Breastfeeding can be a rewarding experience for both mother and baby, but it doesn’t come without its challenges. One issue that mothers encounter is overactive let-down, where the flow of breast milk is too fast and forceful for the baby to handle. While this can be overwhelming for both mother and baby, the good news is that it’s a common issue, and fortunately, there are effective strategies to manage it.
In this blog, we’ll explore what an overactive let-down is, it’s signs, it’s impact on breastfeeding, and, as usual, I’ll provide my top 10 tips to help you manage it.
What is an Overactive Let-down?
Overactive let-down, also known as forceful let-down, occurs when the milk ejection reflex is too strong, causing milk to flow quickly and sometimes unpredictably. To make it easy to understand, I like to call it the “milk fountain”. While a good milk supply is generally positive, a rapid flow can be difficult for the baby to control and may lead to feeding challenges.
This condition often coincides with hypergalactia or oversupply, where a mother’s milk production exceeds the baby’s nutritional needs. However, overactive let-down can also occur independently, even in mothers with a normal milk supply.
Signs of Overactive Let-down in Mothers and Babies
Both mother and babies may show any of these signs of an overactive let-down:
Signs in Babies:
1. Choking, gagging, or sputtering during feeding: One of the most common signs is when the baby struggles to keep up with the flow of milk, leading to coughing, chocking, or gagging during feeds.
2. Pulling away from the breast while feeding: Your baby may frequently pull away or seem fussy during nursing due to the fast milk flow.
3. Gulping or swallowing loudly: Babies often gulp rapidly to manage the milk and may make loud noises while swallowing.
4. Refusal to nurse: If your baby has experienced discomfort from overactive let-down, they may start to refuse the breast or become frustrated during nursing.
5. Gassy or fussy baby: Swallowing too much air while gulping milk can cause babies to be extra gassy and fussy during and after feeds.
6. Clicking sound: Babies may make a clicking sound when trying to slow the flow of milk using their tongue as a break. Keep in mind, a clicking noise could also be related to a shallow latch or tongue tie, so I recommend seeking support from an IBCLC.
Signs in Mothers:
1. Engorgement: Mothers with overactive let-down may feel uncomfortably full, even between feeds. The breasts are rarely soft or comfortable.
2. Breast pain: The force of milk ejection can sometimes cause discomfort or pain in the breast.
3. Poor breast drainage: Babies may not be able to handle large amounts of milk, leading to poor breast drainage.
4. Recurrent blocked ducts: Due to poor breast drainage, some mothers may experience plugged ducts or even mastitis.
5. Milk spraying from the breast during let-down: Mothers may see milk spraying if the baby pulls away.
6. Leaking milk: While leaking milk is not always a sign of overactive let-down, it is common for mothers to experience it.
Recognising these signs early can help prevent complications and ensure a more comfortable breastfeeding experience for both you and your baby. Avoiding nursing refusal is key, as babies may start to associate breastfeeding with discomfort if the issue is not addressed.
My Top 10 Tips to Manage Overactive Let-down
While overactive let-down can be challenging, fortunately there are many things we can do to manage it. Here are my top 10 tips to help you navigate this challenge:
1. Try a laid-back or reclined nursing position: Gravity can work in your favour, helping to slow the forcefulness of the let-down. This position gives the baby more control over the milk flow as their head is higher than the breast. Some mothers also find the side-lying position helpful, especially for night feeds.
2. Hands express or pump before breastfeeding: If your baby struggles the most during the first few minutes of nursing when milk flow is at its peak, try expressing for a minute or two or until the flow becomes more manageable. This relieves the initial pressure. Don’t worry about overstimulating milk production by pumping; it’s more important to reduce discomfort.
3. Let the milk flow: When your baby starts sucking, the breast sends a signal to the brain, triggering the let-down. Once you feel the milk coming out like a fountain, de-latched your baby for a few seconds until the flow slows down. Once the spray stops, latch your baby again. While feeding allow your baby to come off the breast when they need to catch their breath and keep a muslin handy to catch the spray.
4. Clamp the breast: Manually slow the flow of milk by using a scissors hold with two fingers to gently compress the areola at the beginning of the feed.
5. Feed frequently: Frequent feeding helps reduce the volume and force behind the milk spray.
6. Ensure a deeper latch: Make sure baby is deeply attached at the breast, as this will make it easier for them to manage a fast flow.
7. Burp your baby frequently: This can reduce gas, discomfort, and fussiness. Try to burp them every few minutes or whenever they pull off the breast.
8. Watch for feeding cues and offer smaller, more frequent feeds: Babies benefit from shorter, more frequents feeds, as this prevents them from becoming overwhelmed by a large volume of milk at once.
9. Use “block feeding technique”: While this isn’t a technique I recommend often, if none of the above work I’d give a try, but always under the support of an IBCLC as we can make things worse if not performed carefully. Block feeding involves nursing from one breast for a set period of time (every 3-4 hours) before switching to the other breast. This can help to adjust your milk production to your baby’s actual needs.
10. Consider herbal or pharmacological treatments: While there isn’t enough research to conclusively support this, some mothers find that herbs like sage or peppermint, or medications (such as oestrogen-based contraceptives), can help. Always talk to your healthcare provider before taking any supplements or medications while breastfeeding.
Overactive let-down can feel overwhelming, but with the right strategies, you can manage it effectively and create a more comfortable and successful breastfeeding experience for both you and your baby.
Remember, managing an oversupply takes time and patience. If you continue to struggle with overactive let-down, it’s important to work with an IBCLC lactation consultant who can provide personalised guidance and support.
