The common concern of pregnant women or new mothers is whether they will have enough milk to breastfeed their babies. But little is said about the opposite extreme: What happens when we have a lot of milk? Overproduction or overproduction of breast milk is less common than hypogalactia (or perhaps less diagnosed) but it also exists.
Most define hyperproduction as an excess of breast milk for normal growth of the infant; it is also known as overproduction, hypergalactia, or hyperlactation . This, which may seem like a gift (” How lucky to have so much milk to breastfeed your baby “) can also cause certain problems, both for the mother and the baby.
How is the production of breast milk regulated?
Before talking about the hyperproduction of breast milk, we are going to review the mechanisms that regulate its production. Two hormones are fundamentally involved in the production of breast milk: prolactin and the lactation inhibitor factor, known as FIL.
When the baby sucks, the production of prolactin is stimulated, which is secreted by the pituitary (an area of the brain). Therefore, the more the baby sucks, the greater the production of breast milk ,
The inhibitory factor of breastfeeding (FIL) , on the other hand, is present in breast milk. When milk accumulates in the breast, FIL inhibits the production of breast milk. It is a way of saying to the body: ” I am full, I have enough milk, do not make more .” On the contrary, if the baby suckles frequently, emptying the breast well, there will be no FIL and more milk will be produced.
How do I know if I have hyperproduction?
During the first weeks of the baby’s life there is an overproduction of physiological breast milk . Since we don’t yet know the baby’s needs, we produce a lot just in case. At first the breast works as a warehouse, it has the milk ready for when it is needed.
Progressively the chest changes its functioning. This puzzles many babies and mothers and is known as the three-month crisis. The breasts do not feel full (they are no longer warehouses) and it can take a couple of minutes for the milk to come out after the babies begin to suck; that is why some “get angry with their chests.” This behavior usually lasts only a few days as they soon get used to the change.
However, some moms maintain this excess production throughout breastfeeding. And this can be a problem for both mother and baby.
On the one hand, the mother will notice the breast always full, engorged , even if the baby has just sucked, and it will leak frequently. Many report waking up at night due to pain in the chest, which is very full when the baby has not yet eaten. The ejection reflex in these mothers is also often painful . In addition, since the breast is not able to empty properly, mothers can suffer from obstruction of the ducts and even mastitis .
On the other hand, hyperproduction of milk is associated with a rapid flow of milk and babies tend to choke when they suckle and often bite the nipple trying to stop the excess flow. They often get angry, especially at the beginning of the feed, and find it difficult to maintain the latch , frequently letting go of the chest and swallowing a lot of air.
At the beginning of the feeding, the milk is rich in carbohydrates (especially lactose) and towards the end of the feeding it is richer in fat, more calories. As there is a lot of milk available in hypergalactia cases, babies tend to fill up before reaching the fat part, which causes them to drink more of the lactose-rich starter milk, and they can suffer from colic.
At first, these babies tend to gain weight quickly (more than 30g a day in children under 3 months); However, if the hyperproduction is maintained over time, the opposite effect can occur, since as we have mentioned, they do not get to take the final part of the intake, rich in fat and therefore more caloric.
The stools of these infants tend to be more frequent and abundant; they are often green and explosive, as they take a large amount of the lactose-rich starter milk.
Energetic or exaggerated ejection reflex
Mothers with overproduction often have an exaggerated ejection reflex as well. When the baby begins to suckle, the secretion of oxytocin is stimulated. Oxytocin is a hormone that acts, among other sites, by contracting the muscle cells around the milk ducts and promoting the ejection of milk.
This is known as an ejection reflex. This is the reason why when the baby suckles from one breast the opposite drips. If the ejection reflex is exaggerated or very energetic, it causes babies to choke easily and it is difficult for them to latch onto the breast (they latch on and release many times), causing them to swallow a lot of air.
Why is it produced?
The causes of overproduction of milk are varied and sometimes several of them can converge. In many cases the reason is not known (we say that it is an idiopathic hyperproduction). Some women are more susceptible and produce more milk in response to stimulation (suckling from the baby).
In other cases it can be caused by the mother herself, for example when milk is expressed in the initial stages , either to promote the establishment of breastfeeding or to reduce engorgement. Or an excessive expression of milk. Recall that the greater the suction (in this case, the breast pump), the greater the production (due to the action of prolactin). And, the higher the emptying, the less FIL and the higher the production as well.
Excessive use of galactogogues can also cause hypergalactia. In other cases, the breast may overproduce milk as compensation for a baby who has difficulty expressing milk (for example, babies with tongue-tie or poor latch on).
On the other hand, some diseases such as pituitary adenomas, prolactinomas or other causes of hyperprolactinemia , including hyperthyroidism, can cause an overproduction of breast milk.
How to handle hyperproduction?
Before putting a “remedy” to this situation, it is important that we make sure that, indeed, we have an excessive production of baby milk. Of course, in the event that we find an underlying cause (endocrine disorders, of the pituitary, etc.) we must treat it.
To regulate this excess milk, some techniques are proposed:
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In order for the baby to suckle more comfortably and better manage the exaggerated ejection reflex, we can express a little milk just before feeding . We can also separate the baby when we notice that the ejection reflex begins. It is also advisable to breastfeed lying down to reduce choking and we can clamp the breast so that the flow of milk is slower. Wearing nipple shields can also help the milk come out more slowly.
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For breast engorgement it is advisable to massage the breast, thus avoiding the accumulation of milk in a specific area and can evolve into mastitis. It is not convenient to wear tight bras, even at night it is advisable to sleep without a bra. This can make the chest leak less and also prevent engorgement. ** Pain relievers and anti-inflammatories ** can be used for pain and inflammation.
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To reduce the production of breast milk, only one breast per feeding can be offered. You can also breastfeed en bloc : for a period of time (usually 3 hours) the same breast will always be offered. You can progressively increase the time that the same breast is offered while the other remains full. Remember that if the breast is full, there will be a lot of FIL and the body will receive the message that it should not produce more milk. If this does not work, you can have a complete emptying of both breasts with a breast pump before starting breastfeeding en bloc. Finally, some drugs such as pseudoephedrine or contraceptives with estrogens can reduce milk production in those cases in which the rest of the measures have failed.
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