Oversupply or Overproduction of Breastmilk

Do you suffer from oversupply, more accurately referred to as overproduction, of breastmilk? Or are you someone struggling to produce enough breastmilk and wonder how other parents can produce so much more than you?

Lets break down what causes overproduction. I prefer to use the term overproduction rather than oversupply, because it focuses on what your body actually produces and does not confuse the reader with how much milk is actually stored in a freezer.

The amount of breastmilk one produces partly depends on the number of mammary lobules they have in their breast. Lobules are where milk is made and secreted from. Lobules start to develop in puberty, continue during pregnancy, and then continue more during lactation under the right circumstances. If this is your first pregnancy and you have a preterm baby, you haven't had as much time to develop as many lobules as someone who has had a baby and breastfed before or someone who gives birth to a full-term baby.

But you can increase the size and number of lobules. And often parents who already have enough lobules and make enough breastmilk continue to increase their production of breastmilk instead of maintaining an appropriate amount, likely because no one has taught them about breast capacity (see previous blog that refers to breast capacity). Removing more milk than your baby needs leads to overproduction of breastmilk.

Upon giving birth, every parent who wishes to breastfeed should work to increase their prolactin receptors and oxytocin levels, preferably starting within the first 2 hours of giving birth. And they should avoid activating the feedback inhibitor of lactation (FIL) and keep dopamine levels low. Refer to my previous blog about influencers of milk production for more information about this.

Until you reach full milk production, which is about 720-750 mL / 24 hours (24-25 ounces/24 hours), it is advisable to continue to remove milk, either by direct breastfeeding or pumping, at least 12 times/24 hours, followed by hand expression, being sure you do not let your breasts get engorged (More about engorgement to be posted on my blog soon). If you are directly feeding your baby at the breast, you won't be able to directly measure this. But signs that you are making this amount include:

• Baby loses no more than 8% of birthweight in first 4 days then starts gaining weight of at least 15 grams/day (1/2 ounce /day).

• Baby returns to birthweight by at least 10 days of age.

• Baby pees at least 6 times and has 3 loose, yellow poops every day by 6 days of age.

• Baby is feeding at least 8-12 times every day, preferably closer to 12 times in the immediate newborn period.

• Lactating parent feels breast getting heavier or fuller before feedings and feels them become softer or lighter as feeding progresses.

• Lactating parent is able to see and hear signs of swallowing or gulping when their baby breastfeeds.

If you are exclusively pumping, you will be able to measure. If you are doing a combination of pumping and direct breastfeeding, you should be producing enough to fulfil the above requirements.

If you are exclusively pumping and have reached 720 mL/24 hours, then you need to start decreasing actions you are taking which will continue to increase your supply. The goal now is to maintain your supply. If you have been hand expressing after pumping, stop that. Hand expression removes more milk, which in turns makes more milk. You also need to start alternating between going slightly longer between pumping sessions (maybe only 10 more minutes or so) and pumping for slightly less time at each pumping session ( maybe only 2-3 minutes less). Taking a few days to a week to even out your milk production to appropriate amounts helps decrease the risk of engorgement, block ducts, mastitis, and abscesses. Pump just enough to ensure appropriate milk production, Taking a few days to even out milk production decreases the chances of developing negative consequences like those that would occur if you abruptly changed pumping frequency and length, and will give you enough extra breastmilk to use in case of emergencies, spilt milk, or other reason. Babies do not drink more than 900 mL per day, even when they get older, with most taking between 720 mL and 750 mL If you are pumping for twins, triplets, or more, full milk production is this amount for each baby. Pumping beyond a full milk supply puts your breasts at risk for negative health consequences and creates oversupply or overproduction. People with large breast capacity will need to pump less often and will pump more at each session than someone with medium or small breast capacity. If at anytime your production decreases to less than optimal amounts, either increase the frequency of pumping, length of pumping, or follow up with hand expression, to reach the appropriate amount again.

If you are doing a combination of pumping and direct breastfeeding because you were told to supplement your baby, be sure to work with a your baby's healthcare provider or lactation professional to ensure it is safe to wean off supplementing. When you have reached all the goals set forth in bullet points above, stop pumping after feedings. Only pump or hand express for up to 5 minutes after 1 or 2 feedings if you want to accumulate a small stash of breastmilk for emergencies. After 1-2 days of this, stop pumping and hand expression after feeding and just directly breastfeed. Be sure your baby is still meeting all the above milestones. Hand expression is still very helpful before a feed to get your milk flowing, but after a feeding to remove milk just makes more milk, which can lead to overproduction and all it's associated complications.

If you are exclusively directly breastfeeding, the chances of you overproducing are almost zero, as your body will only make what your baby removes from it.

I want to also address strong or forceful let-downs here, as people tend to associate them with overproduction. Let-downs are caused by oxytocin spikes and are helpful to move milk out of the breast and to prevent milk fat from sticking to the walls of your milk ducts. Even people with smaller milk capacity can have forceful let-downs, although people with low production probably do not have the same amount of force. Signs of forceful let-downs can be:

• baby choking when feeding at the breast, especially if:

  • your baby has not latched well, causing your nipple to be pointed at the back of your baby's throat instead of towards the roof of the mouth

  • your baby is not positioned well, resulting in your baby's chin being closer to their chest or shoulder instead of being slightly extended in a neutral position

  • your baby is preterm and is not mature enough to handle the force of let-downs

  • your baby has an abnormal opening in the roof of their mouth (very uncommon)

• baby producing lots of gas, especially if:

  • your baby is not positioned well, resulting in your baby's chin being closer to their chest or shoulder instead of being slightly extended in a neutral position, which makes it much more difficult to swallow

If you mistake strong let-downs with overproduction and cause milk production to drop, you may be inadvertently causing a permanent production issue.