Dear Doctor,

I’m a new mother and my baby is only a week old. However, I seem to have too much breast milk and I can’t control it.  The baby also has a problem taking it in and I have to stop her lest she chokes. Kindly advise. Is there a way to control it? Is it something I’m eating?

Beata

Dear Beata,

Breastfeedingis nature’s way to sustain and nourish a new-born baby. The body of a pregnant woman automatically prepares to produce milk. That is why breasts grow in size, when one is pregnant. After delivery, changing hormone levels triggers the production of milk in the breasts. Suckling by the baby further stimulates it.  The response to hormones and quantity of milk production varies from one woman to another. A new-born may not be able to suckle properly or adequately in one feed, due to not being latched properly, being tired or underweight and the existing milk supply may seem abundant.  Any anomaly in the baby like a tongue tie or cleft palate may also prevent adequate intake of breast milk. A baby may be fed only on one breast; hence that breast may be stimulated more, producing more milk as compared to the other breast.  Pumping the breast excessively can stimulate excess milk production. 

It can be due to disorders of the pituitary, thyroid gland, hormonal contraceptive pills, certain medications like anti-depressants, some antihypertensive medications. Use of herbs like anise and fenugreek stimulates breast milk production and can produce excess.  Whatever the reason for hyper lactation it is uncomfortable for the Mother. Her breasts seem always engorged, there is soiling of clothes and enhanced risk of infection of the milk ducts.

Some signs of actual excess milk production are as follows; if milk comes out as a spray at the beginning of a feed; the baby, gulps, chokes, while feeding; she arches away from the breast, sometimes fussing and crying. Rapid weight gain in an infant, passing excess gas, passing green, watery, foamy stools, by the baby, all these point out to excess milk being produced.

One can try pumping both the breasts till empty, then feed the baby only on one breast, for up to four feeds. This will gradually help in reducing excess milk production.  Before each feeding, express little milk by pump or manually to reduce the flow. Try feeding the baby a little before she is very hungry. Thus she will suck gently, reducing the stimulus for milk production. Nursing the baby in sitting position, may produce slightly less milk as compared to supine position.

Use of herbs like sage, peppermint, application of cool cabbage leaves, are indigenous methods, known to reduce excess milk.  Some anti cold medications also help in reducing hyper lactation, but have other side effects, hence should be avoided. If the problem seems persistent, it is better to get investigated for some hormonal disorder. They are all treatable.                                 

Dr.Rachna  Pande is a specialist in internal medicine.