How to deal with an Overactive Letdown:
Updated: Jun 16, 2021
1. Position Changes:
You will want to use any position where your infant is more upright or forward to use gravity to slow the flow of the milk down.
Koala Hold, Dancers Hold or Straddle Hold:
This is where your baby is straddling your knee and sitting up to latch/chestfeed, tummy to tummy! The hand that is on the same side as the breast/chest you are feeding from supports your infant's head at the neck (this video shows position well, but please do not put your hand on the back of your baby's head. This can often cause them to pull away from the pressure. Put your hand at the base of your baby's neck/skull and shoulders, resting their head in the part of your hand between your thumb and pointer finger). Your opposite hand from the side you are feeding from supports your breast/chest in a c-position.
Laidback or "Biological" Nursing Position:
This is where the feeding parent is in a relaxed, reclined position where gravity helps keep your infant on your body. Almost in the same position you would relax and watch TV! Your baby is tummy to tummy with you, slightly looking up at your breast/chest when feeding (which you can accomplish by starting nose to nipple and then latching). Your arm supports your baby's body weight and your opposite hand still likely will need to support the breast when latching and at points during the feeding, possibly throughout the entire feeding depending on your infant's strength and stamina. Newborns often need the breast/chest to be supported throughout the entire feed. If you are having nipple pain when feeding, you likely will need to support/hold the breast/chest throughout. Your infant's spine should be straight and their body/legs can either be across your abdomen (almost where you and your infant make a perpendicular shape) where their feet rest on your side, or more in a diagonal position where their feet may rest on the top of your thigh. Here is an example video:
Other Techniques & Interventions:
2. Breast/chest Compression
Unlike hand massage and breast/chest compressions used to speed up flow of milk. You can press on the top of the breast/chest to temporarily staunch the flow of that ductal area, allowing other areas of the breast/chest to empty. Then removing that pressure to allow those ducts to drain. Ensure you do not leave this pressure for more than a minute or two as too much pressure for too long can put you at risk for milk stasis related problems. Demonstrated in this video by DIY Breastfeeding:
3. Block Feeding
If your infant is gaining milk well, is older than 6 weeks of age and has been ruled out for tongue/lip ties/restrictions or other related issues, you can utilize block feeding. Block feeding is using one side per feeding. If you have a very extreme oversupply, your lactation consultant may recommend feeding on one breast/chest for more than one feeding, but definitely only do that if discussed prior with your consultant.
4. Reduce Breast/Chest Stimulation
Between feedings try to avoid use of breast/chest shells, lots of hand massage or long showers where water is hitting your chest for a long time. Anything that can stimulate your breast/chest between feedings, try to decrease or avoid it. Just remember stimulation during feedings is just fine! You will still want to ensure the milk is moving every few hours, we just want to avoid anything extra if you are having oversupply or overactive let-down concerns.
In addition to all of these suggestions, it's good to remember that usually time will help as well! As your infant grows, gains strength, stamina and muscle control, they generally learn how to cope with a fast flow between 3 weeks to 3 months of age. Also most people's lactation hormones are more normalized by around their infant's third month and will regulate more their needs instead of being able to feed a small village ;-)
6. Extra Help
If improved positioning, time and those other techniques are not helping, you may need some extra help or opinions! Tongue/lip ties/restrictions can play a big role in an infant's ability to cope with milk flow. As well as sometimes there are body issues at play. Other providers that may be of assistance can include: pediatric dentists for oral evaluations, SLPs (Speech Language Pathologists) for oral strength and skills, Chiropractors or Craniosacral Therapy Providers can aid in aligning the body for maximum function to help with feeding. Babies' abilities to eat is a full body skill!
Excellent resource summarizing all about Overactive Let-downs from KellyMom.com here: https://kellymom.com/bf/got-mi...