Helping the baby breastfeed when the mother has a large milk supply

How do I breastfeed when I have a lot of milk?

Most babies can cope with a large milk supply. They may latch tentatively, clamp and tug, or let go of the breast for a few seconds when the letdown is too large before re-latching. Mothers should allow the baby to set the pace instead of forcing the baby onto the breast. They should be gentle with the baby. A soft, calming voice can be reassuring. If a baby is struggling, the cradle hold may work well because it allows the baby to come off and on the breast as needed. The laid-back and side-lying holds may also be useful. Over time, the baby will learn to deal with the flow. If the baby is really struggling, mothers can occasionally unlatch for around 10 seconds so the baby can catch a breath. Even more aggressive tools include expressing small amounts of milk before breastfeeding or using a nipple shield.

A) Breastfeeding with a large milk supply

If a mother has a large milk supply, her baby can act a little differently both during breastfeeding and when not breastfeeding, compared to other babies of the same age.

Most babies can cope with a large milk supply without help from their mothers. They will use certain coping tools and you may notice your baby:

  1. Latch tentatively instead of deeply.
  2. Clamp and tug and pull back from the breast during feeds.
  3. Let go of the breast for a few seconds when the flow is too fast and then re-latch.

B) Tools to help the baby breastfeed with a large milk supply

If you find that your baby is struggling at the breast and needs help, consider the following approaches.

1) Choose a supportive breastfeeding hold

These babies often do better in a laid-backcradle, or side-lying hold. The cross-cradle hold may limit their need to come off of the breast periodically to deal with a large milk flow. The under-arm hold may result in more choking.  

2) Allow the baby to direct the feed

Babies should be allowed to come on and off the breast as needed. Do not force them to stay on if they are choking or struggling to keep up with the milk flow.

Watch for signs that the baby is done feeding and do not force the baby to breastfeed longer than the baby wants to. A normal feeding pattern for a six-week old baby in this situation may be 10 minutes on one side every two hours.

Do not force the baby onto the second side if the baby is not showing hunger signs.

3) Be gentle  

Babies may get frustrated when there is more milk than they can handle. Be gentle, let your baby direct the feeds, and reassure the baby with a soft, calming voice. Over time, the baby will learn to deal with the flow and the flow will slow down.

4) Pace the baby

Temporarily decreasing the amount of milk a baby takes in is called pacing the baby.

a) Temporary unlatching

If the baby is really struggling with a particular let-down, you can unlatch the baby so the baby can catch a breath.  

To do this:

  1. Take the baby off the breast.
  2. Let the baby rest for 10 seconds or so until the let-down has passed.
  3. Re-latch when hunger signs appear.

Pacing in this way should only be done if the baby can latch easily. 

b) Squeeze the breast

Pacing can be done by the mother using her fingers in a scissor or pinch position to squeeze the breast just in front of the baby’s mouth for a few seconds to slow the flow of milk during a strong let-down.

This should only be done if it does not interfere with the baby’s latch or cause breast or nipple pain. There is a small risk of this causing plugged ducts. 

5) Deal with choking

If the baby chokes, just leave the baby in front of the breast and watch and wait. Normal babies can deal with choking without help. If the baby has a very bad choke, you can raise the baby onto your shoulder. Once the baby gives you a hunger sign, re-latch.

6) Help the baby with tummy pain

Babies whose mothers have a large milk supply will tend to have more tummy cramps during and after feeds. They may also swallow more air. Loud gulping can be a sign of this.

Such babies may benefit from regular use of the over-the-shoulder massage technique to both prevent and decrease the pain.

C) More aggressive options for helping a baby breastfeed with a large milk supply

Some babies need a little more temporary support.

1) Removing milk before breastfeeding

Some babies struggle a great deal with the first let-down. Mothers can consider massaging the breast with a little cooking oil for a few minutes or using breast compression to let the first let-down pass. Such milk can be collected and stored.

Expressing to remove the first let-down is another option but this can be more complicated. Mothers should avoid expressing more milk than absolutely necessary as this can result in even more milk production and force mothers to continue expressing, making the problem worse. Mothers who pump will need to prepare and clean their pump, which is more work.

2) Nipple shields

Nipple shields can minimize the amount of milk going into the baby’s mouth. If the baby cannot keep up with the flow, the excess milk will simply leak out under the shield. If you use a nipple shield, ensure that it is effective. We seldom use this approach as we find other methods more effective and pose less risks.

D) Preventing the baby from hurting you

If the baby tugs and clamps while breastfeeding, the mother’s nipples may become painful. Use the above tools to prevent this behaviour. If the baby suddenly causes pain, consider quickly taking the baby off the breast. Return the baby to the breast if and when the baby shows hunger signs.