Although it is quite normal to worry that you don't have enough milk for your baby (see "Is My Baby Getting Enough?"), many moms actually wish they had less milk. These women are said to have overabundant milk supplies, also known as hyperlactation syndrome, when the supply is more than what is needed by the baby. Often, these moms will suffer with frequently engorged breasts that many times lead to bothersome leaking and plugged ducts and breast infections. Their babies may seem fussy a lot, many times exhibiting colic-like symptoms with excessive gas and spitting-up (and even vomiting). These same babies may also have consistently green, watery stools and gain more than the typical 1/2-1 ounce a day during the first 4 months. They also tend to nurse frequently from both breasts, sometimes as often as every hour. Some babies may clamp down on or fold over the nipple during feeding as a means to slow the flow of milk down, especially if mother also has a forceful letdown (see below). Often the nipple will be white at the end of the feeding and/or creased and feedings will probably be painful. The baby may periodically refuse to nurse due to his frustration at "keeping up with the milk".
The underlying cause of the baby's symptoms is a disproportionate intake of the low-fat foremilk, the milk that is made available to the baby early in the feeding. When a baby consumes large amounts of this watery foremilk and less of the fatty hindmilk, that is made available as the feeding progresses, his stomach empties rapidly while at the same time dumping excess lactose into the bowel. The result is many times like that of colic in the baby.
Usually these symptoms can be relieved for mother and baby by making a few changes in the nursing pattern. Start by making sure that you allow your baby to completely finish one side before you offer the other by waiting until he pulls off himself, goes to sleep, or ceases to actively suck and swallow. Don't feel that you have to interrupt his nursing on the first side after a certain amount of time. It is much more important that he get the right balance of milk during the feeding than that he nurse both sides. If after finishing the first side, he does not want the second side, don't worry. He probably does not need it. If you are uncomfortable, you can hand express or pump just enough to relieve any pressure.
If this change in pattern does not bring about improvement, then it is usually recommend that you limit the baby to one side for up to 2 -3 hours before nursing on the other side. Some mothers with especially over-abundant supplies may have to go even longer periods, nursing on only the same side. Again, if the unused breast becomes uncomfortable in the meantime, you can pump or hand express just enough to relieve the pressure. Nursing and pumping in this fashion will help to regulate your supply to more closely match your baby's needs within a few days and ensure that your baby gets the right balance of foremilk/hindmilk. If after several days of limiting your baby to one-sided nursing for a period of several hours, there is still no improvement, you may want to try using an antihistamine, drinking Sage tea, or applying cabbage leaves until you begin to see improvement. Stop with these more extreme measures once you notice improvement. Another last resort management suggestion is the use of a silicone nipple shield used during the feeding to help slow the flow of milk. Only use a nipple shield with the recommendation and observation of a lactation consultant.
Many times moms with overabundant milk supplies also experience forceful letdowns. Their babies may cough, gag, gulp, etc. in the first minute or so of the feeding as the initial letdown occurs. As mentioned in the first paragraph, they may also pull off the breast repeatedly and periodically refuse the breast. There may be some clamping down on the nipple as the baby tries to slow down the flow of milk. Some babies may try to perch out on the tip of the nipple rather than taking in a good mouthful of breast tissue so that the milk doesn't flow so fast. Both behaviors most likely will make feedings painful for mom. Babies who react in this way may take in more air and will need to be burped more often during the feeding. To help your baby deal with the fast flow of milk, position him so that his head is slightly above breast level. With a younger baby, the football hold works well in this situation. Sit so that you are leaning backwards slightly, such as you would while sitting in a recliner. This enables gravity to help slow things down. You may want to try lying down on your back and allowing baby to perch upon your chest as if he were nursing uphill or climbing up your chest. You also may either pump or hand express until the flow of milk slows down and then put your baby to the breast or you may wait until letdown occurs and then take your baby off the breast while at the same time catching the milk in a towel or diaper. Once the flow slows, you can put your baby back to the breast. In time, with maturity, your baby will learn to deal with the fast flow of milk with more ease and will probably prefer it!