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Breastmilk - Oversupply & engorgement management guide

When milk changes from the small concentrated liquid gold we call colostrum, to the thinner and more common looking milk, it can sometimes feel like you were given breast implants overnight.

Your breast may feel huge, firm, hot, tight and very uncomfortable to say the least. I personally felt like my breast were going to detach and walk out of the room like thing1 and thing2. It’s really important to manage your breast. Ignoring them will only make things worse.

When your milk comes in, if you have too much of a sudden increase and over supply your breast can become engorged. The milk can also get stuck and be difficult to flow and let down. Your milk flow begins as your baby sucks or while you express, this is what we call the ‘let-down’.

The nipple may be so full of milk that it becomes very hard, or retracts and disappears into the breast, it’s almost like your breast has swallowed your nipple and your baby may find it difficult to attach. To help your baby latch on successfully, you may need to soften your nipple. The easiest way to do this is to express some milk by hand. Place your thumb and index fingertips just behind the areola (also known as your nipple) and draw in like a milking motion by gently squeezing and releasing or you can hold each squeeze for 20 seconds or so. You may need to rotate your fingers around the areola to find the let-down point.

Using warm packs for a few minutes before a feed can help melt the milk and allow it to flow. You may find it helpful to continue to use the heat pack during expressing and feeding, till the breast settles. Gently feel around your breast to find where your firmest areas are and place the heat on them. Under your armpit is often a common place. Safety is always important. Carefully follow the heat pack’s instructions and wrap it with a cloth. Make sure it’s not near your baby.

Some women find that heat doesn’t do enough for them. The other option is ice. If you have lumps, ice can treat them like a sports injury, reducing the swelling in the ducts and allowing the milk to flow through.

After feeding, if your breasts are still uncomfortable, use ice to reduce the heat, pressure and swelling of the breast. Ice packs, wet frozen face washers, wet and frozen disposable nappies are good options. (Prepare the nappy by lightly filling the inside from one end to the other under a tap, and then freeze; place one open, frozen nappy on each breast.)

If after 10 to 15 minutes your breasts are still uncomfortable you may need to express a small amount to ease the pressure. It’s normal for your breasts to still feel full and firm, as long as they are not painful or causing you discomfort. You do not want to over express, as it sends a message to your body that you need that extra milk. You want to express the smallest amount for comfort (5–20mL). If you need to express more than that, gradually decrease the amount each time and try replacing the ice on your breast - before you express again.

Reduce over handling and stimulating your breasts after feeds. Wear a good, supportive bra that doesn’t dig in and remove it during feeds - if it’s getting in your way or placing pressure on areas of your breast. You can place ice packs or frozen nappies in your bra after feeds.

Washed cold or frozen cabbage leaves are another good remedy for engorged breasts. Place the cabbage around the breast, avoiding the nipple area – this will also help tame your supply. Use them for around three minutes and expect to smell like a dim sim, but they do help. Do be cautious not to overdo the cabbage leaves, as they can reduce your milk too much.

If your engorgement has happened very quickly – as soon as your milk has come in – you may find it helpful to express and empty the breast with an electric pump. Your breast will feel amazing after it but, remember that you only want to do this once. If you continue to do this your supply will continue to increase, creating extra work for yourself. It’s exhausting and very taxing on your body and you’re wasting all your nutrients. Do freeze your milk for future use.

If it has been three hours since the start of your last feed and your breasts are full and getting uncomfortable, wake your baby up for a feed, or try icing to get you close to three hours, but don’t ignore your breasts. Uncomfortable lumps, soreness and redness can lead to mastitis.

It is important to find the balance of feeding your baby well and having a bit of a routine, while managing your oversupply. If you feed your baby too often, purely because your breasts are uncomfortable, your baby may start to snack feed. This can become another problem that you’ll later on have to fix. You want your baby to have a full feed each time and then have adequate sleep.

My advice is feed your baby what they need to stretch to three hours during the day. The way you learn this, is by timing each feed and how long till they are hungry again. Do get an app on your phone to do that for you, or keep a diary so you remember. So, if they’re hungry before three hours from starting a feed, you know to feed them longer next time.

During the day, wake them up to feed if it’s been three hours and your breasts are uncomfortable, but overnight my advice to you would be to let them sleep, and unfortunately if your breasts are waking you up causing discomfort, you’ll need to manage them.

Try ice first and, if this takes the pressure off, you can leave them. The notion of being able to sleep with ice on your breasts will sound absolutely insane, but you will, and it will actually soothe you. The ice can help the body reabsorb some of the milk and hopefully in time your supply will match your baby’s needs.

If your baby is gaining weight well and feeding well, every three hours during the day, with good urine output, and is over three kilograms in weight - then they can definitely go up to five or six hours overnight without a feed. That’s if they’re not waking up crying to be fed. (Don’t forget that newborns, need a minimum of six feeds in 24 hours)

The idea is that eventually your milk will settle and hopefully your baby will be sleeping well. If you constantly wake them up to feed during the night - when they don’t need it, in time they will become used to it and continue to demand it.

Getting up to ice or express while your baby sleeps is exhausting and will at times feel very unfair. These too shall pass.

Ice first, if that’s not enough to get you comfortable – then express on a slow, soft setting or use a Haakaa pump (expressing on a fast and strong setting – sends a message to your body that you need to make more milk quickly! For that hungry baby) and make sure you sleep during the day. A healthy mind and mum needs sleep.

Most women will find that their supply settles within a couple of weeks, if managed correctly. Others will be blessed with an oversupply for up to three months. It will settle, but you may need to have an ongoing management plan. If that is you, I’m sending you a big hug! It was me too. It will get better and you will get everybody telling you how lucky you are and that it’s better than not having enough. That all may be true, but it’s extra work, and it would be nice to sleep while your baby sleeps.

Here are some more tips for managing an oversupply

· If you block feed, meaning feed from one breast only per feed, your baby will hopefully drain and empty one side as much as possible and feed off the other breast at the next feed. So, within a three- to four-hour block only feed from one side. To manage the breast you do not feed from, use ice packs. If the breast is uncomfortable, express a minimal amount to ease discomfort. Using a Haakaa breast pump may help, but keep an eye on how much is going into it, and remove it as soon as the pressure eases, which can often be 10–20mL. Just enough to ease the pressure and not so much that your body thinks that it needs to keep making more. Remember, if you have an oversupply, using an electric pump can send milk into overdrive. So use it on a gentle and slow setting. Although time flies, and there is a sense of urgency to tick the box and get things done, putting it on too fast and strong can sometime release a milk let-down too quickly, causing you to over express, and it can trick the body into thinking there’s a ravenous baby needing more milk. This is when a Haakaa pump can be helpful. It is gentler.

· A Haakaa can be used at the start of the feed, if your initial let-down of milk is too fast, especially first thing in the morning. Your baby may pull off the breast, overwhelmed by the supply, while your milk continues to sprinkle out like a hose. Using a Haakaa also stops your baby from getting too much foremilk and not enough hind milk. Foremilk is thirst quenching and sugary but it’s not high in fat or calories, so it won’t help your baby gain weight and it is also digested faster, so your baby won’t sleep as long if they’re only filling up on your foremilk.

· To decrease your flow rate, sit as far back as possible – almost lying flat – with a slight incline from pillows propped under your head and shoulders for comfort.

· You may find that your baby bites or clamps down on your nipple, to slow the fast flow of the milk.

· Reduce your water intake. If you’re finding that you’re thirsty and drinking lots of water, but are not urinating as much as you usually would, then decreasing and measuring your water intake is important, as all those extra fluids are probably going straight to your milk. You still need to make sure that you’re well hydrated, so do drink water, but be aware of the quantity and add hydrolyte to it. Water is essential to increase your milk supply, so when you have an oversupply quite often it is going straight to your breast. Drink water slowly. I know the thirst is real, but sometimes drinking two litres of water, doesn’t quench that thirsty feeling. Try munching on ice cubes and ice water, as it’s more difficult to drink quickly and it will soothe that hot, desert-like feeling.

When you’re battling through this, it can all feel like too much. It will pass. Be kind to yourself.

I hope this all helps you!

Love from your takeaway midwife

Always consult with a health professional and stay in contact with your Maternal and Child Health nurse, lactation consultant or your personal midwife to ensure that the advice here, is appropriate for you and your situation.

Refer to the Australian Breastfeeding association for more information and support.

Breastfeeding Helpline: 1800 mum 2 mum – 1800 686 268. There are over 400 counsellors that can provide reassurance and or helpful knowledge and advice. They can also help you with instructions on how to hire a breast pump or connect you with lactation consultants.

The Royal Women’s Hospital – is also a great resource. Checkout their fact sheets for further information – by simply searching Milk over supply. They also translate into many languages.

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