JC Lactation Counseling - Milk Supply and Hyperlactation

“I think I have low milk supply”
“I don’t know if my baby is getting enough milk”
“My baby is hungry all the time”

I’m sure that you’ve heard variations of these phrases or have even said them yourself. I certainly have. I would utter something similar when my son would nurse on one breast and immediately cry after putting him down. I’ve uttered this when family was around and questioning our feeding session, causing me to doubt myself. I would wonder aloud “what am I doing wrong” when my son would latch on, fuss and come right back off. I mentioned many of my challenges in my last post and how I really had no idea what I was doing. I didn’t know that some of these challenges may actually have been that I had too much milk! That is the irony of breastfeeding/chestfeeding American women and families; the milk may be there but actually getting it into the baby is often the misunderstood part.

Cultures Breastfeed

I learned this framework when I started following Kimberly Seals Allers and read her book titled The Big Letdown; How Medicine, Big Business, and Feminism Undermine Breastfeeding. Seals Allers is a Maternal Health Advocate, founder of the Irth App, a writer and speaker. I am not doing her justice at all so, please check out her website. She writes that individuals do not breastfeed, but cultures do. Our choices and decisions are heavily influenced by the media, our families, friends, and society at large. This sentiment was further solidified for me during my readings. In the 1st edition of my textbook, Breastfeeding Answers Made Simple, A Guide for Helping Mothers, Nancy Mohrbacher, IBCLC, FILCA writes:

…In the absence of a cultural history of easy and ubiquitous breastfeeding, and without an established understanding of the physiology of breastfeeding and lactation, health care providers now often pass on to mothers historical recommendations and rues about breastfeeding for which there are no clear physiological rationale. Many of these rules–at least so many minutes on a side, always feed on both sides, always offer the full side….are essentially strategies for maximizing milk production. Thus, as more and more women are breastfeeding in the United States, we are seeing more women who already have plenty of milk trying to breastfeed according to these culturally defined rules…the initial cause of hyperlactation is cultural misinformation about optimal breastfeeding practices. – U.S. pediatrician Christina Smilli

What is hyperlactation?

Hyperlactation is overabundant milk production. It can also be described as oversupply or overproduction. On average, a healthy full-term one day old newborn will drink around 1.8 ounces of human milk in the first 24 hour period. With frequent and efficient milk removal, this amount quickly increases to about 19.6 ounces on day 4! After about 3 weeks of life, the average amount that healthy infants drink is between 24 to 28 ounces of milk in a 24 hour period, whether this is by pumping or feeding directly from the body. When a mother or lactating parent makes more than this amount, or if the amount is much more than the baby can drink, this can be problematic.

Breastfeeding Myths

But Janice, isn’t too much milk better than not enough milk? No, not necessarily. Many new parents perceive that they have low milk supply. True milk production insufficiency or low milk supply is rare, and happens in 1% – 5% of lactating folks. Whether perceived or actual, this is a very stressful time and can be mentally/physically draining. The lack of basic lactation knowledge is prevalent in Western societies where formula has been normalized since the early 20th century. Barely anyone knows what normal breastfeeding looks like and this severely impacts new mothers. What ends up happening is that bodyfeeding begins to happen abnormally when new parents are given incorrect advice – what we call myths. Blanket statements and information sometimes do not work or make sense for everyone, since everyone’s situation is different. We also live in different times. So now we have folks drinking BodyArmor and lactation teas, eating lactation cookies, using fenugreek, pumping in between sessions, massaging and hand expressing, using a Haaka all because of a perceived notion of low milk supply. And this actually tips the scales to where they end up having an abundant milk supply or hyperlactation.

Clinical Lactation Work

So far with my mentor, we’ve worked with several clients experiencing hyperlactation. Not only were they healing from childbirth, they had to navigate a world where quality breastfeeding information and support can be hard to find. Unsurprisingly, managing an abundant milk supply was very challenging for these mothers. And their babies all had feeding difficulties. Some of these moms suffered from anxieties and a severe impact on their sleep due to engorgement. Painful and sore nipples made it hard for their babies to latch on. These babies had to contend with a faster milk flow and end up drinking mostly the low-fat foremilk in a very short period of time (the watery milk at the beginning of a feed). Because these babies had such full tummies and not enough of the higher fat hindmilk, they were hard to settle, were clingy and cranky. Ironically, they still wanted to breastfeed to soothe the bellyaches, but that lead to them drinking even more milk and continuing the cycle.

Common signs and symptoms of hyperlactation in parents

Leaking breasts/chests that interfere with daily activities
Recurring clogged milk ducts and mastitis
Breast infections and abscess
Discomfort from fullness in between feedings
Fast letdown/fast milk flow
Pinched, injured, infected and otherwise painful nipples
Painful breasts
Painful or knife-like letdowns
Severe engorgement
Milk that sprays when baby unlatches from breast

Common signs and symptoms of hyperlactation in infants

Pulling back, clamping down, using biting/chewing mouth movements
Coming on and off the breast
Fussing, coughing, sputtering, and arching away during a letdown
Gulping, choking, or spitting up milk; passing gas
Refusal to breastfeed while falling asleep
Fussiness between feedings
Very fast weight gain
Explosive green, watery stools; mucus or blood
Continuous feeding cues even after drinking a large amount of milk

Professional Lactation Support

Some of the above signs and symptoms could also be due to an allergy or intolerance, structural abnormalities such as a tongue tie, stiff neck and/or other health challenges. Ruling these out with a professional is crucial. It cannot be stressed how important it is to have support and quality information. We’ve all heard that #breastisbest and #fedisbest. You know from my first post that I disagree with both since breast is not best for every everyone and fed is minimum (every baby has to eat). The hashtags and sentiments that I prefer are #supportisbest and #informedisbest. Having information from quality sources is the key to having a healthy feeding journey. If you know you want to breastfeed and the people around you are just as confused as you are, then you gotta get a different type of help. Lactation professionals understand what is abnormal and can help guide you through challenges. Support groups like Chocolate Milk Café, La Leche League, and Breastfeeding USA are peer to peer support groups that are facilitated by IBCLCs, CLCs, CBSs, or other breastfeeding support personnel. We want you to have just the right amount of milk, just like how Goldilocks wanted her porridge at just the right temperature. We definitely don’t want mismanagement of an oversupply to ultimately decrease your milk supply, thus shortening your feeding journey.

Is Too Much Milk Really a Big Deal? In Lactation, It Can Be.