When your baby first latches onto the breast, they do very rapid, or non-nutritive sucking to stimulate the release of your milk. Once that milk is released, they go into a slower, more rhythmic sucking pattern. This “releasing” of your milk is called the milk ejection reflex (MER), or let-down (“let-down”, interestingly enough is a dairy term for cows!). The MER tends to be quite forceful in the early weeks of lactation due to the fullness of the breasts. Over time, this forcefulness lessens, and is self-limiting. For some mothers (and babies!) a forceful MER tends to be a problem for weeks, sometimes a month or two. Babies of mothers with an over-active MER have a hard time keeping up with the flow. They come off frequently, coughing, choking, and spit up a lot. With the fast flow of a forceful MER, the babies get a lot of the foremilk very quickly, and not as much hind milk. The foremilk is high in lactose, hind milk higher in fat. This creates a foremilk/hind milk imbalance. The lactose dumps through the baby’s bowel very quickly, and this makes them gassy and cranky, especially in the evening hours. They may have green explosive stools, have a lot of spit-up, and pass a lot of gas. Some babies struggle so hard to keep up with the flow that they actually may develop an aversive behavior to breastfeeding, and refuse the breast. Some mothers think this is colic, or reflux. Talk to your lactation consultant or pediatrician to help you determine if over-active MER is your issue.
The solution is quite simple. One breast per feeding. If your baby comes off the first breast and it is within the first hour, offer the first breast again. After the first hour, if they are still hungry, they can go to the second breast. Managing the forceful MER in this way enables your baby to get more of the hind milk to offset the large amount of foremilk that they got in the beginning of the feeding. If the second breast is uncomfortably full, pump only to relieve the pressure and only if needed for your comfort, so as not to overstimulate this side. As stated above for fine-tuning of this plan, or to discuss your particular scenario, consult a lactation consultant or your pediatrician for further assistance.