An overactive letdown is the gushing effect that occurs when a mother's milk comes down forcefully and too quickly. It's a common issue in the first 4 to 6 weeks after birth when a woman's body is still working out how much milk to make. It can indicate an oversupply or that you waited too long between feeds.
Practical Breastfeeding Tips: Managing Overactive Letdown
What is letdown?
Letdown is the reflex that occurs when your body gets a signal from your baby, and nerves are triggered in your nipple and areola. These nerves send messages to the pituitary gland in the brain, and signal it to release oxytocin and prolactin into the bloodstream.
Prolactin causes the alveoli in your breasts to remove sugars and protein from your blood and produce more milk. Oxytocin causes cells around the alveoli to contract and push the milk into the milk ducts. Oxytocin also widens the ducts, enabling milk to be released easily.
Letdown feels different for every woman, and there is no exact expectation. Some moms experience:
- A tingling sensation, which may occur only in the first few days of letdown, or continue over time.
- A feeling of fullness in the breasts.
- A sudden thirst - scientists aren't sure why this occurs although it may be linked to oxytocin.
- Pain - which can be the case with overactive letdown.
Practical Breastfeeding Tips: Managing Overactive Letdown
Signs of an overactive letdown
It can be painful when too much milk is released forcefully from the breasts. Additionally, this can also cause problems for your baby as they struggle to drink the milk. Signs of an overactive letdown include:
- Your baby chokes or sputters, and comes off the breast and relatches.
- Your baby is experiencing gas, hiccupping or spitting up.
- Your baby makes a clicking sound at the breast (a sign of a tongue or lip tie)
Practical Breastfeeding Tips: Managing Overactive Letdown
How to relieve overactive letdown
The following tips may help you to manage a forceful or overactive letdown. If you are still struggling, don't hesitate to speak to your lactation consultant or a doctor - they are there to help.
Express a small amount before nursing
Hand express or pump a small amount of milk before nursing your baby. However, be careful not to pump too much, as this can cause your body to produce more milk.
Change how you hold your baby
Try using a football hold or putting your baby in a sitting position as this will give your baby more control.
Try nursing while leaning back
Allow your baby to lay on your belly. Gravity slows down the speed of milk release. You might also find lying on your side to nurse helpful.
Slow the flow of milk manually
Place your fingers around the areola in a 'scissor' position to slow letdown.
Reduce the use of bottles
Babies can tell the difference between bottles and breastfeeding, and may begin to associate bottle-feeding with less stress, and prefer it over the breast. It's better to manage your letdown and let your baby continue to nurse.
Help your baby to burp frequently
if you notice they are gulping air or gagging, to help reduce gas.
Feed one breast per feeding
If the other breast becomes uncomfortable, hand express or pump the breast for comfort. However, do not completely drain the breast.
A note on Foremilk
Moms with overactive letdown might also notice that their babies are burping, hiccupping or even colicky more than they might expect. This may well be happening because baby is feeding too much on foremilk (thinner, more watery milk that helps baby to stay hydrated and gives them energy) and not getting enough hindmilk (creamier milk with a higher fat content, that's better for providing nourishment and 'filling baby's tummy').
Foremilk moves through the intestinal tract faster than hindmilk does, leading to malabsorption, and to excessive gas as a result. However, a 'one breast per feeding' approach will let your baby receive more hindmilk.
Practical Breastfeeding Tips: Managing Overactive Letdown
Helping your baby manage fast milk flow
If your baby coughs, gulps, and gasps when they let go of your breast, they are probably struggling to manage the flow of milk.
Change your baby's position to help your baby manage the fast flow
We would encourage laid back nursing. Sit on the couch and move your but to the edge of the couch and lean back or lean back in a rocking chair. This is good for a cross cradle hold and will allow your baby to manage the flow easier since it is going against gravity.
Position the baby in a more of a sitting position. The football hold will allow you to place your baby alongside you and rest in a sitting position. Use your forearm and hand to support your baby's head and back.
Let the fast flow subside
If the let-down is very fast, remove the baby until the flow slows. However, remember that regularly expressing milk before nursing could lead to oversupply - which will only exacerbate the problem.
Allow your baby to let go
Never hold the back of your baby's head to the breast so that they feel forced onto the breast. The baby needs to be able to protect their airway by taking a break - so allow them to let go and take a break when they need to.
Feed frequently
Leaving too long between feeds can lead to forceful letdown at the next feed. Instead, avoid long intervals between feeds; this can reduce engorgement and faster flow due to the increased pressure of milk inside the breast.
Look for feeding cues
When a baby gets overly hungry, they can be less coordinated and suck more frantically. Look for early signs of hunger, such as sucking fingers or searching with an open mouth, or offer your baby to breastfeed when they are sleepy or relaxed.
Practical Breastfeeding Tips: Managing Overactive Letdown
Will overactive letdown reduce over time?
Most babies learn to handle letdown as their ability to swallow matures. You can adjust your milk supply if oversupply is an issue. Overly full or engorged breasts are often a sign that you have an oversupply of milk, or hyperlactation. You might also find that you frequently get blocked milk ducts or mastitis. However, it isn't always clear whether there is too much milk; a lactation consultant can help you determine whether oversupply is an issue and offer support if so. Usually, a mom's milk production will balance out to suit her baby's needs in the 3rd to 4th month when her hormones are no longer elevated.
The potential symptoms of oversupply can include:
- Breasts that are full or engorged even after a feed
- Lumpy, tender breasts or sore nipples
- Leakage of milk between feeds
- Frequently blocked milk ducts or mastitis
- A very painful let-down at the beginning of a feed
- A very forceful letdown (milk ejection reflex)
Practical Breastfeeding Tips: Managing Overactive Letdown
Support from certified lactation consultants
Limerick is led by a team of certified lactation consultants, who support women along their breastfeeding and/or pumping journey. As moms and lactation experts, we understand what you're going through - our resource center covers a range of common issues new moms face.
