the following behaviors may be common:

  • Baby cries a lot, and is often very irritable and/or restless
  • Baby may sometimes gulp, choke, sputter, or cough during feedings at breast
  • Baby may seem to bite or clamp down on the nipple while feeding
  • Milk sprays when baby comes off, especially at the beginning of a feeding
  • Mother may have sore nipples
  • Baby may arch and hold himself very stiffly, sometimes screaming
  • Feedings often seem like battles, with baby nursing fitfully on and off
  • Feedings may be short, lasting only 5 or 10 minutes total
  • Baby may seem to have a "love-hate" relationship with the breast
  • Baby may burp or pass gas frequently between feedings, tending to spit up a lot
  • Baby may have green, watery or foamy, explosive stools
  • Mother‘‘s breasts feel very full most of the time
  • Mother may have frequent plugged ducts, which can sometimes lead to mastitis (breast infection)

If many of these experiences seem familiar to you, it may be because you have an overabundant supply of milk, which can cause a forceful milk ejection (sometimes referred to as overactive let-down), and/orforemilk-hindmilk imbalance.[1][2] The infant behaviors described above are caused by these issues but may frequently be misdiagnosed as colic, lactose intolerance, milk protein allergy, reflux, or hypertonicity (stiff muscle tone).

If you are experiencing oversupply, a forceful milk ejection, or foremilk-hindmilk imbalance, the strategies described below may greatly improve your breastfeeding experience. Fortunately, many mothers find that oversupply naturally adjusts to a more manageable level by the end of baby‘‘s third month.

Why Does Oversupply Happen?

There are several reasons why a mother may produce too much milk. Some mother‘‘s bodies are very enthusiastic and they seem to overproduce milk from the very beginning. In other cases, the oversupply may result from following breastfeeding management advice that unintentionally increased milk production. This is especially likely to happen if a mother routinely pumps a significant amount of milk before nursing to slow down the flow in order to make it more manageable for baby. She may accomplish the immediate goal, but end up with a chronic problem as a result. Another cause can be routinely switching baby to the other breast before he has finished the first breast. This can happen when mothers feed only a certain amount of time on each breast or when they are trying to find a side that the baby doesn‘‘t fuss on. Some mothers‘‘ breasts are highly sensitive to stimulation, and switching back and forth without ever draining a breast well can result in production of too much milk in both breasts.

Oversupply problems are frequently created by cultural beliefs about how breastfeeding should happen, which mothers read in books and online, or hear from well-meaning friends, family, or health care providers. A mother may have been told she must nurse a certain number of minutes on each side or that baby must take both breasts at every feeding. Yet, for the mother with an abundant supply, baby may naturally fill up so fast on one breast that she finds herself cutting him off very early in order to get him to still accept the second breast. He is taken off the breast before he gets to the creamier milk, and then fills up on foremilk from the second breast. Large feedings of lower calorie foremilk create a self-perpetuating cycle: baby‘‘s tummy feels distended and uncomfortable from the feeding, yet he still feels hungry because he did not get enough milk fat to satisfy him. So baby cries to feed again, and mother concludes that he must not be getting enough milk because he never seems content.

A further problem may also result from this unintentional mismanagement. Foremilk is high in lactose, a normal and necessary milk sugar that in large volumes causes gassiness and discomfort, frequently with green, watery or foamy stools. Over a period of time, undigested lactose can irritate the lining of the intestines, causing temporary secondary lactose intolerance and possibly small amounts of bleeding into stools that can be misdiagnosed as a food allergy. Adjusting breastfeeding to increase the amount of fat the baby receives ("finishing" the breast before switching) usually corrects the problem. For a more thorough discussion of foremilk, hindmilk, and lactose, see our Foremilk, Hindmilk, and Lactose FAQ.

Strategies to Slow Down the Rate of Milk Production

Changing the way you feed your baby can reduce both the overall milk volume and the amount of lactose baby receives, while increasing the amount of fat. Since mothers with oversupply often produce enough milk in each breast for a full feeding, one strategy that can be very successful is to feed the baby on only one side per feeding. If your baby wants to nurse again within two hours, see how he responds if you continue to offer that same side. In the next two hours, offer only the other breast. The breasts should gradually slow down their rate of milk production because milk is being removed less often. This helps down-regulate the milk production rate to match baby‘‘s true needs while also reducing the amount of foremilk and lactose baby receives.[3] When you keep baby at the same breast for a longer period of time, it also ensures that your baby is fully draining the breast and getting more of the higher calorie hindmilk.

If you are uncomfortable on the breast that is not being used before you are ready to nurse on it again, you can hand express or pump for only a few moments (20-30 seconds or less), just enough to relieve some discomfort. Do not pump too much or you will signal your breasts to produce even more milk. There is a certain whey protein in the milk, called "Feedback Inhibitor of Lactation" (FIL), that begins to build up and concentrate when milk is not removed for a while. This protein needs to be allowed to build up high enough to trigger the breast to cut back milk production. By removing just barely enough milk to be comfortable, but still allowing the breast to be full enough to trigger the "cut back milk production" message, most mothers can decrease milk production without risking plugged ducts or a breast infection. Many mothers find that cold compresses -- chilled raw green cabbage leaves or a bag of frozen peas -- help ease the discomfort and reduce swelling from being overly full.

You will know the strategy of feeding only on one side for extended periods is working when your baby becomes less fussy and seems more satisfied between feedings, and his stool becomes less watery and more yellow. He will also gulp, choke, and sputter less during feedings, because the milk is not flowing as fast.

If you find that your baby is still having difficulty after four to seven days of feeding only on one breast per feeding, you may need to breastfeed on just one breast for a longer period of time (two or three feedings or even longer) in order to decrease your milk production further. Some mothers with extreme oversupply may need to feed only on one breast for as long as 12 hours. It is best to extend the time on one breast very slowly and carefully, going longer only if milk production is not slowing down. Feeding on one side for too long could lead to decreasing milk production too much. (Most mothers with oversupply find that it is easy to regain adequate milk production with a few additional pumping sessions.)

If you have very enthusiastic breasts and the strategy of feeding on only one side for extended periods is not taming them yet, you may need to try a more extreme structured approach that initially does include some pumping. Start by pumping both sides thoroughly so that your breasts are fairly soft about an hour before a feeding. Then feed on one breast for several feedings until that breast is completely soft and comfortable and the other breast starts to feel unbearably full. When you feel unbearably full, switch sides and feed on the second breast until the first breast starts to feel unbearably full. It may be necessary to pump both sides a second time during the day, both for comfort and to ward off plugged ducts. For the next several days, continue to feed on one breast until the other one feels overfull. This will result in keeping baby to one side for several hours before switching to the other side. As your body is allowed to get the "overfull" message, it will respond by slowing the rate of milk production, and pumping should gradually become unnecessary.

If after trying these techniques, feedings do not improve significantly, it may be necessary to take stronger measures to regulate your milk production downward. An LLL Leader can share information with you and your doctor to help manage oversupply using medications and herbs. In certain situations, a four- to seven-day course of low-dose oral contraceptive pills, containing both estrogen and progesterone, may be used to reduce milk production to a more appropriate level. Sage tea has helped some mothers in reducing milk production, as has the conservative use of pseudoephedrine (Sudafed, Halofed, Novafed). Some mothers have also found that mints and cough drops containing peppermint, peppermint tea, sage, and thyme help to reduce milk production, though it would take a lot of cough drops to make a difference in a mother who has a severe problem.

Strategies to Reduce Milk Ejection Force

When a mother produces a large volume of milk, her milk ejection reflex will be stronger. All that milk rushing down the ducts may be more than baby can handle. It‘‘s like trying to drink from a garden hose that is turned on full-blast, while lying down on your back. In addition to choking, sputtering, and coughing when the milk comes out, baby may try to control the milk flow by pulling away and adapting a shallow latch. Shallow latching can be very painful for a mother. Or he may simply clamp down in an attempt to slow the flow, resulting in a "biting" sensation. Baby may also scream and arch his back to let you know that something needs to be changed.

It is sometimes recommended that mothers who have oversupply or an overactive milk ejection (let-down) hand-express or pump an ounce or so of milk prior to feeding to help slow the milk flow. However, this practice tends to be counterproductive, because removing that much milk from the breasts increases milk production, which in turn will increase the force of flow even more.

There are many strategies that can help manage a forceful milk ejection without increasing milk production. Placing the baby in a more upright position, so that his head is higher than the breast, will allow him more control during the feeding. Or position yourself so that you are leaning backwards, with the baby almost on top of you after he latches. In this position the milk has to flow "uphill," which will reduce the force of your milk ejection reflex.

Some mothers find that a "scissors" hold on the areola, with the nipple between the forefinger and middle finger, helps restrict the flow of milk. Another option is to apply pressure on the side of your breast with the heel of your hand. (Try to vary the position of your hand to avoid constricting the ducts and inadvertently causing a plug.) You may also find it helpful to breastfeed just as your baby is waking from naps. He will suck more gently when he is still sleepy.

If baby starts to choke/sputter, unlatch him and let the excess milk spray into a towel or cloth. Relatch him when the force of the milk ejection has lessened.

Many mothers with oversupply find that nursing in a side-lying position makes feedings go more smoothly because milk flows from the breast horizontally without the force of gravity and babies can let excess milk dribble downward from their mouths rather than having to swallow it all. (Place a towel under you and baby to absorb the extra milk.) Use a rolled-up receiving blanket against your baby‘‘s back to keep him from rolling away from you. If you are still lying down together at the next feeding and are ready to offer the other breast, you can just roll with your baby onto your other side, so that the second breast is against the bed and not flowing downhill with increasing force.

You may find that the side-lying position is somewhat difficult to master and that it is not as easy to get a good latch when lying down. Sometimes it helps to place baby with nipple pointing at his nose so that his neck is extended and he is looking up toward the breast as he latches. Some mothers latch baby onto the breast while sitting up and then slowly slide down into a side-lying position while holding baby gently but firmly so he stays attached. One great benefit of learning to nurse lying down is that you can drift off to sleep while your baby nurses. Don‘‘t worry that your baby will have difficulty breathing; babies choose air over food. So long as there are no pillows or blankets around his head, he will be able to move his head freely when he is finished nursing. He may rest his head against your breast as if it were a pillow. (Note that mothers with very large, pillowy breasts need to take special care that baby has room to move his head.) For more information about the side-lying position, see our (forthcoming) Side-Lying FAQ.

Some babies cope with their mothers‘‘ strong milk ejection by taking only a little milk at a time, stopping and starting frequently. It is almost as if they are enjoying several courses to their meal. This is absolutely fine; allow him to come on and off the breast as he needs to, making sure to keep offering your baby the same breast for each course so that he has the opportunity to get the cream.

Although it can be tempting to stretch out feedings when your nipples are sore, feeding baby before he gets extremely hungry will keep him from sucking too aggressively, which not only hurts when nipples are already sore, but can cause further nipple damage. An overly strong suck can also cause a stronger milk ejection, making the feeding more difficult.

Other Oversupply Problems

Oversupply can contribute to leaking. When your breasts leak at inopportune moments, apply pressure to the nipples by pressing your arms or the heels of your hands tightly against your chest for a few minutes. Some mothers find that splashing cold water on nipples or rubbing them gently with ice every three to four hours is helpful in reducing leaking.[3] Other mothers have benefited from the use of commercial products that are designed to reduce leaking. Most mothers find that leaking subsides significantly after the first few months.

Although most breastfed babies do not need much burping, mothers who make large volumes of milk find that their babies take in more air while feeding and are gassy from the excess lactose. Frequent burping will minimize problems from swallowed air. Remember to bring baby back to the first breast rather than switching sides after burping.

As you work to manage oversupply, don‘‘t hesitate to contact an LLL Leader for help in solving this frustrating but not uncommon nursing problem.

Summary of Strategies to Reduce Rate of Milk Production and Force of Milk Ejection

  • Nurse on one side for a each feeding, continuing to offer that same side for at least two hours until the next full feeding
    • Gradually increase the length of time feeding from one breast if necessary
    • If this strategy is not effective, try the method of throughly pumping breasts and then feeding on one breast until unbearably full (described in detail above)

  • If the other breast feels unbearably full before you are ready to nurse on it, pump or hand express for a few moments to relieve some of the pressure
    • Use cold raw green cabbage leaves or a bag of frozen peas to reduce discomfort and swelling
    • See the Engorgement FAQ for more suggestions

  • Feed baby before he becomes overly hungry to minimize aggressive sucking
  • Try alternate nursing positions
    • Mother leaning far back
    • Side-lying (letting milk dribble out)

  • Use scissors hold or the side of your hand to compress ducts to reduce the force of the milk ejection
  • If baby chokes or sputters, unlatch him and let the excess milk spray into a towel or cloth
  • Allow baby to come on and off the breast at will
  • Burp frequently if baby is gassy
  • Certain herbs and drugs, used judiciously, may be helpful in reducing milk production
  • by Diana West, BA, IBCLC, co-author with Lisa Marasco of The Breastfeeding Mother‘‘s Guide to Making More Milk (McGraw-Hill, December 2008) and Elliot Hirsch of Breastfeeding After Breast and Nipple Procedures (Hale Publishing, July 2008), and author of The Clinician‘‘s Breastfeeding Triage Tool(International Lactation Consultants Association, 2006) and DEFINING YOUR OWN SUCCESS: BREASTFEEDING AFTER BREAST REDUCTION SURGERY (LLLI, 2001).

    References

    [1] Livingstone, V. Too much of a good thing. Maternal and infant hyperlactation syndromes. Can Fam Physician 1996 Jan; 42:89-99.

    [2] Smillie, C., Campbell, S., Iwinski, S. Hyperlactation: How left-brained "rules" for breastfeeding can wreak havoc with a natural process. Newborn Infant Nursing Rev 2005; 5(1):49-58.

    [3] Newton, M. and Newton, N. The let-down reflex in human lactation. Pediatrics 1948; 33:69-87.


 
 
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