Dealing Successfully
with Oversupply
Marie Davis, RN IBCLC
Disclosure Statement
I have a financial interest in
“The Lactation Consultant’s
Clinical Practice Manual” as its
author and publisher.
Can a woman make too
much milk?
• First described in at length in LC Series
Unit 13 by Andrusiak, & LaroseKuzenko 1987
• Woolrige and Fisher 1988
• Very little has been written since
• Almost no evidence based studies
Culturally Defined
Expectations
• Pre-conditioned to assume low supply
• “Breastfed babies don’t get colic”
• An allergen in mom’s diet
Treatment
•By educated deduction
•Not uniformly applied
•Treatment aimed at mother
Where’s the baby?
Screaming & Miserable
Blame Game
“Mom can’t make the right milk”
“When is it hindmilk?”
Hence,
Pump and give from a bottle…
Or
Formula must be the right milk
Colicky moms make for colicky babies
The Problem With the Internet
Hummingbird Effect
Google 40 K sites
Same breast for 12 to
24 hours
Cabbage to “dry up milk”
Elimination diet not
working
Measured feedings
Nomenclature
• Inconsistent definition results in inconsistent
treatment
- Almost all adjectives indicate pathology or place the
blame solely on mom:
Polygalactia
Foremilk/hindmilk imbalance
Overactive
Letdown
Galactorrhea
Hyperlactation
Hyperactive letdown
Definition remains elusive
Problem described
differently
depending upon
perspective
Overabundant Milk
Supply and Forceful
Letdown Reflex
The main barrier to research
is a lack of an objective and
universally applied definition
Syndrome :
A syndrome is a group of symptoms
that consistently occur together or a
condition characterized by its
associated symptoms
Oversupply Syndrome
is a predictable sequence of symptoms in
both Mother and Baby
Once the syndrome is defined
• Treatment can be standardized
• Research can begin
• Evidence based practice results
Informal Study
Not a researcher
Chart Review
304 contacts
evaluation & treatment
187 who followed up
Protocol
Purpose—not cookbook
Systematic approach
Allows practitioner to see trends
Diagnostic rut?
• Allergy if ----• GER
• 6th time you’ve seen these symptoms
this week
Presenting symptom is usually
“colic”symptoms
Colic rule of 3’s
cried for more than 3 hours a day,
and more than 3 days a week
over at least 3 weeks
True colic; defined as colic that occurs without a
known cause, therefore, not the result of OSS
Differential Diagnosis
Plugged ducts/ Mastitis
Latch on Problems
Allergy
Congestive heart failure
Sepsis
Sore nipples
Low supply
Vomiting
Pyloric stenosis
GE Reflux
Medical findings
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•
•
•
Overlapping symptoms
Colic
Reflux
High tone
Baby’s Symptoms
Excessive, early weight gain plus
Gassy, fussy
Short feedings
Makes popping sounds
Many wet diapers per day
Unusual stooling patterns
Gulps or chokes
Frequent demand
Baby’s Symptoms
•
•
•
•
Stuffy nose
Poor latch
Unsatisfied sucking need
Early ear infections
Mom’s Symptoms
•
•
•
•
Persistent sore nipples.
Linear crack across the nipple face.
Nipples reddened, bruised or purple
pc nipple:: pinched, white
– often has ridge
• Milk sprays or gushes when baby comes off
the breast
• Opposite breast leaks large amounts while
nursing/pumping
Mom’s Symptoms (continued)
• Problems with nipple thrush •Recurrent plugged ducts
• Early or recurrent mastitis
• Initial engorgement
– Moderate to severe
– Lasting 2-5 days
•
Letdown sting or burn (about 50% say can’t feel)
• PPD
Familiar Component
• Some women appear to be genetically predisposed
to excessive milk supplies
• 1/3 report sister or mom with OSS
• Tends to get worse with subsequent pregnancies
unless managed early postpartum
Understand the Controls
Maternal
Initial supply
hormonally driven
Local Feedback
Managing feeds
Infant
Fat slows gastric
transit
Excess Lactose
Fermentation
Air swallowing
Classes of OSS
1. Primary: No apparent cause
2. Secondary: result of disorder
elsewhere (pituitary tumor, allergy)
3. Induced: caused by something the
mother is doing (excessive pumping,
galactologues)
Temporary Oversupply
Strongly recommend not to begin
treatment other than 1 breast per feed
until baby is 3 weeks of age unless prior
history
Phases of OSS
1st Phase: relativity mild colic, easy to treat
symptoms
2nd Phase: Copious amounts of milk Baby is
beginning to fight at the breast, milk supply out
of control, frequent plugs and or breast
infections (stasis)
3rd Phase: Baby refusing the breast and loosing
weight, mom's supply severely diminished
First phase treatment
•
•
•
•
•
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One breast per feeding 2-4 hours
Cue feeding
Posture feeding elevated clutch hold
Frequent Burping IF TOLERATED
Allow some fullness in breast
Work on latch-on problems as flow
slows
Anticipitory Guidence
•
•
•
•
1st 24 hours
24-48 hours
72 hours
Change in stool usually first clue
Second Phase Treatment
More time on one breast but not beyond 4-6 hours
Addition of Sage tea and/or Pseudoephedrine
– Timing of meds is important
– Dose
Mint - Aromatic oil through milk drying and may help
soothe infant stomach
Suggest conservative elimination diet Dairy
Dietary supplements
Pump out Re set milk production
Consider infant meds
Nipple shield
Severe OSS
Mom
Baby
Trial of BCP
Gentle back to breastself attachment
Pump and feed
Rebirthing
Consider unilateral
weaning
Special Situations
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•
•
•
•
The pumping mom
Mom with twins
Previous history
Supply won’t down regulate
Baby’s with huge appetites
Suggestions for further study
• Substances/foodstuffs known to
decrease supply should be studied
Marie Davis RN IBCLC
marie@lactationconsultant.info
• Extended bibilography available
by request