“Overactive Letdown” or “Over abundant milk supply” can be easy to fix.

Question from New Mom
I hope this is the right place to send questions about breastfeeding and pumping.
I have sort of 3 part question…..
I have a 5 week old baby who has been nursing well and gaining weight, wetting and having plenty of BM’s, so supply is not an issue. However, I have a crazy let down reflex that chokes my baby at least 8 out of 10 feedings. He chokes, stops breathing and his lips turn blue. I can hear the air and bubbles in his tummy and can hear the milk coming up and down his throat. After almost every feeding, he spits up an incredible amount, and does it many times over the course of an hour or so. I burp him several times during the feeding and almost always get soaked from the spit up.
The other issue is that, though I’ve been told by two lactation consultants that he has a good latch, my nipples are still sore and red. They aren’t cracking and bleeding, but they are sore (and I do have VERY sensitive nipples to begin with; so much so that I was hesitant to even try breastfeeding). The soreness could be due to the let down, since I see him smacking his lips and popping on and off (in, what I think, is an attempt to control it).
Any recommendations?
The third part of this question is – how would I transition from breastfeeding to exclusively pumping and bottle feeding? I seem to have enough of a supply to feed him, but not enough to pump several bottles a day (I’ve been yielding about 2 ounces per side per pumping session). I think I would prefer to bottle feed but want to utilize the breastmilk. Is this advisable given the issues with let down, etc?
Thanks so much for your help. Love your website – found it very helpful, too!
Answer from Toni
“Overactive Letdown” or “Over abundant milk supply” can be easy to fix.

To begin, if you have been using both breasts at every feeding, then you need to start using only one breast per feeding. You can put you baby back on that breast as many times as he desires, just don’t use the other one for a two hour period. If you have already been using one breast per feeding, then you need to go to one breast for a four hour period or for two feedings. The idea is to reduce the supply. Do not put off feedings though because that just makes the flow harder. You can gently express a little milk in the full breast to relieve any discomfort until it is time to use that breast again. Extra pumping is not recommended during this period.

Once the choking has reduced, you can go back to one breast per feeding. The only time you need to use both breasts might be during a growth spurt. This situation also requires more burping than usual. Another trick is to take baby off the breast when he is choking and let that rushing milk flow into a diaper for a few seconds. You can also lay in a recliner and let gravity reduce the speed of the flow by laying the baby on top of you. Be careful with this position that you baby’s nose is not blocked. Both of those measures will help until the one sided feedings reduce the flow for you.

It can take as long as a week to see the change in milk flow and your baby’s choking, although some moms report an improvement in only a day or two. Let me know how this works out for you.
There is a strong possibility that you sore nipples may be due to improper latch.
Try this latch technique.
Have nipple and baby’s nostrils in line before latching.
Mother’s hand under the baby’s face.
Head supported but NOT pushed in against breast.
Head tilted back slightly.
Baby’s body and legs wrapped in around mother.
Push with base of hand on baby’s back and shoulders when MOUTH WIDE OPEN to move baby quickly onto breast, so chin and lower jaw touch breast first.
WATCH LOWER LIP, aim it as far from base of nipple as possible, so tongue draws LOTS OF BREAST into mouth.
Move baby’s body and head together – keep baby uncurled.
Once latched, top lip will be close to nipple, areola shows above lip. Keep chin close against breast.

Wide Mouth / Gape
Need MOUTH WIDE BEFORE baby moved onto breast.
Teach baby to open wide/gape:
move baby toward breast, touch top lip against nipple
move mouth away SLIGHTLY
touch top lip against nipple again, move away again
REPEAT UNTIL BABY OPENS WIDE and has tongue forward
Move baby not breast
Mother’s View While Latching Baby

Mother’s View of Nursing Baby

Recommendations For The Mother
Mother’s posture: Sit with straight, well-supported back; trunk facing forwards, lap flat.
Baby’s position before feed begins: On pillow, nostril (not mouth) in line with nipple.
Baby’s body: Placed not quite tummy to tummy, but so that baby comes up to breast from below and baby’s upper eye makes eye contact with mother’s.
Support breast and firm inner breast tissue by raising breast slightly with fingers placed flat on chest wall and thumb pointing up (if helpful, also use sling of tensor bandage around breast)
Entice baby to gape: baby’s head and shoulders supported so head extends slightly as baby moved to breast. Touch baby’s top lip to nipple and move baby away slightly and repeat until baby opens wide with tongue forward.
Move baby quickly on to breast: head tilted back slightly, pushing in across shoulders so chin and lower jaw make first contact (not nose) while mouth still wide open, keep baby uncurled (means tongue nearer breast); lower lip is aimed as far from nipple as possible so baby’s tongue draws in maximum amount of breast tissue
Cautions
Mother needs to AVOID:
pushing her breast across her body
chasing the baby with her breast
flapping the breast up and down
holding breast with scissor grip
not supporting breast
twisting her body towards the baby instead of slightly away
aiming nipple to center of baby’s mouth
pulling baby’s chin down to open mouth
flexing baby’s head when bringing to breast
moving breast into baby’s mouth instead of bringing baby to breast
moving baby onto breast without a proper gape
not moving baby onto breast quickly enough at height of gape
having baby’s nose touch breast first and not the chin
holding breast away from baby’s nose
Transitioning from breastfeeding to breast pumping exclusively is fairly simple. You just start pumping.
The issue is the schedule. You may well have been feeding you baby on demand, but you will need to use a schedule like the one below.
Breast Pumping Schedule

You can adjust this schedule to you biological clock. (earlier waking or later bed time)

Waking AM to Noon
6 AM, 9 AM, 12 Noon

Afternoon to Midnight
3 PM, 6PM, 9 PM, 12 Midnight

Wee Hours (A Must!)
3 AM

Night feedings are critical to milk supply. Most successful pumpers state that although they would love to stop night pumping, but they do it usually 2 times per night, even if they pump for a year or more. There is good reason for night pumping. The hormone Feedback Inhibitor of Lactation (FIL) signals the mammary glands to slow or stop production when large gaps exist in pumping/feeding times, especially at night.
This is a lot of info, but you can copy and paste it into a word document and keep it for future reference or to share with other breastmilk moms.
I look forward to hearing how you and your baby do.

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