Many nursing moms would consider having too much breast milk a good problem to have—but in reality, it can be uncomfortable for you and baby. And in rare situations, it may also be dangerous. One mom in 2017 posted in the Facebook group Breastfeeding Mama Talk about her experience calling 911 because her baby was choking on her milk.
"He turned blue and I really thought I was going to lose him," Rebecca Taylor wrote. "Apparently this 'freak' accident can actually happen to babies and it's more common than I thought. Especially when you have an overactive letdown and produce too much milk (something some people wish for)."
Luckily her baby was OK, but her story brings to light a breastfeeding issue you might not be aware of: overactive, or forceful, letdown.
"After 25 years of working with babies, I've seen that many babies whose mothers have a lot of milk do tend to 'choke' on it," says lactation consultant Sara-Chana Silverstein, IBCLC. "Some women have what is called a fast MER or Milk Ejection Reflex, which means that the milk releases from their body in a very forceful manner, or 'explodes' out of the ducts."
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Letdown is simply the release of milk from the breast. It's a reflex that happens when nerves in your breasts are stimulated (usually by your baby's sucking) and signal the release of oxytocin, a hormone that prompts tiny muscles around your milk-producing cells to contract, squeezing milk into the ducts. How long it takes can vary from woman to woman or even from feeding to feeding, but it's usually anywhere from a few seconds to a few minutes.
The letdown reflex ensures that your baby gets enough milk. It's a pretty powerful thing, and can be triggered not just by your baby's sucking, but also by sexual contact and even psychological factors. For example, once you've been breastfeeding for a while, you may find that the sound of your baby's cries (or any baby crying) can get your milk flowing.
Most moms describe letdown as a tingly, pins-and-needles sensation in their chest, which can happen right after birth or even several weeks into breastfeeding. The tickly feeling is actually milk making its way through the ducts to your nipples. Letdown usually occurs in both breasts at the same time, so it's perfectly normal to drip from one breast while your baby feeds from the other (you can use nursing pads to catch the leakage).
If your baby is choking, gagging, or gasping at the start of the feed, or if he clamps down on the nipple or keeps pulling off, it may well mean he is getting too much milk too fast. Here's how to manage a forceful letdown:
A forceful letdown often comes with an oversupply of breast milk, so the way to deal with the problem is to reduce the amount you're making. Silverstein has a strategy she recommends for getting it under control.
"When the mother is breastfeeding from one side, say the right side, she takes the palm of her left hand, presses the nipple on her left side in toward her ribs and counts to five," she says. Applying this counter-pressure several times per feeding sends a signal not to let milk down in that breast.
"In my experience, I have found that using one breast exclusively per feed is the best method," Silverstein says. This ensures the breast fully empties, flow slows down and baby gets all of the higher fat "hindmilk," which helps him feel full and stop nursing. A strategy called "block feeding" suggests to use only one breast for a block of time (at least a few hours) in order to reduce supply in the other breast before switching for the next block.
"Babies who choke often do not have a deep enough latch, which is why they choke," Silverstein says. "The milk is supposed to go straight down into their throats, and with a shallow latch too much milk remains in their mouth." If the baby is latched deeply, he can better learn to handle the flow.
Placing the baby at a more upright angle makes gravity work against the milk's flow. Laid-back nursing, with baby on top of a reclining mom, can slow things down, too. Side-lying nursing can help extra milk spill out of baby's mouth to prevent choking. In any position, when you feel letdown coming on, you can pull baby off (have a towel ready) and then put her back on when flow slows a bit.
Enlist an international board-certified lactation consultant (IBCLC) to guide you in managing all of these strategies, which can help baby be more comfortable at the breast.
"I have seen slowing down the milk makes babies much less gassy and colicky," Silverstein says. And if your baby is dealing with this issue, don't freak. "I have been around hundreds of babies who were choking on their mom's milk," Silverstein says. "After seeing 18,000 babies in my office, we have never had to send a baby to the hospital."