In one of the last episodes, I just touched upon the fact that when moms make too much milk, way more than what their babies need, that this can cause some pretty difficult breastfeeding issues. Now, the moms who are making enough to meet their babies needs or who are struggling to make enough, never like to hear about this. However, I think there are lots of judgements about moms and the more you know, the less judgey we are with each other.
Too much milk? Making enough for 2 or 3 other babies on your block? Having a surplus is a good thing.. or isn’t it? Well, having an ounce or two more than what your baby needs, is typically not that big of a deal. Having 3 and 4 more ounces that you can easily pump off after a feeding? Well, for some moms, they seem to do fine. Other moms and their babies, not so much!
Let me tell you about my a new friend of mine named Raina who is the poster mom for making so much milk that it makes breastfeeding her baby anywhere she goes, almost not doable. It makes breastfeeding even in her own home, a very messy activity. Raina makes so much milk that it even bothers her cute little, or well, not so little baby boy, Oliver. When Oliver was born, he weighed 7 lbs 13 oz and he did look a bit scrawny as he was quite long. All that changed though in a matter of weeks. By his 4 week appointment, Oliver was 11 lbs. 4 oz.
To put that into perceptive for you, if Oliver had been 8 lbs. 13 oz, a full pound above his birthweight, I would have said that Oliver was doing great in the weight gain department. Instead he was 2 1/2 pounds greater then expected. Whoa! His mommy, my new friend Raina, lovingly called him her chunky monkey.
This was Raina’s first baby and this was her life and this was all she knew. Raina did not know that it was not normal to have to place a thick cloth diaper underneath each breast each time she fed her baby. Raina did not know that it was not normal to have to keep a third cloth in a handy place on her knee to cover her nipple to stop the milk from spraying all over the place each time Oliver popped off the breast. All Raina knew that was that each time she stopped to breastfeed Oliver, it was a whole production.
Her cousin, Lisa,, who I had worked with, referred her to me. She was feeling bad that Raina hardly ever left her house. She wanted to go to lunch with her and the baby. She wanted to go for walks and other fun things like go to the mall. But Raina kept turning her down. All this time, Lisa thought that Raina was shy about breastfeeding in public , however, it turns out that Raina was not shy, she just said it was too much work.
So Lisa would come over to her house and after the 3rd or 4th time watching her breastfeeding, with both moms laughing, Lisa did say to her: seriously, watching you breastfeed is bit like going to a comedy show. She pointed out a few things to Raina & encouraged her to come see me. It took Raina a few more weeks until she finally made the appointment. Up until this point, there were things that bothered her about breastfeeding, but as long as Oliver was gaining weight and doing good, she just dealt with it.
Once Oliver started having some problems and once she had her third bout of clogged ducts, she said enough was enough and she reached out for help.
Her complaints: She was soaking through nursing pads,, nursing bras, her shirt. And that was when she was not feeding Oliver. She was soaking through diaper cloths and getting milk all over her clothes and if she did not get milk on herself, Oliver did, when he spit up what seemed like his whole, meal… after almost every feeding. This meant twice as many change of clothes for Oliver then she figured she would have & she was also having several changes of her outfits, all in one day. She was constantly having to wipe up milk off the floor and now she was avoiding sitting on her couch and in the den that had carpeting, all because he was vomiting all over everything.
Raina was also complaining of constant breast pain and dealing with clogged ducts was really getting on her nerves. Those were her words. She has become an expert in what works to get rid of them, but it takes work and effort and is just so time consuming.
Raina complained some more – She want to go out in public and be able to breastfeed her baby and in her words – he was just too messy of an eater to do that. The other thing that made her schedule an appointment is that more and more when Oliver spits up, he seems to be bothered by it now when before it didn’t phase him at all. In addition, he sometimes begins to feed, then comes off breast choking and coughing after a few minutes and then she can’t get him to go back on and she knows he is still hungry.
She kept thinking that there was something in her milk that was causing this. She also suspected that he was getting too much, but she did not know how much was too much and how she could stop this.
I explain to moms that if they are making a lot of milk and it is not interfering with their enjoyment of breastfeeding and if their baby seems to handle the flow of milk well and if spitting up is minimal, then we can say they have lots of milk and it is not bothering anyone, then just let it be.
However, if it begins to cause all kinds of feeding behavior that is not just bothersome to the mom, but begins to intefere with her enjoyment of it and in addition, is beginning to bother baby to the point that they start refusing the breast, well, that is when you want to intervene and actively work on lowering her supply.
So, let’s add up her complaints:
Milk all over the place
Inconvenience of multiple outfit changes for both of them.
coughing and choking on Olivers part
not wanting to complete a feeding at times
chronic clogged ducts
So, this breastfeeding pair, is in jeopardy of losing the breastfeeding if we don’t lower her supply.
The care plan that I suggested is just for this pair as I might suggest or give other options for the
next mom and baby. I take into consideration the age of the baby, the weight of the baby, how much extra milk mom does have, the symptoms that baby is having, any medication mom is taking, any health issues on mom or babies part, when giving her options about reducing her supply.
Raina said that she could pump 7 ounces off of the side that Oliver did not take at a feeding.
During our consult, and after observing Oliver feed and transfer 5 1/2 oz in about 5 minutes on one side, and after much discussion, I concluded that there were no breastfeeding issues to be concerned about, other than her abundant supply.
In this case, after considering her options, Raina chose to reduce her supply by reducing breast stimulation. This meant that she was going to be doing same side feedings times 3 feeds in a row. This means that she would be feeding from the right side for a feeding, and hand expressing some milk from the left side, just enough to keep her comfortable and from getting all backed up.
For the next feeding, she would bring Oliver back to the right side for a feeding, and follow the same routine onf hand expressing for comfort.
next feeding, she would bring Oliver back to the right side, for a feeding, and repeat this all over gain.
Now, the next 3 feedings she would reverse this.
It is very important for me to tell you that this is not anything you should do on or own. What is good advice for Raina may be very, very bad advice for you.
For some of you, this may cause your supply to drop drastically and in a few days you could be in a position of not making enough milk for your baby.
So, I can’t stress enough, do not follow this care plan without meeting with an IBCLC and determining what will work best for you.
I stayed in close touch with Raina over the next few days. Two days later, she backed off and did feedings 2 times in a row
At this point, Oliver was spitting up, but the volume was much less and not as often.
The following day, based on Oliver’s response, I suggested she go down to one feeding on one side and the
next feeding on the other side, pumping the unused side for comfort.
I needed to be mindful of dropping her supply, while ensuring she did not get clogged ducts from not removing the milk enough.
All in all, it took about 6 days, until Oliver was having good feedings at breast, no longer choking and popping off.
He was spitting up some, but it was much less and did not appear to bother him.
Her breast pain, while not gone, was reduced dramatically.
She still needed nursing pads, but was not leaking all over the place during feedings
and she was not leaking through shirts in between feedings.
I spoke to Raina about a week later and she said they ahd found a happy medium.
Oliver was thriving on feeding from on breast per feeding, she no longer had any breast pain,
and she was real excited to tell me that she had been to the local mall for about 4 hours.
She found a quiet place to feed Oliver, and he did really well.
I am happy that this all worked out for Raina. I have seen enough mothers like Raina who give up on breastfeeding because breastfeeding has become such an ordeal for the mom. I feel that while there is a learning curve with most of us with breastfeeding and that while many of us should be staying home or close to home the first several weeks, there does come a time where you want to go out and take your baby with you. Breastfeeding should be rather easy and convenient and it should be enjoyable. It is like I told a mother that I worked with today. You should not have to work so hard at breastfeeding, especially once your baby is a month or so old. When you have a whole laundry list of complaints like Raina had…. something is just not right.
Gotta love the mom who has tons of milk! By the way, I am a strong advocate for keeping a couple of weeks supply for yourself in the freezer, but if your freezer begin to runneth over and your baby is breastfeeding well, I sure hope you would consider donating your milk to a milk bank. I will give some links for more info on this in the show notes.
Lori J. Isenstadt, IBCLC
Lori Jill Isenstadt, IBCLC is a huge breastfeeding supporter. She has spent much of her adult life working in the maternal health field. Once she became turned on to birth and became a childbirth educator, there was no stopping her love of working with families during their childbearing years. Lori became a Birth doula and a Postpartum doula and soon became a lactation consultant. She has been helping moms and babies with breastfeeding for over 25 years. Lori founded her private practice, All About Breastfeeding where she meets with moms one on one to help solve their breastfeeding challenges. She is an international speaker, book author and the host of the popular itunes podcast, All About Breastfeeding, the place where the girls hang out. You can reach Lori by email at: firstname.lastname@example.org or contact her via her website: allaboutbreastfeeding.biz/contact
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