Oversupply, rapid let-down, and block feeding questions

[atpeace]

DS is almost three weeks old, and I'm having hyperlactation and "rapid ejection reflex" issues. We had no idea, until a lactation consultant told us last week (we were there for tongue-tie clipping) that the challenges we've been having are due to over-supply.

Symptoms: lots of leaking and spraying, engorgement, baby is fussy, gassy, explosive bowel movements, gaining weight very fast, and choking/gagging at the beginning of feedings (screaming and pushing me away).

The LC suggested we do "block feeding", so since last Friday, I've been feeding him on one breast only for blocks of six hours. Very uncomfortable (engorgement) for the first few days, but now it seems to have gotten better. However, I'm wondering:

1. How long do I continue the block feeding for? Will I always have to do it as long as he feeds? Will my supply increase again if I stop doing it?

2. If he wants to nurse for comfort (rather than just for food), won't that increase my supply again since he'll be suckling? How do I prevent this?

3. When can I expect the symptoms to improve? It's been almost one week since we started block feeding. The explosive BMs have lessened a bit, but he's still often snarky when not asleep (doesn't seem comfortable in any position, fussy and cranky, burpy and gassy).

4. Also, what else can I do to decrease supply, and what can I do to prevent the rapid let-down that chokes him?

Any input from you very wise mamas would be appreciated.

[EmTheWife]

First, do you have any follow up appointments with your LC? I'd highly recommend that.
We've btdt, and are mostly resolved at 11wks, so I feel your pain.
You may need to continue to block feed for up to 3 months, when the milk making side becomes better regulated, and the baby is better able to handle fast let-down. However, it is sometimes possible to reduce the blocks to 3 hr segments, or even one side per feed. If you stop block feeds entirely, and feed from both breasts with each feed, your supply will likely increase again because demand (suckling/stimulation) leads to supply. But again, around the 3 mo mark you may be able to go back to "normal."
Nursing for comfort will increase your supply as it's stimulation just the same. If you are not ok with a pacifier and holding baby close (that's what we've found to work), then make sure you stay on the "correct" side for the block of time you're in.
You will find that there will be good days and bad days, and slowly the good will overcome the bad, but the timing is different for everyone, but usually a few weeks is what I've heard.
For decreasing supply, you can try cabbage leaf compresses, which some swear by (see kellymom.com).
It's not possible to prevent rapid let-down, but when you sense it, gently unlatch him and let the milk flow onto a cloth, and when the flow slows, begin nursing again - he'll probably be fussy when unlatched, but doing so can really help with the gagging.
best wishes momma!

[PatioGardener]

I could have written your post two months ago!

We are at 12 weeks now. I went from block feeding every 10 (yes, ten!) hours to every 6 or so now. I guess I spent 3-4 weeks at every 10 hours. Also I took sage to decrease my supply. I had more milk than we would ever need! Seriously, I could have fed triplets with milk to spare. I had (and still do occasionally) to pump before the first feed of the block, or baby would be over run by milk. I would pump off about 4 ounces in about 60 seconds - wild! Now I try to just take an ounce to take the edge off for him, which takes about 20 seconds.

I am sure we will rarely feed both breasts in 1 feed, but I'm OK with that!

He comfort sucks at the breast sometimes, and other times he sucks my finger. I always let him try the breast first. We have tried pacis and he hates them all.

For let down he pops off and I soak a burp cloth (usually only 1st feed of the block now, I think mine is directly related to over supply). We also nurse in a reclining position with him lying on top of me - that is feeding 'up hill' - which slows the flow. Side nursing in bed is also good for that.

I was going to take pseudoephedrine to decrease supply, but the sage, positioning and block feeding seems to have worked. http://www.kellymom.com/herbal/milks...versupply.html
and http://www.kellymom.com/bf/supply/fa...down.html#help

Good luck! PM me if you have any questions or just want to talk to someone who has been there!

[Artichokie]

this was me 2.5 yrs ago, minus the tongue tie. the specifics seemed so important at the time and i felt as though it was all consuming, but honestly I can no longer remember the details. I blockfed for a long time but idk when i stopped - at some point DD started leading when we switched sides and I went with it. My DD comfort nursed and we never used a pacifier and yet somehow my supply did equilibrate and everything became wonderful. We've been at it 30 months and still going strong. I wish I could remember more of the details - it was such a crisis for us at the time.

nak.

[Diyan]

As long as you stay on the same side, the other side is getting the message to produce slower. If you're on the right side, baby should comfort nurse as much as he wants from the right side.

Six hours is a long time - did you try shorter blocks first? You may need the long blocks to lower your supply, but if you start with much longer blocks than you need, you could end up with low supply. It's going to be a matter of trial and error to find what works best for you, and staying in close contact with your LC during this time will be helpful.

The previous posters' suggestions to catch the first let down in a cloth will help with the immediate problem while you're working on lowering your supply.

[Artichokie]

Originally Posted by Diyan

As long as you stay on the same side, the other side is getting the message to produce slower. If you're on the right side, baby should comfort nurse as much as he wants from the right side.

Six hours is a long time - did you try shorter blocks first? You may need the long blocks to lower your supply, but if you start with much longer blocks than you need, you could end up with low supply. It's going to be a matter of trial and error to find what works best for you, and staying in close contact with your LC during this time will be helpful.

The previous posters' suggestions to catch the first let down in a cloth will help with the immediate problem while you're working on lowering your supply.

I am searching my memory and I am pretty sure I did 4 hours per side, and I always put a prefold diaper under the opposite breast to catch the flow from the other side. I also expressed a tiny bit before baby latched so that the flow wasn't quite so forceful when she got the first mouthful.

[ariatrance]

You've gotten some great information here already, so some of what I wrote will be repeating. My daughter is 16.5 mos. old now and my overactive let down finally slowed around 13 mos. My oversupply was present for 10 mos., even with block feeding/one side per feed, but most women regulate around 3 mos. As long as you correct for any foremilk/hindmilk imbalance, the rest is mostly inconvenience rather than a true 'problem.'

Originally Posted by atpeace

1. How long do I continue the block feeding for? Will I always have to do it as long as he feeds? Will my supply increase again if I stop doing it?

I would continue until symptoms improve in baby. Once he feeds without lots of fussiness, once his poops even out, etc. I don't remember exactly how long I block fed but it was 4 to 6 weeks, maybe. I started with 2 hour blocks and increased to 4 hours blocks within a few days. I found block feeding helped me figure out what a single feed looked like for my daughter - she fed for 10 minutes about 3 times in an hour and then was good for an hour before feeding again. After I quit block feeding, I only fed her one side per feed and still do actually. I have never fed her both sides in one feed since she was 2 weeks old. As long as you watch to make sure your foremilk/hindmilk balance is correct and you don't start switching sides every time, your supply should even out around 3 months or so.

2. If he wants to nurse for comfort (rather than just for food), won't that increase my supply again since he'll be suckling? How do I prevent this?

Comfort sucking (which still has nutritive value for baby) should be done on the side he just nursed from, the 'empty' breast.

3. When can I expect the symptoms to improve? It's been almost one week since we started block feeding. The explosive BMs have lessened a bit, but he's still often snarky when not asleep (doesn't seem comfortable in any position, fussy and cranky, burpy and gassy).

I found symptoms improved around 3 weeks of block feeding. Some of those symptoms may be due to a foremilk/hindmilk imbalance which can happen often with overactive letdown and oversupply.

4. Also, what else can I do to decrease supply, and what can I do to prevent the rapid let-down that chokes him?

I didn't do anything other than block feeding to decrease supply, so no tips there. As far as overactive letdown, let him start suckling until letdown, pop him off and let it spray somewhere, then latch him on when it starts to just drip. I will say that my daughter learned to deal with it around 5/6 mos. old. I also had to wear breast pads for leaking until she was 13 mos. old. It never bothered me as long as I didn't leak through my shirt, , so I didn't worry about trying to change it if that is even possible.

Any input from you very wise mamas would be appreciated.

[atpeace]

Thank you so much for all your replies! Very helpful.

The weird thing is that I probably also had this issue with my daughter, but I never knew it was a problem! She didn't have the severity of symptoms that DS is having, and I just assumed this was normal. Your comments about wearing breast pads for a few months also surprised me, since I had to wear them (the heavy duty, washable ones that are super-thick, and they were pretty wet at the end of the day!) for the entire duration of breastfeeding, which I also assumed was normal! Funny how we don't realize these things are not normal...

I'm already doing most of the things everyone suggested (feeding "uphill", unlatching and catching the spray before relatching, block feeding, one side per feed), but thank you for all your suggestions anyway.

For those who said that it's ok to continue nursing for comfort, I thought this will stimulate more production...I'm a little confused about that. I've been letting DS suck on my pinkie finger at times when I know he's not hungry, and he has no problem with this.

Also, the whole foremilk-hindmilk imbalance confuses me as well. How do I know exactly how much of each he's getting (i.e. how do I know there's an imbalance)? Is it just by symptoms? I can't tell otherwise. He seems to be a snacker as well, so he'll nurse rabidly for a few minutes, then come back like half an hour later for more, then again an hour later. How do I know how much hindmilk he's getting? And how fast do the breasts refill? In other words, how do I know he's not just getting more foremilk the second time he nurses in a short time if the breast refill quickly. Would he get the hindmilk first since he didn't finish it at the last feeding?

I'm seeing my midwife for another appointment on Monday, and if she can't help me some more, I'll get another referral to the LC (they need a referral each time you go see them). Thanks again!

[ariatrance]

Here is some of the best information I read while figuring out my daughter's issues. The foremilk/hindmilk imbalance can also be easily discovered by the presence of green, frothy poop rather than the typical yellow, seedy poop.

http://www.llli.org/NB/LVSepOct95p69aNB.html

[Diyan]

Originally Posted by atpeace

For those who said that it's ok to continue nursing for comfort, I thought this will stimulate more production...I'm a little confused about that. I've been letting DS suck on my pinkie finger at times when I know he's not hungry, and he has no problem with this.

Comfort nursing is about more than just comfort - baby is getting nutrition at those nursing sessions too. The comfort nursing sessions are just as important as the "meals" are. Every time your baby nurses, your breasts are getting the message to keep producing, which you want - you're not trying to end milk production, just slow it down. As long as you stay on the same side, the fuller side is getting the message to slow down.

Also, the whole foremilk-hindmilk imbalance confuses me as well. How do I know exactly how much of each he's getting (i.e. how do I know there's an imbalance)? Is it just by symptoms? I can't tell otherwise. He seems to be a snacker as well, so he'll nurse rabidly for a few minutes, then come back like half an hour later for more, then again an hour later. How do I know how much hindmilk he's getting? And how fast do the breasts refill? In other words, how do I know he's not just getting more foremilk the second time he nurses in a short time if the breast refill quickly. Would he get the hindmilk first since he didn't finish it at the last feeding?

Yes, you can only tell there's an imbalance by the symptoms. Your breast are always making the same kind of milk, it's just that when your breasts are fuller the cream comes out slower. So the fat content gradually increases as your breast gets less full - there's no distinct difference between foremilk and hind milk. You can help the cream come out quicker when your breast is fuller by doing breast compressions. Otherwise, just let him nurse as he likes and don't worry about it. And once your supply is more in line with your baby's needs it won't be a problem any more. (There are many reasons his poop might be more green than yellow and most are not a problem, but the green, frothy poop is generally caused by too much foremilk).

[Kikibell]

I have all the same issues at the OP, but does anyone have any tips for twins? I already do only one side per feed per baby. Should i be doing both babies on the same side for a period of time? Thanks in advance! Babies (and me) are very frustrated.