Forceful or Overactive Letdown

Overactive letdown is a common issue the first 4 to 6 weeks after birth when your body is still learning how much milk to make. If your body produces too much (you have an oversupply), that can lead to a rush of milk to your breasts that wants to come out quickly. This can cause your baby to be gassy, colicky, experience frequent hiccups or want to eat to soothe, similar to a baby with reflux.

Once your baby is about 2 months old, your body should have learned how much milk it needs to make. This is typically when you’ll stop feeling the overactive letdown, or it will be less painful; however, some women will continue to experience a forceful letdown after 2 months.

Most moms notice they have a forceful letdown if their babies are fussy at the breast and are choking, gulping, pulling off the breast, tugging the breast, coughing or gasping. Babies may also experience painful and excessive gas, hiccupping or spitting up. This may make you think your milk doesn’t agree with your baby, but that’s generally not the case. It’s more about the fact that he can’t handle so much all at once.

Here are some things you can try to help manage a forceful or overactive letdown:

• Hand express or pump a little bit of milk before getting your baby, and then help him latch on. But be cautious to not pump too much, as this can make the problem worse (by tricking your body into thinking it needs to produce more of a supply).
• Release or detach your baby when you start to feel the overactive letdown. Catch the first milk of the letdown in a towel or bottle (about 30 seconds), and then help your baby get re-latched.
• Try laid-back nursing. Lean back as you would in a hospital bed and allow your baby to lay belly-to-belly with you for the feeding. Gravity will help slow the forcefulness of the letdown. (This is also known as biological nursing.) Some women also use the side-lying position to help.
• Manually slow the flow of milk at the areola with your fingers. Use a scissors-hold, and “clamp” the areola at the beginning of the feeding to slow letdown.
• Limit bottles. Babies are smart and know the difference between the breast and the bottle. They may associate feeding as less stressful with a bottle and become less interested in the breast. Managing the letdown will help ensure your baby continues to breastfeed.
• Burp frequently if you notice your baby is gulping air during a feeding. This will help diminish gas later.