January 20, 2020
It is possible for a mother to produce volumes of milk in excess of her infant’s needs1. A common cause is pumping after nursing, creating excessive demand for milk production. Some mothers do not excessively stimulate breastmilk production, and it is not well understood why their breasts don’t down-regulate to match their milk production with the infant’s demands.
Common infant symptoms include coughing and choking while nursing, especially with the first milk ejection, excessive weight gain, gas, frequent green explosive, watery stools, and/ or breast refusal.
Common maternal symptoms include breast fullness, frequent plugged ducts or recurrent mastitis, and sore nipples due to infant pinching to slow the flow.
Referring to a lactation specialist is a best strategy for management, as this process often must be individualized. Strategies for managing hyperlactation include:
- Nursing in a ‘laid back’ position so that the infant is level with the breast, allowing the infant to manage the flow
- Gradually wean from pumping in excess of infant’s needs.
- Block feeding- keeping infant on one breast for 3 hours at a time. This means that all feedings during that block of time, such as from noon to 3 pm, come from one breast. The mother then switches all feedings to the other breast from 3-6 pm, etc. If the side not nursed from becomes uncomfortably full, just a small amount of milk should be expressed for comfort. After 36-48 hours, the milk supply should down-regulate on both sides. At any time that the infant is no longer satisfied with just one breast, she should return to nursing her infant on both sides each feeding. This would signify that her oversupply has improved.
- Medication/supplement intervention-
- Pseudoephedrine2 has been shown to decrease milk production and prolactin Single 30-60mg doses, repeated daily just as needed until the desired effect is seen, can be recommended.
- Estrogen-containing birth control pill (if not contraindicated), taken once a day, will typically drop the supply3 by 5-7 days of use. It can be stopped at that time.
- Sage extract or sage tea, anecdotally, can also be very effective at decreasing the milk supply. It is used in a similar fashion to pseudoephedrine, 1 dose just as needed, usually not more than once a day.
- Eglash A. Treatment of Maternal Hypergalactia Breastfeeding Med 9(9) 2014
- Aljazaf K, Hale TW, Ilett KF, et al. Pseudoephedrine: Effects on milk production in women and estimation of infant exposure via breastmilk. Br J Clin Pharmacol 2003;56:18–24
- Lactmed National Institutes of Health Drug and Lactation Database https://www.ncbi.nlm.nih.gov/books/NBK501922/ (accessed 12/14/19)