Breastfeeding Positions For Overactive Letdown

Introduction

Did you know mothers with overactive letdowns could spray breast milk across the room?¹ Many mothers face the issue of an overactive letdown, which can cause a range of problems for both mother and baby.² If your baby is having difficulty feeding, it's important to consider whether overactive letdown may be the cause. This occurs when your breast releases milk too forcefully for your baby to handle, potentially leading to choking.^2,3 Additionally, overactive letdowns can be painful, causing sore nipples and breast infections, amongst other issues.³ 

In this article, you will find what you need to know about an overactive letdown, guidance on various breastfeeding positions and how to ensure the well-being of you and your baby.

Understanding overactive letdown

Explanation of overactive letdown and its causes

The letdown reflex refers to how milk is produced and released from a mother's breast. When the baby cries and suckles the breast, a hormone called oxytocin is released into the blood.² This hormone causes milk to be produced in the breast.² Overactive letdowns can be caused by your breasts producing too much milk (oversupply), but this is not always the cause.³

In other cases, it is simply that the milk is being sprayed out too vigorously.³ After around two to three months, many mothers find that this issue starts to resolve as the breast learns how much milk to supply and the right pressure its released.^1,3 However, this is not the case for all mothers, as the issue could persist longer.³

While the reason some people are more prone to having overactive letdowns is often unclear, it could be a sign of a more serious underlying condition.^1,3 Therefore, you must consult your midwife or doctor if you suspect you might be suffering from an overactive letdown.³ Regardless of the cause of the overactive letdown, the resultant effects are often similar. 

How overactive letdown affects breastfeeding for both mother and baby

When feeding, babies can get overwhelmed by too much milk coming out at once.^1,3 This can cause them to gulp several times, choke, gag, or pull away from the breast and try to re-latch multiple times. They may even refuse to re-latch altogether even before they feel full.^1,3

They might also develop a shallow latch in which the baby clamps its tongue on the tip of the mother's nipple to try and reduce the volume of milk flowing through.³ This often causes the mother pain and could lead to fissures or cracks developing in the mother's breast. If not addressed promptly, the breasts could become infected and/or lead to blocked milk ducts.³ 

Identifying signs of overactive letdown in breastfeeding 

Both mother and baby often exhibit the signs of an overactive letdown, some of which we have just mentioned. 

Signs from the baby

• Agitation before, during, or after breastfeeding
• Often being gassy and flatulent
• Excess weight gain
• Insufficient weight gain
• Green and frothy stools
• Often hungry, even after feeding
• Gulping rapidly and/or loudly
• Pulling away from feeding early
• Defensive shallow latch
• Arched back during feeding
• Excessive spitting up and dribbling of milk^1,3

Signs from the mother

• Hard, tight and full feelingbreasts
• Sore nipples
• Painful letdown reflex
• Mastitis
• Much milk leaking
• Breasts that are not noticeably softened after feeding
• Milk squirts out after the baby pulls away^1,3

Tips for breastfeeding with overactive letdown

Burping 

Burping the baby can alleviate some of the agitation and fussiness they have been experiencing.^1,3,4 During breastfeeding, babies gulp air and milk, causing an uncomfortable and maybe even painful sensation in their belly.⁴ urping your baby during feeding multiple times if necessary, could improve their comfort.⁴ Signs that babies need burping include an arched back, lifting their legs toward their belly, and clenching their fists.⁴ 

Breastfeeding schedule changes 

A common cause of overactive letdown is waiting too long between breastfeeding.^1,3 Waiting too long could cause excess milk to build up in your breasts, leading to a more forceful letdown.^1,3 Changing your nursing schedule could prevent this from happening. There are no clear guidelines on how often to breastfeed, as it depends on the baby's needs on an individual basis.^1,3,5 However, studies have shown that the nursing schedule should be as often as the baby requires and ideally promptly.⁵ 

As a general rule of thumb, the baby should want to breastfeed less frequently as they grow but for longer per session.⁵ Most exclusively breastfed babies tend to feed roughly every 2-4 hours.⁵ However, some babies may cluster feed and have more frequent feedings, occurring as often as every hour during specific periods. Conversely, some babies might experience longer sleep intervals, lasting around 4-5 hours between feeds.⁵ Due to these differences, it is best to be attentive to your baby's needs and not delay breastfeeding.^1,3,5 

If you're having trouble keeping up with your baby's nursing schedule due to other commitments, using a breast pump can often help.

Using a breast pump to regulate milk supply

A breast pump is a simple and effective way to breastfeed your baby without subjecting them and yourself to an uncomfortable and overactive letdown. You can use a manual breast pump or an electric one.⁶

Nipple shields

A nipple shield can help in three ways.^3,7 

• It helps babies with a weak latch as the shield is more prolonged and easier to latch on to 
• Secondly, it protects the nipple from the baby clamping it, preventing cuts and cracks and effectively preventing concomitant breast infections
• Lastly, it reduces the sensation of the baby suckling on the nipple, helpfully reducing the strength of the letdown reflex⁷ 

However, the use of nipple shields should be discussed with your doctor or midwife before using them. They can increase the risk of blocked milk ducts, prevent the baby getting enough milk as well as difficulty weaning them off them.^3,7

Releasing the initial letdown 

Expressing some milk into a cloth or towel just before feeding releases the initial fast-flowing milk. While the milk could still be fast-flowing for the duration of the feed, the beginning is often the most forceful.^1,3 You can do this by hand expressing or taking the baby off the breast right before the first let-down.^1,8 

Clasping the breast

You can also slow down the initial fast-flowing milk by pressing down on your breast using the side of your hand.⁹ After the first letdown, you can slowly remove your hand to allow the milk to flow.

Breastfeeding positions to manage overactive letdown

 You can use gravity to your advantage to help manage the fast milk flow. To slow down the milk, you can position your baby so their throat is higher than your breast.⁹ This way, the milk has to travel against gravity, which slows it down.⁹ Also, utilising positions that allow you to guide the baby to the nipple and promote a healthy latch can help reduce pain when breastfeeding.^1,3

The following positions allow for excess milk to dribble from the baby’s mouth providing comfort.¹ 

Clutch hold or football hold 

1. Position a pillow next to you for added support
2. Cradle your baby in your arm, facing upward, while using your palm to support their neck
3. Keep your baby's side snuggled closely against your side, with their feet and legs tucked under your arm
4. Finally, lift your baby gently towards your breast for breastfeeding

Laid-back (biological nurturing) position

This position involves leaning back comfortably on a soft sofa or bed. If you've had a caesarean section (c-section), your baby can lie across your body away from the incision area.¹⁰ 

1. Find a comfortable half-reclined position on a sofa or bed, propping yourself up with cushions or pillows to support your back, shoulders, and neck
2. Once at ease, place your baby on your chest, ensuring their tummy rests against yours. If this feels uncomfortable, you can lay them to one side
3. Stay upright enough to make eye contact with your baby
4. With gentle support, guide your baby to latch onto your nipple

The side-lying position

The side-lying position is ideal for mothers who have had a c-section or challenging deliveries or are breastfeeding at night.¹⁰

1. Lie on your side, and have your baby facing you, tummy to tummy
2. Ensure your baby's ears, shoulders, and hips are aligned straight and without twisting
3. Use cushions or pillows to support the baby to stay in that position
4. If you're using a pillow for your head, ensure it's not too close to your baby's head or face
5. Tuck the arm you're lying on under your head or pillow (without altering your baby's position), and use your free arm to support and guide your baby's head to your breast

Summary

Several techniques in your arsenal could help manage overactive letdowns. It is important to remember to consult a doctor or midwife if you still suspect that you have an overactive letdown. With time, your breasts could adapt to the amount of milk your baby needs, stop over-supplying, and reduce the letdown reflex's strength. Meanwhile, the techniques we covered could comfort both mother and baby. Namely, these include breastfeeding positions that use gravity to slow the milk flow and a healthy latch. In addition, other tips such as burping, adjusting the nursing schedule, breast pumps, nipple shields, hand expressing and breast clasping are also invaluable.