Some moms have a super-fast letdown which makes their babies cough, sputter, unlatch, or even cry at the beginning of a feeding. This is called overactive letdown, or overactive milk ejection reflex (OAMER). Specifically, this is referring to how fast the milk comes out, not an over-supply of milk; that is a different issue to cover in a different blog. Thankfully, a fast letdown is usually a temporary problem, lasting about 6 weeks. If you and your baby have this struggle, you can try some of the strategies below.
There are three breastfeeding positions to try that may help your baby manage a fast flow.
Try breastfeeding in a super-reclined position—like in a reclining chair—with your baby laying on his belly on top of you to nurse. In this position, your milk has to flow (squirt!) “up-hill” against gravity, which may be easier for your baby.
You can try sitting up and letting your baby sit on your lap, facing your breast to nurse. This position may help your baby suck and swallow without having milk squirt up her nose.
You might try lying on your side, with your baby lying on his side facing you. Keep a burp cloth under your breast to catch milk, and allow your baby to pull off when necessary.
A different way to manage a fast flow is to let your baby avoid the first, strongest let-down. When your letdown begins, unlatch your baby. You can catch this first letdown in a cup or bottle to save for later, or in a burp cloth. When it stops flowing, re-latch your baby. If your baby doesn’t like waiting, you can try hand expressing or pumping off the first letdown, and then offer your breast.
Did you know you can use your hand to slow your milk flow? This works by applying pressure over some of your milk ducts, limiting the number of milk ducts that flow at one time. You will want to use your fingers (or the side of your hand) to apply pressure where your areola meets the skin, without disrupting the latch of course. You can try applying pressure on one side of your areola, or use your fingers in a scissor hold to apply pressure on both sides. Hold pressure for a few seconds, and then rotate where you are applying pressure so all of your ducts have a chance to empty.
If these ideas don’t work, a nipple shield can be a temporary tool. Nipple shields have a limited number of holes on the tip, so it will automatically slow a fast flow. Just use a shield during the first one or two letdowns, and then remove it to finish the feeding. You will want to have a burp cloth close by, because while a shield will slow the flow, the back flow may get messy.
Let your baby try taking the first letdown on occasion. Your milk supply will usually down-regulate during the first 6 weeks. At the same time, your baby is becoming a more effective feeder. Eventually, most babies can manage a fast flow!