Do you have an overactive letdown?
A really common issue that many breast feeding mothers talk to me about, during telephone support and breast feeding drop ins, is that their baby is coughing and spluttering when they come to the breast, and they seem to be sucking in a whole lot of air, maybe arching his back, very unsettled and this is happening even at intervals throughout the feed as well.
So if this is happening to you it may be a sign that you have an overactive let down or forceful let down, and it can be a really distressing situation for you and your baby – you may even be experiencing sore nipples as your baby tries to clamp down to control that flow, and this can be particularly upsetting.
When your baby comes to the breast, he will do fast sucks initially to send impulses to the brain, the brain then releases hormones and the hormones cause the letdown of milk – and the letdown happens in both of your breasts at the same time. So you can imagine if your baby has been happily calling down that milk and then he is suddenly faced with a really fast flowing deluge, he is going to cough and splutter, he will try to control that flow if he can, by whatever means, sucking in a whole lot of air, and may actually become quite windy in the process – some babies may bring up milk because of that as well.
So I want to talk you through a few things that you can do to help you to do forward in this situation. One of the first things is to allow your baby to come to the breast frequently to feed, keep your breast as soft as possible, and to prevent engorgement, because engorgement is when you actually feel overly full to the point of pain- and at that point it can be really even more difficult for your baby to latch at the breast, together with the fast flow. So keeping your breast as soft as possible will just enable the flow to be as slow as needed, a lot more manageable for him.
And secondly, a really good thing that you can do is to use hand expression, just getting the first fast flowing bit of milk off the breast before you bring your baby to the breast, so it literally could be seconds-worth of hand expression. Have a look at the video on the technique of hand expression if you have never done that before. Before each feed, just take that small amount of milk off – you don’t have to save it as such and give it to your baby, you could literally put it into a muslin cloth and that will enable that initial fast bit to slow down and to be far more manageable for your baby to cope with.
And it can also make a big difference to allow your baby to feed in more upright positions – it might be that you are slightly reclined back, but allow your baby to be resting against your body more upright, any angle around the clock face of the breast, as long as his head is a little bit higher than the rest of his body, this will give him more control over that flow.
And another tip is to try to allow your baby to feed from the same side until you feel that he has had a really good feed. Now some babies are literally bobbing off every five minutes but it is certainly better to keep him coming to the same side for as long as he can until you are fairly satisfied that the breast is drained as well as it can be before offering the other side.
But please remember to use your hand to do hand expression on the breast where your baby isn’t feeding, just to keep yourself comfortable, if you happen to get uncomfortably full, and this will prevent blocked ducts. The good news is that as your baby gets bigger he will be able to control the flow of milk a lot better and your supply nearly always settles down.
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Version 1.1 published in March 2019. Next review date: Jan 2022
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