Oversupply

Many parents worry that they won’t make enough milk for their child to thrive, but oversupply is much less talked about. For families who experience it though, it can cause pain, worry and lots of stress. This week I’m joined by fellow IBCLC Alice Lucken to identify the signs of oversupply, its causes, and what you can do to ease it. We talk about pumping, positioning, block nursing and supplements, as well as well-meaning advice to avoid.

Follow Alice on Instagram @babyetaluk or go to her website Home - Baby et Al

Find out more from my article on oversupply: “You’ve got so much milk! You’re so lucky!” “No, I’m bloody not”: oversupply, ‘colic’ and ‘reflux’ — Emma Pickett IBCLC (squarespace.com)

Find out more about breastfeeding and chest feeding older babies and children in my book Supporting Breastfeeding Past the First Six Months and Beyond: A Guide for Professionals and Parents

Follow me on Twitter @MakesMilk and on Instagram  @emmapickettibclc or find out more on my website www.emmapickettbreastfeedingsupport.com

Resources mentioned - 

The Womanly Art of Breastfeeding: The Womanly Art of Breastfeeding (lllgbbooks.co.uk)

For donating milk:

Home - Human Milk Foundation

UK Human Milk Bank - Breast Milk Donation, BreastMilk Storage, UKAMB

This podcast is presented by Emma Pickett IBCLC, and produced by Emily Crosby Media.

Transcript

Emma Pickett  00:00

Hi. I'm Emma Pickett, and I'm a lactation consultant from London. When I first started calling myself Makes Milk, that was my superpower at the time, because I was breastfeeding my own two children. And now I'm helping families on their journey. I want your feeding journey to work for you from the very beginning to the very end. And I'm big on making sure parents get support at the end. So join me for conversations on how breastfeeding is amazing. And also, sometimes really, really hard. We'll look honestly and openly about that process of making milk. And of course, breastfeeding and chest feeding are a lot more than just making milk. 

Emma Pickett  00:46

Thank you very much for joining me for today's episode, we're going to be talking about oversupply now, for some people, the idea of producing too much milk sounds a bit like a dream. But anyone who works in breastfeeding support knows that some of the saddest families are the ones who have overproduction. It really can be a miserable experience. And it can be difficult to find the right information and the right support. So that's hopefully what we're going to provide in the next hour or so. And I'm very lucky to be joined by Alice Lucken, who is previously a nurse, she worked in the NHS as an infant feeding specialist health visitor for seven years. She's now an IBCLC. She works with families in a variety of different ways, often talking about babies who are unsettled and struggling. But today we're going to focus on oversupply and overproduction and hyper lactation. So thank you very much for joining me today, Alice.

Alice Lucken  01:37

Thank you so much for having me, Emma. It's a really interesting topic to talk about, because I think it's one that's not often talked about, certainly not not as much as like under supply. So yeah, I think it will be quite enlightening to lots of people. 

Emma Pickett  01:50

Yeah, yeah, um, I think low milk supply or perceived insufficient milk supplies is a kind of a real issue that was obviously at the heart of our work, and particularly perceived insufficient milk supply, because that's almost a sort of epidemic. I mean, people often very much doubt their milk supply, even when all signs suggest everything's okay. But as you say, hyper lactation, and overproduction is often not talked about enough. Let's just start with a really simple question. How would you define what oversupply means when it comes to lactation?

Alice Lucken  02:21

So I think in its simplest terms, oversupply means when you are producing more milk than your baby requires. And so there are times when that's a kind of normal phenomenon. So in those early weeks, as our milk supply is building, and trying to learn how to respond to our baby, it's quite normal to almost have more milk than your baby needs in those in those early weeks. But what then happens is, it starts to respond to that demand and supply. It regulates itself as to what your baby needs an A milk supply that's been well established will will fluctuate in response. So when baby's feeding more you make a bit more milk, when baby doesn't need so much, you make a bit less. But for a mum that's struggling with oversupply, it's like an ongoing excess milk, and lots lots more than your baby needs for more than just a short period of time. It's an ongoing issue.

Emma Pickett  03:26

Yeah, yeah. And other times when somebody's over producing isn't remotely a problem. It's not an issue and it's, it is actually a positive.

Alice Lucken  03:34

Yeah, it's not causing you or your baby, any symptoms that are concerning you it's not causing you discomfort or issues that can go round it. I know, we're going to go into what all of those could be. But yes, if it's just simply that you've got lots of milk that you don't mind, expressing some off donating it I know we're gonna talk about that a little bit if it fits in with how your baby and lifestyle and family work. No, absolutely. It's not a problem. It's when it might be causing your baby discomfort symptoms, it might be causing you some issues, then yes, it might be that that needs addressing 

Emma Pickett  04:12

Yeah, I'm glad you mentioned milk donation. Shout out for people with overproduction that that slot in donating milk as a normal course of their everyday so I'm a trustee for the Human Milk Foundation. And we look after the hearts milk bank in Hartfordshire that has hubs in Wales and Norfolk and in the north of England and in Brighton and we have mums who overproduce who regularly donate melt that then goes into the those milk banks gets gets processed, goes to babies and hospitals and you know literally saves lives. So just incredible. So thank you to anybody who was donating milk and if you want to learn more about milk donation, you can go to the Human Heart Foundation page and learn about hearts milk bank, or go to the association UK association of milk banks as well to get more information about that. And some people will just pump you know once or twice a day, to make life more manageable for them and their baby, it might be in the morning when they're particularly producing a lot of volume. And that's how things work for them. But that's, that's not necessarily an option for everybody and for everybody, even if they were to do this extra pumping sessions, they haven't necessarily solved the problem. So let's imagine we've got a family that we're supporting who really is struggling with overproduction? What does their sort of day to day life look like?

Alice Lucken  05:25

I mean, this, like you said, this will vary from family to family. But I think that, that when it starts to become a problem is if for you as the lactating parent here, it's causing you distress and discomfort issues. So what I mean by that, like, for example, ongoing issues with say encouragement. So encouragement in those early weeks is when you feel very full. And it's often a sign that you're you've got bit more milk at this point, or you or you need to feed your baby. And normally, with breastfeeding, progressing well, that will that will settle and certainly that comes into when we were talking about perceived low milk supply, we often interpret that I don't feel in gorged as meaning we haven't got enough milk anymore. And that's not necessarily the case, it is part of our milk regulating that we don't continue to be in gorged, but for a mum experiencing over supply, then absolutely this encouragement can be part of your day. And that's incredibly uncomfortable to be in that position. It can cause you to maybe, frequently frequently be needing to change breast pads, if you are leaking a lot of milk all the time, I mean, the practicalities of that if you know going out and about and just if your baby goes a bit longer between a feed and you're leaking everywhere, it's doesn't make life easy. I think then we can talk about things like blocked duct. So when you are in a state of engagement, and if that milk is not being drained, it can lead to blockages that we we now know cause inflammation, incredibly uncomfortable, and puts you more at risk of developing things like mastitis. So dealing with those issues as a mom is, is difficult enough. But sometimes over supply can also cause issues in in your baby. And some of the symptoms we might see of this very, very much unsettled, fussy behaviour. That's more than just normal baby behaviour. And gosh, that's a can of worms to open what what constitutes normal baby behaviour, what constitutes unsettled normal baby behaviour. But I think that for any family, that's when it's becoming very difficult to manage that your baby's not really having any periods where they're content or settled, that it's overwhelming you trying to cope with a baby that isn't settled very easily. We might also see it in how they feed so unsettled at the breast, that baby that's often I think parents describe it as a battle. It's such a battle to feed them, because their milk flow is fast or they're unsettled, they're unhappy. It hits the back of their throat very quickly. So they're on and they're off, then they don't feed and so it's a very vicious cycle, I think of breastfeeding not going smoothly. And it can cause them all sorts of tummy discomfort things like colic and reflux very much can be linked to oversupply and then problems for baby digestive Lee. So gut discomfort, their stools, their outputs can be affected by this very explosive nappies, sometimes mucus and that often sends us down a track of always this analogy, it can give them awfully sore bottoms. You know, lots of frequent stores that are hitting that nappy at a high speed can be a real cause of a sore bottom in a baby. So yeah, lots of different symptoms, that can mean different things. But could all be down to oversupply.

Emma Pickett  08:52

Yeah, yeah. As you said, there's a lot of stuff isn't there that really can be contributing to to an unhappy life. And the breast is sort of not your baby's friend, you know, the, you know, the idea of comfort nursing is just alien. Because as far as that baby's concerned, that's the last place where they want to chill out and fall asleep and it doesn't become relaxing for you either. And you know, your baby's going to be stressed coming to the breast, you can just get into this really miserable cycle of a baby feeding filling up on the sort of lower fat content, higher water content, higher lactose content milk, seeming full, but they're not necessarily being 100% satisfied because they didn't get the higher fat content, milk. Talk to me a bit more about the the the unsettled tummy stuff, what's actually going on inside that baby's tummy.

Alice Lucken  09:35

So this really leads to as you've just sort of polluted is about the balance of milk. And this is so massively misunderstood, because we were always told weren't really about for milk and hind milk and that babies need the high milk to gain weight and that's where all the fat is. And actually, it's not quite as straightforward as that those terms came from research where they were trying to understand breast milk a bit more There's fat throughout your milk, just the balance of how that works. And the ratio fat is a much heavier molecule. And so generally speaking in a whole 24 hour period, fat doesn't change on how often your baby feeds, but it is affected by the volume of your milk. So as more milk is removed, that part is tends to be more high in lactose. And as your baby feed for longer, we know they then access a better ratio of fat. And the fats really important for helping the digestive process, it kind of makes it hang around for a bit longer to be digested properly. So what's often happening when you've got a large large volume of milk is baby goes to the breast, they get quite a high volume of milk quite quickly. So they don't necessarily stay on the breast to get that better ratio that includes the fat, so they tend to get a higher lactose concentration. And we know that lactose is definitely affected by how frequently your baby feeds. So if your babies go into the breast, but not there for very long, they're getting quite a high dose of lactose. Now in babies guts, they have receptors that will detect the arrival of lactose. And their job is to help digest it. But what can happen when a lot of lactose arrives in the gut, and often it arrives quicker than it probably should. Because when that balance of fat isn't there, it's sort of pass through the stomach much quicker. So it arrives in the gut, in high quantities. And it overwhelms these little receptors. They're like little villi is what we call them in inside the gut. 

Emma Pickett  11:40

So these are receptors that are making enzymes are they Alice? So so the lactase enzyme?

Alice Lucken  11:45

Lactase enzyme. That's, that's absolutely right. So these little villi in the gut, their job is to detect the arrival of lactase but also to release the enzyme lactase, that's job is to digest the lactose. So what happens here is a couple of things. When the arrival of lactose is too much, it can damage the villi. And so therefore, they can't really release as much lactase as they'd like, because they're a little bit damaged. But also, there's just too much lactose for the lactase to digest enough. So what happens, our human bodies are just so incredible. We'll try and do something else to make this work. And what the gut then does is it tries to break down the lactose in another way. But that just creates a lot of excess gas, probably discomfort, maybe to the baby because of that excess gas. But also the body's like, Oh, this isn't quite right, we need to get this out of the system. So it's trying to kind of force it through the gut much quicker than it should do. And that's where we often get these explosive nappies. Or they often look quite foamy, because it's hit the nappy at quite a rate. And sometimes we will see things like mucus, because of the inflammation that's going on in the gut from having to try and digest this milk in a different way. And sometimes actually, even blood because of that irritation. And that's I think that's often misunderstood. We interpret that as a sign of something else. Whereas actually, yeah, what's going on with feeding? What's going on with supply? Does this link back?

Emma Pickett  13:12

Thank you. I know not everyone wants to go sciency. But I think it's really useful to understand what's happening. So. So we've got too much lactose not being able to be digested effectively, causing that faster gut transit. And this is my understanding, and correct me if I've got this wrong. So the body kind of produces bile, which is green puts it in the poo, but it because there's got transit, that's too quick. It doesn't have time to reabsorb that. Yeah. And therefore you get green stalls. So green stalls as a sign of faster gut transit faster than normally naturally, we would expect because we haven't had those those buyers that bile reabsorb removed. Yeah, absolutely. oversupply babies will have sometimes not always, but sometimes will get, as you say, blood specks, mucus frothiness Green stalls, and as you alluded to, sometimes that can lead people down the rabbit hole of allergy, for example, when we would always want to rule out, you know, hyper lactation, and hyperlactation first. 

Alice Lucken  14:06

It's always so important to never really look at one symptom in isolation. And to look at what are we seeing here for baby for mum, because they're at their a dyad to their unit? What are we seeing here because green stalls in a breastfed baby doesn't always mean something's wrong. And we can have green stalls for different reasons. So how often is this happening? Isn't it happening all the time? What else is that happening in conjunction with? It's like putting a puzzle together? Yeah. And we have to take those little pieces and what is this telling us and look at everything. 

Emma Pickett  14:41

Yeah, and digestive discomfort can also come from ingesting air. So if you're dealing with superfast flow, and oversupply an overactive letdown will often go hand in hand and baby can't call up coordinate their suck, swallow breathe. There'll be ingesting air as well and they may be able to burp it out. They may not and that can also because that that distress and discomfort later on. 

Alice Lucken  15:02

Yeah. And I think some of that is about often that the loss of the latch, and we'll come on to this about like really identifying what's the cause of oversupply. But you know, for that baby, they're they're trying to control the flow of milk so often as it starts to flow really fast, they will lessen the latch, if it's, if it's overwhelming to them, they'll come off and that loss of the seal that slipping on and off the breast is a big cause of air intake. I mean, we all take in it. As we as we eat, that's a normal phenomenon. But it's about that excessiveness and gulping I think is another reason you know that not controlling the flow Gulp, gulp, gulp, gulp, gulp. That's more air than needs to be there!

Emma Pickett  15:43

Yeah, and I'm sure you've seen this as well as but sometimes when there is oversupply, you know, babies are really quite clever at trying to find solutions to problems and even little babies will go. If I clamp my gum ridge, if I plant my lips, if I pull back and have a shallower latch, maybe I can cope with this a little bit better and and we start finding you know, parents who are in pain and there's pinch nipples and and actually the baby shallowing the latch but staying on with quite a you know, firm grip to try and control the flow in the same way we would and you know, we're almost ticking every box or what can go wrong with breastfeeding in terms of you know, discomfort and pain, pain for everybody. And then then a more increased risk for block ducts and mastitis, if you have the milk isn't being drained and the latch isn't great. So if anyone's listening to this and struggling with oversupply, I want you to know that we see you and we know how hard this is. And please do know that lactation consultants can support you through this and we know this is pretty miserable. So let's talk about the difference between oversupply and a fast letdown. First of all, for those anyone who doesn't know what to let down and and then let's talk about the relationship between the two things.

Alice Lucken  16:48

Okay, so that letdown is the reflex that happens when your baby feeds to release the milk if you like and what's happening sciency sorry, is the oxytocin hormone is your what I call the waiter hormone. So it's responsible for delivering the milk, prolactin is your chef, it's making the milk, oxytocin's job, it works on the muscle cell muscle that surrounds the milk cell, and it responds to so clever, oxytocin is an amazing hormone, but it will respond to hearing your baby cry, your baby suckling Lots of things can stimulate your oxytocin. And that causes the muscle to contract. And it puts some pressure on that cell to sort of force the milk down those ducts and out to your baby. And what we know is, I mean, some moms can feel they're let down, they can feel it as like tingling, or dragging pins and needles kind of sensation. I certainly remember mine being incredibly strong. I had oversupply. And so actually lots of these things. Now, I'm an ibclc. Makes sense, but very, very strong sensation. Some mums don't feel it at all. And again, it could be another perceived, oh, my goodness, it must mean I haven't got milk, I never feel it. It's just we all respond in different ways. And actually, all of those things are totally, totally normal, totally normal. But I think sometimes in families where they've maybe got more milk, that maybe they're more likely to feel it than when you've got a lower volume of milk. But again, all of that range is totally normal. So the letdown is where that flow of milk happens and helps deliver the milk to your baby. And we know that actually, quite a large proportion of your baby's feed comes from that thirst letdown, you get let downs throughout a feed. So it's not like one and they're done, the baby will drink that milk, usually a higher rate. It's the bit where we say we see the active feeding, so suck, suck, swallow, suck, suck, swallow, they might pause but you should be able to hear your baby drinking, you can definitely see a difference from those little sucks to that longer, deeper, drinking that chin drop and pause as they're swallowing. And then that will settle because it only lasts like a few minutes really doesn't it for most of us the strength of that let down and so it settles and then baby has to do a bit more sucking for each swallow. But as the feed continues, it often means they'll stimulate another letdown. We know that the second third subsequent ones are probably less strength behind them and maybe less milk delivered in that letdown than the previous one. But again, it means your baby's still getting milk, which is why we talk about you know leaving babies on until they say they've had enough before a case of maybe over supply. You know, it's fast and lots of milk has been delivered in that one sort of letdown, and so your baby's probably not getting into the feed to create more letdowns so it's getting that milk just from that point really.

Emma Pickett  19:46

Okay. Um, can somebody have a fast let down and not have overproduction and not have oversupply? I mean, could you have a fast let down and be under producing? Is that ever a combination? 

Alice Lucken  19:56

Oh, that's a good question. I think we certainly see it more when women have a higher volume of milk. I don't think it's necessarily always linked to oversupply. Certainly it isn't. And we know that some, some people just have a fast flow. And there are definitely things that we can do to help that. And sometimes those measures are all we need to do to help that mum and baby to feed more optimally. I'm trying to think now whether we see it in low supply, I think you can, it just depends on how much oxytocin you've got going on. And what's happening again, it's about taking a full history, isn't it and seeing what's going on here? Is this something that's happening all the time? You know, where in the feed? Is your baby struggling? Is it just at that point of letdown? That information tells us quite a lot. It is quite linked to oversupply. When we see an issue with oversupply, we can often when we're looking at the history, see an issue with the letdown bit of the feed as well. But yeah, you can have a fast let down and not have oversupply. And we would know that by looking at you and your baby and the other issues that are going that are going on or not going on.

Emma Pickett  21:02

Yeah, I'm looking at weight gain in the whole history. I think I'm trying to think about, you know, I've been doing this for sort of 1516 years now. And I don't think I've ever seen somebody who was struggling with milk production and how to fast let down? I don't think so. But I'm not going to say quoting from research that is here. 

Alice Lucken  21:19

No, we haven't got research about that have wheat. But I think you're right in in my practice do it's less likely when there are issues with lower supply. Babies aren't struggling with flow. They're struggling with creating the flow. They don't suck today, because they need the flow. Babies need the flow to stimulate them to suck, don't they? Yeah, yeah. It's much less likely.

Emma Pickett  21:37

Actually, one thing you said that just reminded me, I think it's super important. At this point, we highlight that when a baby's struggling with flow, we mustn't assume that's about over supply or over production. And actually, if someone's going, Oh, my baby's struggling with flow. But yeah, I don't have overproduction. And weight gain is a problem. You know, sirens going off red flags. Possibly we've got a baby with the tongue function issue or suck function issue or there's something with positioning attachment that's causing them to not be able to manage flow. And it's not about you over producing. So a baby choking and spluttering is not a baby that's necessarily with a parent without lactation. 

Alice Lucken  22:12

And often, if a parent came to me and said, Oh, my, my baby is struggling with fast flow. Actually, my ibclc always thinks, is it that your baby's struggling with a fast letdown? Or actually is your baby struggling to effectively transfer milk control the flow of milk and always, always, part of that assessment involves, you know, watching the feed and seeing what's going on, and having caution that this is not all dysfunction, because actually, I mean, I think we're going to talk about causes of oversupply. But I see that actually, our bodies are amazing. And sometimes when your baby is actually not able to feed effectively, the body sometimes recognises it. And sometimes we see that where we assume to see it as low supply. So when baby's not feeding properly, it means you've got low supply, actually, sometimes it's the opposite. It creates this fast let down and Quick Transfer of milk, because it knows the baby needs it to be able to get milk. And so yeah, for me as a lactation consultant, if a mom says, Oh, I think I've got fast blow my baby's choking straightaway, I'm thinking Yep, we've got check what's going on with how this baby's feeding? 

Emma Pickett  23:17

Yeah, yeah, I'm definitely that's a moment for an in person consultation and a face to face group. And, you know, that's, that's not the online Facebook chat moment where someone says, Oh, I've got fast flow, and someone says, Oh, here's an article about block feeding off you go. You know, that's when we start to get into dangerous territory, because these are situations that really need assessment. So if you took a little video camera of a baby dealing with hyper lactation overproduction, and then he did a little video of a baby with a tongue tie struggling with normal flow, they would look very, very similar in terms of in terms of what we see. And actually one thing we haven't mentioned in terms of what's the daily struggle positing, you talked about leaking and, and it sounds like you've had an experience with oversupply when you were lactating. I did as well and bringing milk up in a way that isn't doesn't require treatment doesn't require Gaviscon doesn't require a mat Prasad is not a medical problem is just distressing and messy. And it's you know, as part of the daily life can be a downside to over supply that can really, really start to wear people down. 

Alice Lucken  24:17

Yeah, absolutely. Yeah. And it's a real spectrum. I think here and I think that I talk a lot about reflux in my work with unsettled babies. And that was precisely the issue I had with my second son, that he had awful reflux, but it is a scale and we have to remember what is normal normal. When it comes to reflux, that just means something coming through a valve the wrong way. You know, babies are on milk, how we care for our babies, you know, they're designed to be held upright most of the time and so, yes, babies will posit milk. It's a defence mechanism. Actually, when the stomach is too full. Let's get rid of a little bit. We also think it's designed that way to give the oesophagus another coating of all that amazing stuff that's in your breast milk, it's really protective. And not to undo the fact that if you've got a baby, that's positing a lot, how tricky that can be to manage changing your clothes and their clothes and the difficulty that comes with that. But then when we're looking at it on a scale, it's about how that's impacting you and your baby. And when it starts to be a baby, that's getting very distressed by what they're bringing up the frequency of it, if that's impacting their weight gain, if it's causing your baby to cry for long periods of time, they're not settled in your, you know, in your arms with a cuddle or a little a little bit more of a breastfeed, then we're starting to sort of slip into that, okay, there's something going on that's causing this to be more distressing to your baby than it should be. And oversupply can absolutely be one of those causes. And that's exactly what the cause was for my baby. But it didn't know it at the time, because I wasn't, I didn't have all the knowledge I have now. And he was gaining weight really, really well, which is sometimes a symptom of oversupply, not not always. But he had this terrific weight gain. And so we were very unfortunately, dismissed as there's nothing wrong. It's just a little bit of sick, and he's gaining weight so brilliantly, he will just grow out of it. And looking back now, I just think so much could have been different for us. If I had understood about what was going on here. We were absolutely in that vicious cycle of constantly feeding to settle a baby that had just brought up milk. And then he bought more milk. And then you needed to feed to settle and he bought more milk. And I had oodles of supply credibly explosive nappies. And we were only offered Gaviscon and I didn't agree that that was the right thing to do. But I didn't know what else to do. So we just battled through and it, it really ruined my experience. Yeah, but I use that now to try and support families when it's tricky to say, let's find a way to support you and your baby. If there's something we can find out what's going on. Let's work together. But actually, sometimes it's about helping you when things are tough.

Emma Pickett  27:03

Yeah, yeah, I'm sorry, you had that experience. I mean, that I think that's, that really does illustrate how not getting support for oversupply really can hit you hard. And then you know, can affect your mental health if every aspect of your life with your baby's tough. And sadly, you know, GPS, and some health visitors don't necessarily have full training and dealing with oversupply and overproduction. So, you know, she'll both of us regularly, we've talked already about how people get diagnosed as having allergy and potentially even stop breastfeeding and start elimination diets and start giving specialised formulas, when it's simply hyper lactation. That's all it was. Also, people go down the route of being given Gaviscon and being given medication to sort of keep the milk down. Whereas as you've just suggested, it's precisely what we need is to let the milk come out because that safety valve, potentially that little sphincter muscle at the top of the stomach is looser for a reason. And then we also get families who are told, you know, your baby has colic. This is and it's just sick. All we needed was a session with someone who knew about lactation, all we needed was someone to support with hyper lactation. Do we know why some people get over supply? What's the kind of cause of why some people over produce? 

Alice Lucken  28:10

Again, I guess, this is why it makes it so complex, because it is multifaceted. There can be different reasons behind it, I think that some women are just super super producers of milk, like, you know, your podcast makes milk, I certainly felt that I just thought, oh, my gosh, this is something I'm really good at, is making milk. And yeah, I just made a huge amount of milk. So for some of us, we just, I'm guessing we're more responsive, you know, save baby feeds a bit more frequently, our milk supply, hyper responds to that. Whereas for some other other of us, it just doesn't respond in quite the same way. But there are certain things that maybe can sort of predispose you to that. So from a maternal side of things, we do need to just consider whether there's a medical reason behind this. So we know some endocrine issues might cause that with the pituitary gland could be stimulating you to make more milk than necessary.

Emma Pickett  29:05

So potentially more prolactin being produced. Yes, yeah. A small number of cases you can get benign cysts on the pituitary gland which stimulate prolactin. 

Alice Lucken  29:14

Yeah. And absolutely to say that's not the norm. But we do have to sort of bear those things in mind when we're thinking about what's going on. And what's the root cause of things, that there is a possibility that that is a reason behind somebody producing more milk. Often, I think it's about feeding and what's gone on in those early days. So sometimes I see this in parents where maybe with your first baby, you had an under supply or you were worried about under supply, second time round, think I am not gonna let this happen this time. And we sometimes create that situation by maybe expressing more than we need to pumping more than we need to to try and make sure we create a good supply. And actually we tip ourselves into oversupply. We know that the glandular tissue where the milk cells sit is where we sort of make the milk and how much glandular tissue you've got will impact this, but you grow that glandular tissue through pregnancy and through breastfeeding. So if your first experience was that you had some issues and you didn't have enough milk, you've probably made a bit more glandular tissue during your second pregnancy and the time that you breastfed. So second time round, it might be a bit better, you might naturally just have a bit more milk. So you might not need to overstimulate it to try and increase your milk supply. I think feeding behaviours as well, if you know if baby, like we said, If baby's got oral dysfunction, it doesn't always cause low supply sometimes, that can create the body thinking, right, I need to make more milk and scheduling things. You know, it can just interrupt the natural pattern, if you if you like of what's what's going on here.

Emma Pickett  30:50

Yeah, but point about pumping, I think is really important. I mean, I've met parents who literally thought they were supposed to pump. I mean, I've even met people who were told they were meant to pump after every feed just to help their milk come in and doing that for the first couple of weeks is going to be telling your body you've got twins or triplets essentially. And I think there's it's also worth just pointing out the sort of silicone one piece breast pump, that people were astounded, they're super valuable, they've really got a place in lactation. But they do exert a little bit of negative pressure, they're telling your body to make a little bit more milk than they're not just catching. They're doing something else. And I've often seen a relationship between that and overproduction. 

Alice Lucken  31:29

Yeah, I agree, I have to, I think it's tricky, because there's a few things that can be an issue with using a silicone sort of pump thing. And actually, often you start using it to try and maybe cope with when you've got a bit more milk than you need to go or get a bit off before baby feeds or this breasts really fall or does pop this on. And actually what we're doing then is sort of starting to create the telling the body you need to make more milk, your baby's taking this volume of milk, and a freezer stash, you know, that I think has huge pressure to think that we need to have a stash full of milk in the freezer for a rainy day, we are sort of bombarded with pictures of women sort of pumping with with the collecting sets full of milk. And actually, that's not how breast breasts work, you know, we know the breast normally synthesise about 30 mil an ounce an hour. And so if your baby's feeding regularly, you would not be making huge amounts of excess milk to put in the freezer. Now, if that is something that you want to do, and you want to build that that in, you can, but it's about if we're pumping excessively on top of how our baby's feeding, our body is quite likely to respond to that. And you are making more milk than your baby actually requires.

Emma Pickett  32:44

Yeah, yeah, I'm glad you mentioned that thing about pumping to possibly help because I think that is a common myth. I have regularly spoken to someone who said oh, I've you know, I've had oversupply for a while now. I was told by a particular person to pump before every feed. And that would help and that's what I've been doing. And they are literally pumping for five minutes before every feed. And you know, the first day brilliant, renewed, they took off all that high volume, high water content. I like to post good content milk, possibly baby was a bit more settled, it did get easier. But then the body's going Oh, okay. You wanted all that? No worries. We'll make that all tomorrow. We'll make that all the next day. You know, breasts are clever. And if you tell them yeah, we want all that milk. They'll do it the next day and the day after, and and you will eventually not be able to catch up. Even though the practicalities of pumping every time is a nightmare. But it isn't going to help. It is going to make the situation worse. That is not a solution to overproduction to remove milk before every feed is not a solution. So let's talk about some solutions. We've talked about how grim it is, we've talked about how often in terms of why it happens is you say sometimes people might produce more prolactin, sometimes people might have more milk ducts. So we know from research and the University of Western Australia, you know, some people got 20 milk ducts, and some people have got for milk ducts. And if you've got the 20 milk ducts, and you've got, you know, pretty high volume of milk whizzing down those milk ducts, chances are, that's going to be a forceful flow at the receiving end your baby, if you've got only four milk ducts, and slightly smaller volume and storage capacity, potentially less overwhelming. So there's something going on about the kind of configuration of the breast as well. But let's imagine someone is struggling in those early weeks. Maybe like week three, week four. we've alluded to this, but let's just confirm this. What do we need to check before we assume it's oversupply? What do we really need to check we've we've ruled out?

Alice Lucken  34:33

My first response to that when you are asking that question is caution caution. Because we know that it's so fundamental to the longevity of your breastfeeding journey, how well we establish your milk supply at the beginning. It's at the foundation. And so we want to be really careful about what we're doing so that we're not reducing that signal to the prolactin and those priming those receptors, we're not stopping that at a time where actually, that's precisely what the body needs us to be doing. So it absolutely does depend on where you are in your journey. And if we are still within very much those early weeks, I personally have a very, very cautious response to how we cope with this. And I think it's about starting very gently, and trying something, how are things? Trying the next step? How are things now? Because often, it might be this step, this step? And actually things are fine. So we can just stop right there. And there's a sort of process I think that I certainly support families with when oversupply fast let down are things so? Absolutely, first, we've got to check is feeding Okay? Can we make that optimal, and that's one of the first things we're going to do is, okay, what is optimal for you and your baby, because we often see breastfeeding as this is how I should hold my baby. But that might not be the best position for you and your baby. And it might not be the best position when you've got a fast flow, we want to see if altering the position at the baby that we're bringing baby to the breast, you know, can we help tip their head right back the position that we're getting the breast into the mouth, so that is stopping that fast flow, hitting the back of the baby's throat quite so fast, and causing them to then want to come to that shallow latch. So a lot we can do straight away with just let's try some different positioning and attachment does this mean baby feeds better, because that might be all you need to do that if baby can feed better at the breast, the breast responds better to that. And it just helps settle and regulate the supply. The next thing I'd often say is about can we lean back, we often sit right up, don't we, when we're breastfeeding. That's how we think it's designed to do how we want to be. But actually, certainly when you've got fast flow, baby being more in control and you laid right back can make a massive difference. So often a baby in a prone position. So on their tummy on top of you like I think this is like ideal to sort of say like, you know, when they're first born and they're born and placed on your chest, you're slightly reclined, and they're on their tummy, just gives them control of the flow, and it slows the milk a little bit. So those would be the first things I'd say let's try a bit of changing a positioning, shall we try some laid laid back nursing? How are things has this made any difference at all. The next thing I'd often say is sometimes we talk a little bit about what I call a like a brush, shake a gentle massage of your breasts, like before baby feeds, can we kind of we know that those fat molecules are sort of heavier, thicker, and they sit back. So if we just gently and I mean gently the breast is an organ, treat it with the respect it deserves. But just some gentle massage and moving that breast a little around a little bit might mean that we're just bringing a bit of the fat into some of that volume of milk. So that's going to help baby a little bit, hopefully,

Emma Pickett  37:58

That's definitely new. That wasn't some people talked about 1520 years ago, and I've forgotten the name of the lactation consultant who who did the research. But it's basically that, that if with a little bit of massage, essentially, sort of breast massage you might do in preparation for hand expression, you can cause some of the fat molecules that are adhering to the side of the milk. So you can cause them to break away and begin more quickly to enter the breast milk is that is that the sort of basement summary.

Alice Lucken  38:24

That's the understanding that I have about it. And I think it's one of those things that we can do gently. And it's a steady step, that's not going to necessarily put you into under supply, knock the supply interrupt feeding too much that we can try. It's pretty non invasive in that respect, and give it a go. And actually, if doing that means that baby's getting a better balance of that fat during that feed. And it's settle some of those symptoms for baby then. Great, perfect. Let's let's give that a go. 

Emma Pickett  38:53

Yeah. So that's sort of some of the stuff we can do in the early days without having done a disruption to milk supply. Yep. And also, just to double check, I know we've said this two or three times, but also important for babies struggling with flow in the early days to get an oral assessment done. Yeah. So if a baby has a tongue restriction, they're not going to be great at grooving the tongue. And it's, we need that groove to be able to swallow that bolus of milk in a safe way. If the if the tongue muscle can't do that groove milk is gonna fly all over the place go down the epiglottis No, no, go down the the the tube that the epiglottis covering the trachea and and you know, cause spluttering and difficulty with flow. And so we need to make sure we've checked oral function and you know, even things that are very, very rare, but you know, we can miss cleft palates, we can sometimes that's not always picked up and that the little submucosal clefts might be missed. So if a baby's struggling with flow, we do need to get everything checked before we necessarily assume it's all about your production and all about what's happening at your end. We're talking about some rare cases here. And then, but but tongue tie, probably not as rare. I mean, like, that's something I probably will meet several times a month a baby with an undiagnosed tongue tie who is struggling with flow? So I think we always have to keep that in the back of our minds. I think. 

Alice Lucken  40:12

I think also, it's probably important to mention here, part of the history that we would be taking is, you know, what was your pregnancy like, what was your, your your birth, like, because things like quick birth, long births, traumatic intervention, can massive, you know, my baby got stuck, or you know, really long, and it just so many things can impact the comfort that your baby has been brought to their breast. And so if your baby is in discomfort when they're at the breast, if they've got an issue with tone, or tension in their body, it can impact how they feed. And so that can then create some of these things that we see with not being able to control the flow of milk, difficulty with latching staying attach, it's could be issues with tone, it could be issues with tension, it's not always oral restriction. And so we have to look at all of those things and see, okay, what's going on in this in this case? 

Emma Pickett  41:08

Yeah, that's super important. Thank you for highlighting that. So for example, after forceps delivery, we may sometimes find a baby has a little bit of nerve bruising. And that if that nerve is not as effective that that means that the tongue can't move as easily, we may not find the jaw might not move in the same way, the baby might have sort of physiological barriers that stop them being able to control milk flow, which are not going to be permanent in vast majority of cases, any sort of post birth, impact will lessen over time, but certainly the first couple of weeks might be more difficult. And the baby may struggle to have the muscles doing what the muscles need to do. So that's, that's helpful to highlight that thank you. So let's imagine we've we've week three, week four, we've done the laid back feeding, we've brought the baby's throat above the breast, we're not now still doing that traditional cross cradle hold under the rest of the baby's being flooded and overwhelmed. When we've looked at positioning, it seems to be that the baby is still really struggling with flow. What happens next? I mean, when when would we maybe start adjusting supply? If we've given it several weeks? And what are the next sort of steps?

Alice Lucken  42:14

This is tricky, isn't it? Because we do have to caution I'm like caution, caution. Because our milk supply, like we said right at the beginning, in those early weeks, it will usually create more milk than your baby needs. And then as it figures out how your baby's feeding, it will say, Okay, I need this much. So I can add in usually I can down regulate a bit, which is why we don't continue to have that engagement between a feed our body just does the dance a bit better, it kind of knows this is how much your baby feeds. And so it doesn't want to make milk where it doesn't need to it's wasted energy doing that. And generally, we know that it can take sort of that first six weeks or so for that sort of first regulation of milk supply to really happen. And we also know that actually, there's there's another sort of point at about 12 weeks where our milk supply sort of regulates itself again, and so you have to be super cautious. If we're doing things that will decrease your supply, because your body might then naturally do its own decreasing. And we will have put you into an under supply potentially an under supply situation. So I think we do have to be extremely cautious, especially in that first six weeks. And you have to weigh this up. Don't wait. Don't you know if if the situation is awful, and it really seems like it's oversupply. And we've ruled out all things and try this gentle approach. It might be that we need to now start sort of saying, Okay, we need to maybe try and change how how we're feeding, and just slow the flow of milk and things a little bit to see if that helps. But I certainly would be moving with caution in that first six weeks for that.

Emma Pickett  43:55

So my understanding is that our prolactin baseline drops a little bit after those first six weeks, we're less likely to be making new breast tissue. But as you say, that could happen around six weeks. So if someone's merrily gone down the block nursing route at week four, and then the braid baseline prolactin drops at week six, they may they may get a bit stuck. But I guess in an absolute worst case scenario, and they did get a bit stuck, we could support them to increase supply again. So I don't want them to feel it's necessary reversible. So let's talk about block nursing week seven, we're helping mum called Maisie she's really struggling with oversupply. We can see the milk flying we can see the baby overwhelmed milks leaking all over the place. It looks like block nursing is the next step. What do we mean by block nursing what's actually happening when we use block nursing.

Alice Lucken  44:42

So the idea behind block nursing is that you're using one breast for a longer period of time to feed your baby so that you're not sort of stimulating both breasts and increasing milk supply. And I guess the idea is as well about that balance of milk If baby feeds very quickly from one breast, and then goes to the other breast, then they nearly always get and you've got high volume. They're nearly always getting a higher dose of lactose than then they need. And so the idea behind block nursing is that by keeping them on the one breasts longer, and not stimulating the other breast, it's just helping you to downregulates supply. I mean, I would usually suggest starting to say, can we encourage baby to feed for longer on one breast? And sometimes that's about breastfeeding behaviour. So, you know, sometimes we've been told we must offer both breasts per feed, and yes, babies do sometimes need both breasts. But at what point are you doing that? Baby's on for five minutes? And then you think, oh, yeah, okay, now we need to offer the other breast and then we're done. That might be what's sort of causing some of the issue here. So could we try and just offer this breast or certainly offer this breasts for as long as baby's happy to be on this breast per feed. Sometimes, even if the flow slows, and baby's getting a bit fussy, actually a bit of breast compression, which seems a bit weird in a situation of oversupply, we talk about breast compression helping with flow. But some babies get so used to that fast flow, that when it then slows down because the oxytocin has settled or let down has settled, they then get really annoyed, like, Oh, come on, I don't want to have to work for it. So actually, in this scenario, a little bit of breast compression, where you're just gently as baby is sucking, using a bit of compression on the breast of squeezing gently, gently to put a bit of force behind that milk to encourage them to keep drinking on that side. And when they've really had enough that side, yes, I would suggest you to take them off and see how settled they are. And if they are asking for more than yes, you can offer the other breast at that point. And I would say that's the best place to start, before we go to block nursing. Can we encourage a really good feed on one breast? You know, because the idea behind what you're trying to do is help them get that better ratio of fat in the milk that they've that they've taken.

Emma Pickett  47:04

Yeah, I think that's super important. Because I've seen people go to block nursing when they're actually double sided feeding every feed. And first step is, maybe in your case, single sided feeding is right now for little babies. for newborns, we will always say to parents offer both breasts, because you don't know what's going to happen with your physiology, we want to give yourself the best chance to get milk supply after good start. But if later on, if weeks on that doesn't feel right anymore, it may be that your baby needs you just to feed on one breast. And that could be right for your baby. So let's imagine that someone's done single sided feeding. I'm glad you said that thing about how babies. Babies that are used to fast flow are a bit sort of like excuse me, I've got I've got to work for this. I don't know No, no, no, no, no, you just produce it love. I just sit there with my mouth open. What do you what are you talking about, I've got to actually start doing something with my tongue. So we can get into a scenario where babies are sort of, they literally sort of lose track of how they've actually got to continue exerting negative pressure during the clever wave like motion with their tongue. They're so used to the letdown producing everything, you know, they get fussy, and we bond them on the other side, when actually you're right, we need to get them used to staying on that higher fat content milk side, doing a bit more work. So we're starting with that single sided feeding, then if that's not working, we may offer the same breast for two feeds in a row, possibly.

Alice Lucken  48:23

Yeah, and I think it's like we said, it's about the gradual how we do this to see how you respond and starting cautiously. So we might say let's do two feeds one side. So you offer the breast you encourage baby to have as much as possible from that breast, when they've then had enough, you go about your day as normal. And the next time that they're sort of queuing to feed, you feel that you need to feed you offer the same breast as you did last time, again, with the theory that the milk production hasn't sort of increased the volume as much that side. So again, they are accessing a better balance of milk, and you're not stimulating the other side. Now, for most women, when you are in a situation with over supply, there is no way that feeding to feed one breast that your other breast is going to let you just ignore that it's there, it's going to be uncomfortable, you're going to be leaking quite a lot. So in these early steps you are going to probably have to express but we would say Express for comfort. So just take as little as you can off because we don't want to keep stimulating it to tell the body you need to make more milk we're trying to say slow down a little bit, but it's uncomfortable and we have to be aware of blocked ducks the risk of mastitis if we're not moving milk so this is one of those times where you just I would say hand Express because you can be gentle when you're uncomfortable and so you can just keep going enough you're not stimulating mess it necessarily a great big letdown and pumping it all off before you've even necessarily realised you can titrate that your flow and how that's working for you in terms of comfort and you just try and take enough off to feel comfortable and ideally like As the days are going on, and you're following this process of two feeds, you know, for this amount of time on one breath, you're trying to reduce maybe slightly how much you're taking from that other side, if you can. 

Emma Pickett  50:10

Yeah. So it is that minimum, isn't it? Because it's so difficult. What do we mean by engorgement and discomfort because actually a little bit of discomfort or certainly a sensation of fullness, is your body getting the second alternate less milk, which is sort of part of the process of block nursing. So block nursing is not just about the baby getting a second feed on that fattier milk. It's also about what we're physiologically doing to the kind of neglected breast and we've got the prolactin receptors being distended, we've got that feedback inhibitor of lactation, that whey protein that tells us to make much less milk. If we then express that all off, the body's like, okay, no problem. We'll meet again, tomorrow. So, you know, we're not, we don't want to risk blocked ducts, or mastitis. And I think it's probably going to depend quite a lot on what your history has been. So if you're somebody who's had mastitis, block nursing probably doesn't sound great fun, that's scary to live with that situation. But if you haven't, and you're happy about your positioning attachment, you may find two feeds on one side, tiny bit of hand expression, but maybe nothing on the neglected side, then when you swap sides, that breast, you might need to just pay a little bit of attention to just check, there aren't any blockages after that first feed on that new side. But that first feed on that new side could be quite overwhelming because that breast is going to be really full. And this is where we come to this technique that that we can read a little bit about online, which is called Full drainage block nursing. And that research study, that is the sort of set of case studies that we can read about in this paper. What's interesting about this paper is that it's being done really early on. So people are doing it within the first kind of couple of weeks. But let's put that to one side, let's, let's talk about full drainage block nursing what's happening when people do that technique?

Alice Lucken  51:48

I guess the difference here is what you're doing is that you are removing the volume of milk. So with that goes that high portion of lactose. And so the theory I suppose is here is that when your baby then feeds on a lesser volume of milk, they are straightaway getting that that better volume of fat. And I guess the potentially maybe this will produce a happier baby quick, quicker, if we can get the right balance into them quicker. If we can maybe reduce some of the lactose. I mean, lactose isn't a bad thing. It's a really important quality of milk, it's just in this scenario, the balances are wrong and too much of that lactose in that gut is causing your baby irritation. And that's temporary, we can undo that with time it will get better those receptors are ready to release the lactase again, and it will all work properly. So actually, maybe, you know, full block nursing, where you you take that volume of milk and baby is just getting the milk that's being made as they feed. And that better sort of balance allows that sort of process to start quicker. 

Emma Pickett  52:52

Yeah, so in this particular recommendation, you you start your block nursing day with a full pumping session, you'll remove almost all the milk you possibly can, you can't remove everything. Breasts are never empty, there's always at least some milk there. And then you do a feed on both sides of really high fat content milk of what's left. And the idea is the baby then is in a settled place before you start the process of block nursing, then you do normal block nursing. And you might need to pump again at some point possibly. So weirdly, it's pumping sitting alongside blog nursing, with very extreme cases of oversupply. And I think people probably need to go and go and find the paper to read it in a bit more detail. I think one thing that's important to flag up is that people might say, Oh, well, how long do I stay on one breath for? You know, I only I only feed every four hours? So I do do I do eight hours on one breast or I feed every two hours? So it's four hours on one breast? Or long enough? I think there isn't a definitive answer to that question. Because we're all different. We've all got different storage capacity, our feeding patterns are all different. So when we say block nursing, we're simply saying, hang on one breath for a bit longer, and see what happens. And it may be a couple of feeds. And there have been some really extreme cases, I've come across in the literature of people doing kind of 12 hours on one breast and really extreme cases. And, you know, I'm certainly not advocating that will be normal, but it just highlights how individual this can be.

Alice Lucken  54:10

Absolutely. It's about responding to, it's about trying it's try this, and what's the response. So if you've tried, you know, to feed and that's been, that's two hours on one side and two hours on the other breasts, and it's really not making much difference, you still got lots of milk and babies still got all those symptoms. Okay, after some time, and again, that's tricky to know. There's no like, definitive, it's got to be three days of trying this and then we'll know, if we're not really seeing an improvement in symptoms. It might be then okay, we've got to go a little bit longer. And we'll say right, what would be the next bit of extension we could do to the block feeding, okay, you were doing two hours on one side, let's try go three hours on one breast, and just expressed for comfort. And if we leave it alone, if you can, and then do three on the other side, what's the response? How is your baby doing? Because at that point, when things are getting better, we sort of know that we're probably really getting it about right? And then we can start to sort of say, okay, has my supply slowed down a little bit. And in an ideal world, you might be able to go back to just offering the breast as baby needs it if the supply is regulated, but again, it's totally individual, a mum might find, she sort of always has to do a couple of feeds one side and a couple of feeds the other, she might find that things settle much better. And baby feeds much better from that one breast. They don't necessarily need both, but she could do alternate breasts, you'll find your way. I also think sometimes for mums with oversupply, you'll get a spanner in the works when baby hits a bump. So if they're having a growth spurt, or they're teething, and they want to feed a bit more frequently, they start, you know, fussing and wanting to go to the breast more and wound up your supply just goes again and you so you sometimes have to repeat the process of trying to help regulate your supply again after that period where babies sort of like needed it.

Emma Pickett  55:57

Yeah, yeah, I think that's important to mention, it's not necessarily a one off, it might be something you come back to. Okay, so the next question is a little bit delicate. I'm gonna try and word this as sensitively as I possibly can. So if you Google oversupply, and you go to some really reliable websites, people talk about block nursing as a method. And you will sometimes come across a description of the complete opposite as a method. So people talk about switch nursing, and having five minutes on one side, five minutes on the other side, you're still leaving your breasts quite full. That's what sends signals. And this first started to crop up maybe about 10 years ago, it was a, it was the practice of a lactation consultant in the states and someone who worked with her, she then reported it. And it got put into a really an article on an established website, which then got moved into another article on an established website. And I've written to people who own websites, and I've asked for evidence behind this because it doesn't seem to fit with what we know about how milk supplies reduced, it seems to be the opposite message. haven't had any answers. But I'm a little bit concerned that this is the literally the literal opposite of block nursing is still sometimes being reported as a method to reduce supply. And I don't know if you've come across this as well. And if I'm getting it wrong, and I misunderstand it, educate me what I mean, what do you think's happening here?

Alice Lucken  57:23

I agree with you in terms of that, I've seen it. I've seen it in literature. And, you know, forgive me, I do not know everything. But when I read it, I was like, what? That does not make sense. And so I've sat with it and thought, well, what's the theory behind this? And I think you're right, it's about that maybe if the milk is staying in the breasts, that fell feedback inhibitor, a lactation is doing its job, and you will down regulate supply by not moving enough milk. But I think in the case of oversupply, the symptoms that we're seeing in baby and the rate that those mums are making that milk, switch nursing is designed for the frequency to increase the prolactin to think oh my goodness, feeding twins need to make more milk and so by sending that signal of baby on an off the breast quickly and frequently, we're going to make more milk so no, I don't use it I would never suggest it for a man with oversupply I think it's what causes over supply actually is this on my babies unsettled? I put them on one breast I put them on the other breast, you know, they're unsettled, we try again, we put them on one breast, we put them on the other breast, it kind of creates a supply. So no, I wouldn't I wouldn't use it as a as an option. 

Emma Pickett  58:39

I'm genuinely quite confused. I think I need to write some more emails. I think maybe I went into someone's spam folder before. The idea that you know, you feed for five minutes. So feed for two minutes. If someone's got significant oversupply production and, you know, decent letdown reflex, they're gonna get three ounces in five minutes. I mean, the idea and then certain times of the day, they'll get more milk in five minutes, and they will at other times of the day and, and you could be dealing with some babies with serious lactose volume that they're in and on the babies, so yeah, more thinking to be done. Anyway, I'm glad we're on the same page. So block nursing, fuller breasts, leaving breasts. This is how we been why now I know, as ibclcs we're not able to talk about medication in the sense that we can't prescribe we can't recommend, even it gets even to slightly grayer when we're talking about herbs. But let's talk about some of the things that people will come across online and maybe other practitioners like herbalist or doctors can help them find what are some of the things that people take, I think is important to mention this because sometimes people come to me and go, oh, I want to have some medication to reduce my milk supply. You know, what can I take what what sort of things are taking out there?

Alice Lucken  59:50

Yeah, so thank you for alluding to that. Yes, as an IBCLC, it's really important that we work within our scope of practice. And if you are not an author, a registered herbalist or botany It's not the right thing for us to be doing to recommend things. But it doesn't mean that we're not asked these questions all the time. So I think it's about our job here is to support people to find information from reliable resources to seek the right people to help them if this is a route they want to take, and to maybe have that discussion with, these are some of the things that might be positive. These are some of the things that might be negative. This is how it might impact supply in your breastfeeding journey. But you need to find out more information from good sources about this. I think the common things that I've heard are some herbs some foods may help reduce milk supply. Peppermint is often talked about as a possible reducing milk supply, as is. Sage is often talked about. And I didn't know this so much. But Jasmine, I didn't I didn't realise that. 

Emma Pickett  1:00:47

Some people rub jasmine flowers actually on engorged breasts sometimes that's used in in some cultures. And I think Weren't you Jones, who is a bit of a legend and breastfeeding Well, breastfeeding medications expert and pharmacist and founder of the drugs and breast milk service for the breastfeeding network. Still active still researching still producing information for parents and supporting parents. I think she said if you had to drink gallons of peppermint, for it to make a difference. But sage I think is a little bit more sensitive. And potentially, you know, in current, you know, it's Thanksgiving actually this week and not we're not when this goes out, this will go out in a few more weeks. But But actually when parents are eating stuffing with sage in it, even just a few meals of sage can possibly sometimes have an impact on people's milk supply. And it's certainly in my experience, sage can be quite useful. 

Alice Lucken  1:01:35

And and the difference here is that I'm not a registered herbal herbalist or a botanist is, but we don't know how you are going to respond to these things. And some people don't respond so brilliantly to any of these things. And some people are really super sensitive to responding to these things. So again, it would be you know, with caution, but potentially, you know, if the moms done some research about that, and wants to try something like that, that's another way of maybe a softer approach to seeing whether it impacts milk supply. I think it's as you sort of sad yet often it is about the quantities of what you would need to eat would have to be so much that it's probably not that possible. And but also it's worth sort of saying here, I also sometimes think and this is, as you said, like not getting advice for this from groups where people are maybe not qualified to give that advice is often things like some over the counter medications might be offered to help suggest dropping your milk supply. 

Emma Pickett  1:02:32

Yeah, like decongestants. Yeah, so that's where it gets a bit tricky. So sudo actually, there's actually a piece of research has just come out recently, which suggests that pseudoephedrine is not a great product to be using. And in some countries like Japan, it isn't even given an over the counter decongestants. So people talk about having one dose of a decongestant, reducing milk supply by about 30%. And you'll see people talking about that on social media. That is something we can't really suggest that anybody does, and, and some of the other medications that are sometimes used to reduce milk supply. So often X, for example, there are a couple of different medications that are used around the world that have quite serious side effects and side effects around hypertension and risk of stroke and some pretty serious stuff. So if you go to GP and say, give me a pill that reduces my milk supply, you could be getting into some quite risky. 

Alice Lucken  1:03:22

Yeah, absolutely. And I've not worked with a family where we haven't successfully been able to regulate the supply to the baby's needs. With with using anything else to do that. I supported a mum once who classic case where her thirst had not gained weight brilliantly. And she really, really wanted to breastfeed this time. And there. It was a classic case of oversupply, she'd been doing a lot of pumping, to try and get extra to top baby up. And she was actually at a point where she was able to express three litres of milk on top of feeding her baby a day. And I'm like, oh my goodness, oh my goodness. But it was also other things going on here. She was so scared to try and drop her supply because she'd had a baby that had significantly lost weight. She you know, she didn't want to lose that. So we just really cautiously and with lots of support, just did sunblock nursing a little bit, a little bit and it took some time, but she got her milk supply down and all of those symptoms in the baby that everybody said, Oh, your baby's got an allergy and it's this that and the other orders disappeared as the milk supply regulated. And she didn't need to take any medication to help with that that was done by breastfeeding management. 

Emma Pickett  1:04:30

Yeah, yeah, definitely doable. I mean, there are times when perhaps after a loss somebody does want to stop medic milk production and and we understand that there are times when there are places for medication, but it's it's certainly not standard. I think different parts of the world have different attitudes. I knew a mom in Austria who was prescribed very small amounts of a medication, stick the edge off over production which will was really quite surprising to me. I don't think that would be the case everywhere. We know we've all we've got the medication in our bodies as it were we know We've got the hormones here, we just need to know how to manage it and how to do it in a safe way. But I think sage is something I do see having a positive impact in them. The mothers that come to me that have done their research and are using it, I had one client who actually took sage quite regularly. And she felt it took the edge off her milk supply. Who knows? I mean, you never know what's placebo when it comes to taking herbs and, you know, alternatives medicines, but you know, she felt it, it made a difference. And you can you can read more about that online. What would you say to someone the opposite to the mother, you just talked about who had oversupply with her first baby. And he's really worried it's going to happen again with a second baby.

Alice Lucken  1:05:39

This totally depends, doesn't it on what the reason was for the oversupply being created the first time around. And if it came from sort of how you were feeding, if you'd been given some advice about how to feed and it led to an oversupply. And now you know more that potentially No, it won't, it won't create an oversupply this time around. I think the benefit sometimes when we have another baby is all the knowledge we've had from from before. And things like getting a good latch attachment positioning, just got a bit more confidence with some of those things. Second time around knowing what feels right, knowing what doesn't feel right. And so I think that you, as difficult as it can be, you just have to head into it with assuming, okay, let's just see what we're dealt with this time round, let's feed our baby, as I'm supposed to in terms of responding to their cues, following their cues, and see what goes on. And if symptoms start to arise. If you start to feel like you've got way too much milk, then yes, it might be that you need to take some steps to to have caution with that to help reduce your milk. But again, I still would say we're still in that period of time often in those early days, aren't we of regulating a milk supply, so that those things would still stand that the way that we would deal with that would be a gentle approach with caution. So things like optimal latch and positioning, you know, allowing the baby the control, leaning back, you know, feeding as fully as you can from one breast doing all those things first before we necessarily assume Yeah, this is definitely a case of oversupply, and I've got to reduce my milk supply. But mums do no don't know, you know, you know your body. And if you've, if you've know straightaway, this is exactly what happened last time when I'm producing lots of milk, then yes, maybe it might be that we need to just manage how you're feeding your baby. But still with caution, I say in those early days. 

Emma Pickett  1:07:25

Yep. So before we finish, I just want to go back to something that you said earlier that I think many people would be surprised to hear. So when a baby has, you know, a tongue tie, for example, people always assume, Oh, you're going to have low milk supply, it's going to reduce your milk supply, because maybe he's not removing milk effectively. And those things go together. But actually, bizarrely, if a baby has a tongue tie, we can sometimes get overproduction happening, because a baby is coming to the breast more frequently, they may not necessarily be fully removing all the milk they need. And they may be struggling in other ways. But you could have longer feeds and more frequent feeds, which means more prolactin stimulation. So you could actually weirdly have a tongue tie and overproduction, both at the same time. Yeah. And in that situation, we've said the word caution, a lot of times with a penny for the workforce, we obviously need to look at both sides of that at the same time. But we can't obviously just decrease milk supply and response to that situation. Because the baby needs that milk. If that's all you know, they're not able to remove it effectively, they have been feeding more frequently for a reason. And that's when people just need to get expert support. So you've got to have a tongue toe practitioner, who knows what they're talking about? And if it's a tongue tie practitioner who's an ibclc, even better, so they can give you that sort of holistic, whole picture? 

Alice Lucken  1:08:52

Yeah, absolutely. I think it's always a thought and somebody says, Oh, you know, my baby struggling with fast flow is you think, Okay, this could be this could be oral dysfunction. And is this how the body's responding to this by pushing this milk into this baby. And what we don't want to do is drop a supply. That's, it's helping that baby to feed at this point in time. Because if we take away the flow, and the milk, then we're going to see a baby that's really, really struggling. And we definitely have, we don't want that we've got to put all of these puzzle pieces in the right order. And yeah, work out what's going on in this case, and and then act accordingly and address the things that need addressing before if you know before we then tackle the oversupply, let's tackle what's causing the oversupply and deal with that and get that sorted and then see, and actually, it might be that things settle with your oversupply on its own as you're addressing those issues. It might be that you then need to address the oversupply, but only when we know that baby can then feed.

Emma Pickett  1:09:51

Yeah, yeah. Are there any resources that you'd recommend about overproduction that we haven't touched on already today? Any any particular reading or resource you'd recommend?

Alice Lucken  1:10:01

The one thing that I love, and I thought this is really old school, but actually, the Womanly Art of Breastfeeding is a fantastic resource for this. I find that actually oversupply isn't even mentioned in quite a lot of the lactation books and things that I used to study when I was training to be an ibclc. It's not even mentioned, it's not even talked about in there. And so it can be quite tricky, I think to find good information about oversupply. And the women who are breastfeeding actually does it really well. 

Emma Pickett  1:10:28

Yeah. Good advert for that. Yep. La Leche League book. Yeah, one of the good things about the book is they've they update it, so you get those kind of new additions, um, sometimes apologising for the name because for young, young hip mums, it doesn't sound very kind of, kind of, you know, on finger on the pulse, but it's a bit hippie dippie. But, but um, ya know, definitely a vote for that book for me as well. Thank you so much for your time Alice really appreciated. We'll put your website and your social media stuff in the show notes so people know to come and find you and out to get you to get your help. Thank you so much, and really appreciated and a final word to anyone out there struggling with overproduction. Find someone to help you you do not have to suffer alone, you do not have to dread every feed, you do not have to spend your whole life carrying around five changes of clothes. There are people who can support you. So reach out to us and find us and it could be your local peer support team. It could be your local specialist feeding health visitor. There's lots of different people out there to help you but don't suffer alone. And don't think that we don't get how hard it can be to over produce.

Emma Pickett  1:11:27

Thank you, Alice. Have a good day. 

Alice Lucken  1:11:29

Thank you so much. Thank you, Emma, thank you.

Emma Pickett  1:11:36

Thank you for joining me today. You can find me on Instagram @EmmaPickettIBCLC and on Twitter @MakesMilk. It would be lovely if you subscribed because that helps other people to know I exist, and leaving a review would be great as well. Get in touch if you would like to join me to share your feeding or weaning journey or if you have any ideas for topics to include in the podcast. This podcast is produced by the lovely Emily Crosby Media.