Overactive Let-Down: Consequences and Treatments
by Mary Jozwiak,
Villa Park, Illinois, USA
from LEAVEN, September-October 1995, p. 71
We provide articles
from our publications from previous years for reference for our Leaders and
members. Readers are cautioned to remember that research and medical information
change over time
Eight years ago, as a new
nursing mother, I thought Sarah just didn't like to nurse. She would
often cry and fuss at my breast, choking on milk. She had frequent stomach
aches and green curdy stools that blasted out with loud, almost comical,
noises. She did have plenty of wet diapers and was growing like a weed
though. I suspected something was wrong with my milk and tried many
suggestions (including, I'm afraid, a few formula feedings). Although
the doctor said my milk "just didn't agree" with my baby, I kept nursing.
Overcoming nursing strikes and nipple confusion, I eventually eliminated
the formula. After several months our problems seemed to dissipate.
However, Sarah rarely nursed for comfort; she got her milk quickly and
went on to other things.
With my second baby, I resolved:
no bottles, no matter what. Like Sarah, Rebecca experienced gas, lots
of gulping, sputtering and choking at let-down. My let-down actually
hurt. Milk would spray and I would leak nonstop. Becca's green stools
were incorrectly diagnosed as "lactose intolerance." To my relief, the
doctor said she was very healthy; she gained three pounds and grew an
inch in the first three weeks. He said to continue doing what I was
doing. Again, I eliminated dairy products and a host of other foods
from my diet. It helped a little but Becca remained gassy and fussy
like her sister. It wasn't until Becca was ten months old and no longer
having problems that I ran across some literature on overactive let-down.
Everything made sense.
When a mother has an overactive
let-down, milk is ejected forcefully from the breast and in great quantity.
If this happens early in the feeding, baby may swallow air and consume
too much foremilk in proportion to hindmilk. When baby fills up on the
watery foremilk, he may get a stomachache from the combination of filling
the tummy too fast, swallowing air to keep up with the let-down and
the laxative effect of a large quantity of lactose (milk sugar). Some
babies are so upset by the forceful spray of milk that they refuse the
breast and go on a nursing strike.
Several solutions may help
remedy an overactive let-down. When the baby is very young (a few weeks
or less), a mother can try different positions so baby can be "uphill"
from her breast. For example, mother can lie on her back with baby on
top so he can control his head and back off if the milk ejects too forcefully.
Another suggestion might be to take baby off the breast when the let-down
starts, catching the overflow in a clean cloth, and placing the baby
back on when the flow lessens.
If the problem continues
when the milk supply is well established, another approach can be tried.
The goal is to increase the amount of hindmilk baby receives and make
the let-down less forceful. Let's suppose the mother begins breastfeeding
on the right breast. When she feels her milk let-down, she gently removes
baby and allows the forceful spray to gush into a clean cloth diaper
or burp cloth. Then she places baby back on that same breast, letting
him feed as long as he wants. Baby should not be timed at the
breast. The mother should not use the left breast at all during this
feeding. If baby needs to nurse again during the next two to four hours,
the mother should offer the same (right) side. During the subsequent
two to four hour period, the procedure is repeated using the left breast.
This procedure can be adjusted
for both mother and baby. If the mother is very engorged or uncomfortable,
she can go ahead and use the opposite breast briefly. It is important
that the baby have at least six wet diapers in 24 hours. If the number
drops below six, suggest that the mother go back to using both breasts
at a feeding. However, most women with an overactive let-down have no
trouble making enough milk with one breast at a time.
Women with a milder case
of over-active let-down can use one breast at each feeding, instead
of using one breast for each two-to-four hour period. Remind the mother
to allow the first let-down to flow into a cloth and then re-attach
the baby. These suggestions will help "tame" her let-down, and help
her produce a quantity of milk her baby can comfortably handle. The
baby should be fed often--the more the baby nurses, the less intense
the flow of milk.
Needless to say, a baby who
is having problems handling the let-down should not be introduced to
a bottle too soon, if it can be avoided. The less forceful flow from
the artificial nipple makes this baby a prime candidate for a stubborn
case of nipple confusion and breast rejection.
As the baby grows older,
he may be able to better tolerate the strong let-down. Some babies,
however, will nurse only until their tummies are full and refuse to
stay at the breast any longer. This lack of comfort sucking may lead
to early weaning. The techniques to reduce flow described above can
help even the older baby.
A mother with an overactive
let-down might find reading Nipple Confusion (No. 32) and
How to Handle a Nursing Strike (No. 62) helpful. She will
certainly benefit from ongoing help and support of an LLL Leader. [See
on-line catalog for ordering information.]
My children learned to adapt
to an overactive let-down. Becca would entertain herself by popping
off the nipple, watching the milk spray and giggling. Sarah got to the
point that she loved the strong let-down so much she would cry and fuss
when it was over! She weaned early and seemed happy with that decision
although I was not ready for her to wean so soon. It was a frustrating
experience for all of us that fortunately resolved in a happy--if perhaps
prematurely ended--nursing experience.
References
Andrusiak, Frances and Larose-Kuzenko,
Michelle. The Effects of an Overactive Let-Down Reflex. Lactation
Consultant Series, 1987.
Benson, K.D. "Clinical Problem
Solving," CERP session LLL of Illinois Area Conference. September 4,
1993, Chicago, Illinois, USA.
Mohrbacher, Nancy and Stock,
Julie. THE BREASTFEEDING ANSWER BOOK. La Leche League International,
1991.
Page last edited Sun Oct 14 09:30:36 UTC 2007.
