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.
Mary Jozwiak is a mother
of two girls and has been a Leader for six years. She answers LLLl's 800-line
at Headquarters two days a week and is an AAPL [Assistant Area Professional
Liaison] in Illinois, USA.
Page last edited Sun Oct 14 09:31:33 UTC 2007.
