I found breastfeeding very challenging. I struggled with low milk supply early on, fortunately, as the weeks passed my milk supply improved. However, there are some mothers that struggle with breastmilk oversupply.

The production of breast milk is determined by the infant’s demand.  A woman’s breast will often produce enough milk to feed an infant, but some mothers experience milk overproduction.  In this case, the supply of breast milk far exceeds the demand of the infant.

Milk oversupply often occurs early in lactation, but can also be worse if you have had multiple pregnancies.  When the breasts are engorged and milk is in oversupply, milk may expel from the breast at a forceful rate, called Overactive Milk Ejection Reflex (OMER).  A forceful letdown may cause your infant to have difficulty feeding. 

Signs your breasts are in milk oversupply:

• Breasts are frequently engorged
• Infant is coughing and choking during feeds
• Infant is biting on the nipples to try and slow the flow of the milk 
• Infant is restless during feeds or pulling on and off the breast
• Infant is gaining more weight than average because they are drinking too much milk; OR the infant is not gaining enough weight because they are not drinking enough milk due to forceful letdown and not receiving the high caloric hind milk from pulling off the breast early 

The good news is that milk overproduction typically improves over the first few weeks of nursing.  Medications and herbal supplements that increase milk supply such as domperidone and fenugreek should be stopped.    

There are some tips you might want to try to deal with milk overproduction:

• Change your nursing position to have your baby in a more upright position, and the mother leaning back so that gravity is working against the flow of milk
• Make sure the baby’s ear, shoulder, and hip are positioned in a straight line.  This will help to ensure the baby’s throat is not closed off and they can swallow easily. 
• If your baby is pulling away from the breast, allow them some time to swallow or burp.  If the milk is flowing forcefully, they may need a bit more time to swallow and digest. 
• If milk is flowing very forcefully, you may want to try and mechanically slow down the flow.  This can be done by placing pressure on the areola or breast to restrict the flow of milk into the nipple.  
• Express milk for 1-2 minutes prior to feeding your baby to release the forceful letdown, and then bring the baby to the breast.
• Avoid breast pumping.  The more the breast is emptied, the more milk will be produced.  
• Consider a technique called block feeding.  Breastfeed from only one breast at a time instead of offering both breasts at feeds for a while may reduce milk production.  This is because the milk in the “unused” breast is not being emptied, which may signal to the body to slow down milk production. 

References

Lawrence RA, Lawrence RM. Breastfeeding: A Guide for the Medical Professions, 7th ed, Elsevier Mosby, Maryland Heights 2011. p.253.

Wilson-Clay B. Milk oversupply. J Hum Lact 2006; 22:218.

Eglash A.  Treatment of maternal hypergalactia. Breastfeed Med. 2014 Nov;9(9):423-5.