Normal gut function needs a balance between carbohydrates and fat in the food that is being digested. In my private practice, I have developed this combination of remedies into one that I call the full drainage and block feeding method FDBF. The treatment sequence starts with an as-complete-as-possible mechanical drainage of both breasts. It is impossible to really empty an active, lactating breast completely, because the production of milk is an ongoing process.
Emptying the breast is a major trigger for renewed production activity. Manual expression is a possibility, too, but in most cases mechanical extraction will work more efficiently and rapidly, especially if a simultaneous double pump is used. The infant will latch on immediately after drainage and will be offered both "empty" breasts to satisfaction.
Many infants will fall asleep fully satisfied with high fat hindmilk, many for the first time. Subsequently the rest of the day is divided into equal time blocks starting with about three hours, initially. Every time the infant shows hunger cues or other signs of interest in the breast the same breast will be offered without any restriction in either frequency or duration of feeds. At the end of such a time block, or after a multi-hour period of sleep, baby will be offered the other breast for all feeds within the next time block.
It is important that the best possible positioning and efficient latching techniques be used starting right from the very first feeding after pumping, for the sake of both the baby's improved suckling habits and the mother's comfort and future production. Depending on the seriousness of the symptoms time blocks may gradually be increased to 4, 6, 8 or even 12 hours. For less complex situations one-time mechanical drainage will suffice; for others occasional repetition may be necessary. Intervals between drainage will gradually increase as the symptoms lessen.
Mothers must be cautioned not to drain the breasts too often in order to avoid extra stimulation for milk production. Only if engorgement is becoming severe again should another drainage be carried out. In using FDBF the mother will need to be instructed, cautioned and monitored for temporarily recurring over-fullness and plugged ducts or mastitis. After the first full drainage, in some women the breasts will initially continue to produce more than asked for and thus refill.
In many others just a single full drainage will suffice to decrease milk production to acceptable levels. B is a healthy mother of a toddler and a nine day old infant. She is breastfeeding both children.
With her first child she experienced oversupply syndrome during the first four months postpartum. Treatments included milk removal prior to breastfeeding to soften the breasts, unlatching the child at the start of milk ejection reflex to release the most powerful milk flow, and stretching feeding intervals to ease baby's stomach. After four months of trying these strategies milk production stabilized at an acceptable level.
In the first eight postpartum days with the second child she was advised to use the same strategies, with no effect until her visit at the lactation consultant's practice on day nine. Baby started to refuse feeding at the breast or only wanted to breastfeed lying down. Baby was fussy and showing signs of stomach problems. Breasts remained full and uncomfortable in between feeding sessions.
One health care provider urged her to stop tandem nursing; this advice was not an option for this mother and toddler. B does not want to experience oversupply for four months this time. Assessment showed an apparently healthy, well gaining baby and toddler, nipples within the range of functional-normal with no signs of damage and no oral cavity abnormalities.
Baby latched on well, but fussed while drinking, losing vacuum intermittently. B reported that the infant had multiple very wet diapers daily and copious loose yellow stools.
FDBF was discussed with Mrs. She decided to try this, despite some questioning how this would fit into tandem nursing. She started expressing both breasts as completely as possible the same day, then putting the infant to the breast. At observation, the baby nursed well, without losing vacuum or fussing.
He fell asleep after finishing the second breast. B started block feeding after this initial milk expression and subsequently breastfed ad lib unilaterally in blocks of three hours.
The toddler was nursed within the block schedule that was set for the infant and did nurse well. During the first 24 hours her breasts started filling again and she repeated expressing 30 hours after the initial expression. Block feeding continued as started. In the course of the following week Mrs B. At follow up at one month postpartum Mrs.
B reported no more signs of overproduction. The toddler kept nursing occasionally, following the infant's schedule. Baby is fussy and noisy at breast, and Mrs. A reports that she can "hear the milk squirt into baby's stomach". Baby needs to burp often, but this does not ease his stomach-ache. Baby is not happy, is colicky and often brings up substantial amounts of milk after feeding. Stools are greenish, "foamy" and come often and in large amounts.
Baby's weight is grams above birth weight on day 8, without initial weight loss. Previously health care providers diagnosed mother and baby with overproduction syndrome and advised Mrs. A to hand-express some milk prior to feeding, breastfeeding while lying on her back, and block feeding; another provider advised to stretch feeding intervals to ease baby's stomach. These approaches did not work for Mrs.
Visiting the lactation consultant's practice is a last resort. Breast assessment showed rather small, but full and firm breasts. A does not report any pain, but she is in substantial discomfort during most of the day and night. Her concern, however, is more about baby's apparent unhappiness and pain. A started with initial expression of her breasts as completely as possible; mls was expressed from the left breast and mls from the right breast.
The upcoming 24 hours were divided into blocks of three hours. Special attention was paid to informing Mrs.
This resulted in more frequent, smaller feedings. A's breast did refill in the first 24 hours, but not so much that repeated expression was needed. The milk ejection reflex remained strong, but the smaller amount of milk seemed to make it easier for the child to cope. The first feeding of every new block did give some discomfort in the first days, but baby's fussiness and colic disappeared.
S is a healthy, 34 year old mother of a fifth child, 4 days postpartum. She breastfed her previous children without problems or complications. This fifth child was bigger than her previous children 4.
Baby was with his mother for the next 48 hours without more separation than needed for a bathroom visit and he was at the breast most of that time, frequently changing from one breast to the other. Blood sugar levels rose quickly and stayed high and stable. During the third postpartum day copious transitional milk came in and amounts were rising throughout the next 24 hours. The breasts were hard to the touch, red and shiny. FDBF is discussed and started during the consultation.
S expressed a total amount of mls and started block feeding in blocks of three to four hours. There was no need for further milk expression and milk production stayed within normal levels throughout a total lactation period of 30 months. She is breastfeeding her two month old baby boy. Her initial engorgement did not decrease. The baby is breastfeeding frequently at short intervals, a few minutes at a time.
Baby is not fussy at the breast, has no gastrointestinal problems and is growing within the higher range of normal. Breast assessment is difficult, because every handling of the breast causes milk to spray. Breasts do not feel very hard, but are firm and full. Concern about milk supply. If you're having a problem with oversupply, get help as soon as possible.
Contact your public health nurse, your GP or a lactation consultant. Get personal advice from our lactation consultants. Find a breastfeeding support group near you. These are a relaxed place to discuss breastfeeding issues with other mothers.
Page last reviewed: 19 March Next review due: 19 March Read our cookies policy to find out more about our cookies and how we use them. Home Wellbeing Babies and children Breastfeeding Common breastfeeding queries and challenges Back to Common breastfeeding queries and challenges. Breastfeeding - Leaking breasts oversupply. Problems with oversupply for baby If you have an oversupply of breast milk, your baby may experience: choking and sputtering when feeding milk leaking from their mouth or nose as they feed pulling away from the breast, arching their back, fussing and crying when they try to feed refusing to attach to the breast quick feedings, but hungry very soon after colic, fussiness or gas uncomfortable tummy most of the time spitting up often refusal to comfort feed refusal to fall asleep at the breast green, frothy, explosive bowel movements some may even have a streak of blood.
Important If you do notice blood in your baby's stools or if any of the other symptoms worry you, get advice as soon as possible. How to help oversupply Follow the advice below to help reduce oversupply. Nurse your baby often This may solve the problem of green, frothy bowel movements. Feeding often keeps your milk flowing so that you can avoid blocked or plugged ducts Positioning and attachment Pay close attention to positioning and attaching your baby to your breast.
Let baby decide duration of feeding Allow your baby to completely finish one breast before swapping to the second breast. Block feeding When you have been breastfeeding for 6 weeks, think about trying a block feeding routine.
Cabbage leaves Many women have found that consistent use of cabbage leaves reduces supply. Read on to find out if you really have an oversupply of milk, and what you can do about it.
Breast milk is amazing, so having lots is a good thing, right? Well, not always Some babies struggle with the fast flow that usually accompanies an overabundant milk supply. And mums with oversupply can often feel very uncomfortable, with frequently or constantly leaking breasts, and may be more likely to suffer from recurrent mastitis. Fortunately, there are a number of strategies that can help. But before you try any of these, ask yourself two key questions:. Do I really have too much breast milk?
Some symptoms of oversupply outlined below may have a number of other possible causes. Most cases settle down after the first few months. During the first four to six weeks after your baby is born, your levels of the milk-making hormone prolactin will be increasing each time milk is removed from your breasts. In these early weeks, your breasts are learning how much breast milk your baby needs and how much to make every hour. As a result, excessive leaking and breasts that fill quickly — and even spray milk during let down — are common and normal.
At the same time, your newborn is also learning to coordinate the way he sucks and swallows, so some coughing and spluttering at the breast is also to be expected. Some mums find that their milk supply settles down quickly, while for others it may take a little longer. Overabundant milk supply seems to go hand-in-hand with a fast flow, especially during the first let down. Your baby may respond by coughing and spluttering near the start of a feed, clamping or biting down, or holding the breast very loosely in his mouth.
He may come off the breast because the fast flow is a bit of a shock to him, and then cry because his feed has been interrupted. At the start of a breastfeed, the milk your baby is getting is relatively low in fat and consists mostly of lactose sugar and protein.
As the feed progresses and your breast empties, the fat content of your milk steadily increases. In cases of oversupply, your baby may become full before he has completely drained your breast.
This means that he is getting plenty of lactose-rich breast milk, but not as much of the high-fat milk that comes towards the end of a feed. Too much lactose, instead of a balanced meal, can be hard for babies to digest, resulting in explosive, frothy, green poos.
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