Managing Fast Letdown & Over Supply

Tips for Fast Letdown & Over Supply

The below information aims to help you optimise latch positions so your little one can better manage your fast flow at the start of a feed. When good or rapid weight gain is present, alongside spit up or discomfort from a full tummy, moderating milk intake can be helpful.

When true over supply is an issue (green stools, constant and prohibitive leaking, challenging letdowns even with optimised latch and position), helping to regulate your supply beyond 6 weeks may be necessary. Please ensure you have consulted with Heidi Hembry IBCLC before undertaking any of the methods below to actively reduce your milk supply.

The information here is written for a generic audience, and all information may not be appropriate for you - please refer to your personalised plan and contact Heidi Hembry IBCLC if further clarification is needed.

Managing a Fast Let Down

Aim not to express before feeds if possible. Regular expression tells your body to keep making more milk which can make the situation worse.
Latch baby in your usual position and then hold them in close, bringing baby with you as you lean right back until s/he is on top of your breast. This uses gravity to slow your flow down and helps baby manage it better
When your fast letdown has subsided you can sit back up if comfier, or stay laid back and relaxed.
Always check baby is in the best position. If their nose is squished into your breast it is a sign that s/he has not got the best latch and baby will struggle to coordinate suck-swallow-breathe.
Tuck baby's bottom in closely to you, pulling her/him slightly down downwards their own toes to allow the head to tilt back a little further and free up space around his/her nose. Alternatively, unlatch, move baby slightly further away from your nipple, nipple to the bridge of the nose to encourage baby to stretch and reach, lifting their chin from the chest and tilting the head so that baby’s nose is away from your breast.
Avoid baby lying in flat, horizontal positions (except for side lying positions where you are both on a firm flat surface). Drop baby’s bottom so that it is lower than the tummy, and head is higher, eg baby’s bottom resting on your lap. This will help to keep the high volume of milk down in the tummy and baby will be more comfortable.
Any time baby wants to feed/drink a short while after initially feeding, return baby to the same breast for a slower, relaxed, fat-rich addition to their meal.
If these tips are not helping, you can unlatch when baby struggles, catching the excess spray milk in a muslin, then relatch - you should notice this spray reduce over a couple of days. OR express off the minimum amount to gently soften your breasts and take the edge off the first letdown. Again, look for the amount you express to reduce each day.

Reducing Breastfeed Volume (reducing reflux & discomfort in high weight gain babies)

Return to the same breast for multiple courses during a feed.
Each time you return to the same breast, you are helping baby to better drain the breast.
Each course, as the breast softens, will be lower volume and higher fat helping baby to settle better with less possetting and less digestive discomfort.
Fattier milk isn't digested as quickly as high-sugar, fast-flowing milk, so repeated courses on the same breast can help baby settle better between feeds.
Fattier feeds are usually slower flow, with less clicking and less air intake (and so less burping), and with higher fat, and lower sugar, creating less digestive gasses, so less wind at the bottom end too.
When a baby is used to fast-flow feeds it can take some encouragement to work harder and trigger subsequent letdowns on the same breast. Compressions can be useful here.
If baby becomes increasingly frustrated and compressions aren't helping, switching to the other breast is fine.
If baby seems settled but wants to feed again after a short while, then return to your softest breast to allow a small volume, high-fat feed.

Easing Digestive Discomfort for Babies

Our babies are designed to be held upright often, if not all the time. It is a small distance from the top of a full tummy to the back of the throat. Some babies really struggle with their milk feeds pushing back up their oesophagus when they are laid down flat after a feed. This can result in grunting, writhing, crying and other signs of discomfort. You can try some of the following tips:

Hold baby upright for 20+mins after a feed, allowing digestion to start and milk to thicken. The milk is then less likely to regurgitate and cause discomfort.
Wear baby in a sling - research shows babies that are carried often cry up to 50% less and suffer less with colic and reflux symptoms.
Place something under mattresses/cots to raise the bed at an angle. This can help gravity keep milk feeds in the tummy better. Play with the angle - too little and it is ineffective, too much and baby will slip down the bed. You should always be in the room with your baby if they are inclined so you can observe and adjust for any risk factors (rolling, slipping etc)

All babies are windy. Wind can be taken in during feeds and during crying. Wind taken in this way usually comes up as a burp. Wind from the bottom is almost always created as a normal part of digestion, it is not because you haven’t effectively winded your baby. If you are concerned about wind, try some of these tips:

Hold baby upright on your shoulder or lap after a feed. Wind usually comes up within a couple of minutes.
Rocking baby gently back and forth, side to side in a sitting position can help release trapped wind.
If your baby is struggling with passing stools or gas, getting into the habit of gently cycling their legs at nappy changes can ease motion through the digestive system and prevent discomfort from building up in the first place.
Baby massage can be fantastic for easing discomfort, as well as bonding and aiding baby’s overall development - many courses are available from 6 weeks of age or sooner

VIDEO: https://youtu.be/Fcn6gVX5y4I

You should not take steps to reduce your supply until after 6 weeks for a first time breastfeeding parent, or 4 weeks if you have breastfed before with a history of over/abundant supply. Please consult Heidi Hembry IBCLC to discuss which of the below is the most appropriate first line management for you. You should only engage with one practice at a time, assessing over 7-14days

Block Feeding to Reduce Supply

Select a block of time that would usually cover 2-3 feeds. For many mums, this is about 3-4 hrs, but it can be more or less.
Feed on one breast only during this "block" - eg if the first feed of the morning is at 7am on the right breast, then 7 am - 10 am, all feeds from the right breast. At the next feed, eg 11am, any feeds will be from the left breast in the next 3hrs.
If it's easier for you to remember you can decide to feed for 2 or 3 feeds in a row from one breast, rather than counting hours.
The first feed from each breast may be fast and furious, but the subsequent feeds in the block should be comfier and slower for baby.
Meanwhile, the other breast is getting full. This fullness is important to send feedback to your body to slow down and reduce the amount of milk. A certain amount of discomfort associated with fullness is necessary, however, extreme discomfort, pain and any dimpled (orange peel) skin, hyperpigmentation (darker or redder colouring) or heat should be managed immediately by expressing off some milk. Express the minimum amount needed to reduce the engorgement.
At the second block, use the other, now full, breast. Again the first feed may be fast and unsettled, though the subsequent feeds will be easier.
Over 2-3 days if block feeding is working, you may notice some of the following: less fullness between the blocks, less pain for you, less un-latching, less coughing/spluttering during feeds, more settled behaviour at the breast and between feeds, less watery stools, fewer green/more yellow stools, perhaps with more seedy deposits.
You can increase the block by an hour (or an additional feed) every 24-48 hours if you feel a further improvement to supply would be helpful.
Over the following days when your milk supply feels reduced and stable, then you can slowly decrease the block times if this feels helpful.

One-off Full Express to Reset Supply

The theory behind this method is to reset the milk production of your breasts, from operating at “Max to half full” to “half full to well-drained”. Once established, your body will hopefully maintain this new level of production.
It is usually best to start this process in the morning.
Feed baby until satisfied and restful. At this point, it doesn't matter if baby feeds from one or both breasts.
Immediately or soon after the feed, express off as much as you can from both breasts. This is a one-time thing - is it not something you repeat at each feed, or each day.
You may choose to use a double pump, pumping 2 or three or more times in quick succession until your breasts feel well drained. If using a single pump or hand expression, switching back and forth between breasts will likely be necessary to drain them well.
Feed Baby within 2-3 hrs of this. Ideally, your breasts won't have had time to fully 'refill' and the feed should be slower and more comfortable for both of you.
Ensure you feed from both breasts for the next few feeds to prevent one from being unused for long periods.
You may need to wake baby to feed regularly
If baby cannot be coaxed to take the second breast then it may be a good idea to express a little to prevent refilling.
After 24 hours, if you have noticed lots of positive changes (comfier latch, more consistent feeding, more settled at the breast) then you can start to feed one breast at some feeds if this feels ok.
Though a single expressing session is often enough to reset, should your milk supply start to climb up again after a period of time, you can do another full expression to reset again. For some women with an excitable supply, 2 or 3 sessions over a couple of weeks are needed.

Using Herbs to Reduce Supply

Sage has been used for centuries as a herbal solution to oversupply. Take 1/2 - 1 tsp dried sage, once only.
Observe feeds over the next 24-48 hours.
If the sage has had a good effect, mums may notice some of the following: less fullness of breasts between feeds, less engorgement pain for you, less un-latching, less coughing/spluttering during feeds, more settled behaviour at the breast, more yellowy orange stools, perhaps with more seedy deposits and less green tinge.

If there is no apparent change, you can take another 1/2-1tsp of sage and observe the next couple of days, increasing the dose if no/minimal change is noticed in a further 24-48hrs.
Peppermint is an alternative for some mums. Recommendations vary - some mums find drinking regular strong peppermint tea is enough. Others find taking extra strong mints (with real peppermint oil) is a more effective solution.
You can read more about herbs and managing milk supply here: https://kellymom.com/bf/can-i-breastfeed/herbs/herbs-oversupply/

Non-Nutritive Sucking - Breasts, Soothers & Thumbs/Fingers

Sucking is a really important part of your baby’s development, and some babies are more “sucky” than others.
Other babies who are able to take a lot of milk quickly can find getting their sucking needs met challenging. Returning to a full breast just gives them more milk and agitates them further.
A well-drained breast can be an option to settle a full baby - full babies will often happily comfort suck on a drained breast without being overwhelmed with milk.
If breastfeeding is well established (good consistent weight gain, pain-free latch, reasonable feeding pattern) then offering baby a dummy can be a low-risk option. PROS: You can choose when to get rid of the dummy, even though your baby/toddler may protest and have other ideas. CONS: Babies cannot find dummies by themselves in the middle of the night, you may still have to wake up to do this for them. They can get lost/dirty and finding a replacement “now” is not always easy.
Encouraging thumb or finger sucking after a feed can be an alternative. This can be easier for babies over 4-6 weeks PROS: When your baby has learned to find their fingers and thumbs, they can always find them in the middle of the night. It’s great for developing hand-mouth coordination needed for self-feeding later. Thumbs never wear out or need replacing. CONS: if you have a baby/toddler who loves to suck, it can be tricky to wean them off their own thumb, though there are some great cotton sheaths that can be used to undo a habit with older toddlers/children.

Expressing to Provide a Bottle (avoiding oversupply)

Having a well fitting flange/flange adapter can make a huge difference to your expressing comfort, volume expressed, and efficiency. Though fit seems to be the most important aspect, there is some early research that suggests hard flanges are more effective than soft inserts. Soft inserts are often easier and cheaper to purchase in a set of sizes. Once you have found your best fit, you can purchase the correct hard flange if desired.
Finding a few minutes to express after feeds is a great way to collect small volumes of milk to make up a full bottle later. Treat an expressing session as a feed and plan to express form the breast you have most recently fed from, rather than your unused breast
You won't expect to get a large volume, but what you do get will be fatty high high-calorie milk and different expressions can be added together to make a full bottle as needed
Expressing from the breast you are feeding on will reduce the risk of stimulating an over supply.
If you express after the first feed of a “block”, you may get plenty of milk, but find that your block is shortened if baby is feeding from a softer breast next time. If you express toward the end of a block (after a 2nd or 3rd feed), you are likely to get less volume, but it will have a higher fat content.
Aim to express alternate breasts, rather than finding yourself always expressing eg your left.
When you have collected enough for one bottle over several expressing sessions, you can offer this to baby, using paced/responsive feeding. However, babies used to a fast milk flow may get agitated if you pace/slow the feeding too much. The aim is to replicate/approximate the flow, swallow and rest patterns that you see at the breast.
https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2019/04/Infant-formula-and-responsive-bottle-feeding.pdf
When you give this first bottle, you will be missing a breastfeed. You can do a larger/longer expressing session around this time and may collect enough milk for your next bottle.
There is no need to sterilise kit that is only used for breastmilk. You can wash in hot soapy water and rinse in fresh water and leave to dry. Many mums expressing often keep their expressing kit in a clean Tupperware box in the fridge and only wash or sterilise once a day to reduce time.

BFN - expressing and storing

VIDEOS (hand expressing)

How to Express Breastmilk

UNICEF guide to hand expressing