	Further comments on Oversupply Syndrome AKA Foremilk - Hindmilk Imbalance
Marie Davis RN IBCLC	UNDER CONSTRUCTION A Work in Progress Not proof read--not spell checked! Tuesday, November 9, 2010 10:42 PM
I have added this page to my site to further explain the issues, share what I have learned from following literally thousands of mother-baby pairs over the past 25 plus years and my “professional opinion” about the whys and wherefores of Oversupply, for the interested mother and professional alike. Introduction I spoke on this topic in July 2008 at the International Lactation Consultant Association’s conference. My lecture was entitled “Dealing with Overactive Let-Down.” About 12 hours before my presentation, much to my dismay, I became aware another LC was scheduled to speak on Foremilk - Hindmilk Imbalance on the same day. My own poor choice of an initial title contributed to the confusion. Unfortunately, once the title was submitted, it was written in stone. On the other hand, the conference committee failed to realize that the two lectures were actually one in the same topic. The oversight further confirms that the multiple labels on this group of symptoms confuse lactation professionals and breastfeeding women alike. Andrusiak (et al) state, "Like the proverbial blind men who were describing an elephant by describing its different parts, this condition may be described differently depending upon perspective." No one has a clear image of the whole and each has an opinion as to what it could be. They continue, "Nevertheless, adding the parts together may result in information that has proven helpful to mothers and babies experiencing the symptoms of an overabundant milk supply and a forceful let-down reflex." We are desperately in need of consistent terminology, a clear delineation of its symptoms and their possible causes. Then, and only then, can we arrive at proper treatment recommendations. *Until we name the thing,* we cannot study the thing, and most certainly, we cannot treat the thing. We are pompous, beyond belief, if we think anything different. I am past the point of frustration with some of my LC sisters. This group of symptoms is over-simplified, downplayed, misattributed, and/or flat out denied into nonexistence. As a result, a large numbers of women and infants receive little or no help beyond feed management techniques from their LC’s. Physicians may not know that the cluster symptoms might be breastfeeding related (physicians actually receive very little if any breastfeeding education), quite another to be blind to the problems as a professional Lactation Consultant (LC). It is the lack of recognition and care that sends a desperate woman to the Internet for help. She will self-diagnose and treat the problems herself, based on what she has learned from multiple sources. In this case, "a little learning IS a dangerous thing,"** but when your baby is screaming nonstop, every feeding is a battle, and feeding just makes things worse,she will try just about anything, even if it sounds absurd. There is an inherent danger in the Internet because not everything posted is factual, or logical with much of it based on a study of one. Self-diagnosis and treatment is also fraught with danger. In my opinion, information on most breastfeeding and parenting sites leave much to be desired when it comes to this problem. Many methods to "control" the symptoms defy common sense. Some suggested treatments have the potential for maternal milk reduction, breast infection, weight loss in the baby, early weaning, and more. I am extremely concerned because “treatments” fall back on old wives tales and reveal how lactation physiology (how the breast makes milk) is still misunderstood. This attitude of "one size fits all" (same problem equals same treatment) is merely a portion of the malignancy eating away at all allopathic medicine, and its many branches, today. I see it everywhere. Medicine is guilty of treating patients using preconceived ideas of what and how the patient is feeling. They make a diagnosis (sometimes even before they see the patient) because it is the 10th time they have seen the same symptoms this week. Or the patient is sliced up and the provided lookes at only their particular "area" of expertise. Things get missed for lack of the whole. I clearly remember a story of a woman who kept coming back to the emergency room during a flu epidemic with a fever and generalized aches, back and forth she came 3 days in a row. Each time she sent home with over the counter medications. On her last visit, a resident was assigned to this "troublesome" old woman. The resident went to her room and told the woman to undress completely. When he came in she still had her socks on. When he asked her to remove them she said, "But Doctor, my feet are so cold." to which he replied, "Madam, I need to look at ALL of you, I promise they will only be off a moment." The old woman dutifully removed her socks. Finally, the source of her troubles were revealed. She had scratch on her foot that looked severely infected, possibly gangrenous. "Why didn't you mentioned this earlier?" the doctor asked. "It's just a little scratch," she replied, "and no one asked about my feet." Blood work showed she was septic (had bacteria in her blood stream). She lost her leg but not her life. So how does this relate to oversupply syndrome? A thorough history first, then diagnosis, then treatment. As practitioners we must look at the whole patient. In cases of lactation difficulty, we must look at BOTH mother and child. Separate individuals, with separate histories. However, during lactation they function as a single unit. One cannot "slice up" a mother and see only her breast. Nor can we take the baby's mouth away from the rest of his body. We cannot look at one's set of symptoms without seeing the other's. There are just too many things that can cause the same symptoms in mom and baby, from "allergy” - to illness - to inborn errors in metabolism. We know that "weird looking," bright green, stools are a sign that baby's digestive system is irritated. However, sometimes green stool, is just green stool. . . What Is Over Supply Syndrome? Oversupply Syndrome is most often called "Foremilk - Hindmilk imbalance." This is where I depart from my sister LC's. I believe that "Foremilk - Hindmilk Imbalance" is a misnomer. Taken literally, that particular terminology gives a false impression of how the breast works. In actuality, there is never a point where breastmilk is all foremilk, or all hindmilk—milk is always mixed together inside the breast. By definition, a "let-down" means hindmilk is being produced and is present in the milk. Few women know that hindmilk is only a small fraction of breastmilk. Foremilk contains more nutrients,vitamins and antibodies and represents the largest proportion of infant intake. I am often asked, "how long does it take to get to the good milk?" Proving that many women now believe foremilk is "bad" milk and hindmilk is "good" milk. Calling the cluster of symptoms an “imbalance,” like many breastfeeding issues, blames the mother for the "problem." (Why are we so quick to accept the premise that women are unable to make the “right milk” for their infants?) Why have I chosen to call these symptoms "Oversupply Syndrome" over the objections od my peers? Foremilk- hindmilk imbalance* represents only the baby's symptoms, targets only a supposedly seperate portion of mother's milk, and further targets only one element in mother's milk, lactose. So the treatments are limiited. According to my dictionary a syn-drome (noun) -- a group of symptoms that consistently occur together or a condition characterized by a set of associated symptoms (dictionary). Oversupply manifests in a definite group of characteristic symptoms, that effect both mother and baby. Mom has an ample milk supply, the infant is gaining weight quickly, there are difficulties with breast feedings, baby is uncomfortable most of the day, See for a list of symptoms After reading about the symptoms of oversupply from my web site, mom’s often write to me asking for information on how to go about treating the symptoms. Treatment suggestions for “Foremik-Hindilk Imbalance” can be found almost everywhere on the Internet, but is deliberately left off my web site. In our clinic we've seen the various treatments backfire, and babies lose weight in a very short time or mom's milk supply is negatively impacted. I firmly believe that It is UNWISE to attempt treatment on your own. I prefer to evaluate your situation first, target symptoms, their possible causes, and then send personalized treatment information. Please request, fill out and return the assessment form.. Some common suggestions and why they may backfire First and foremost -- These babies almost always have major weight gain in the first 3 months -- normally seen, in these babies, is one pound (or more) weight gain per week. If the baby isn't gaining a lot of weight, oversupply isn't the entire problem. Pumping some milk off at the beginning of a feeding, will appear to help symptoms at first, but in the long run, it aggravates the problem by driving the overall milk supply higher. The early aggressive use of a breast pump to increase milk supply so mom has a freezer stash for when she returns to work leads to oversupply. In some mothers. if we calculate the number of ounces her baby needs and the amount she pumps each day, the total equals double or triple the amount her baby actually needs. Putting a baby on "one breast per feeding" or making recommendations for increasing the duration on "one breast," without treating other problems and/or taking precautions to prevent potential complications, is unwise. For instance, did you know that going longer than 6 hours on one breast is not "physiologically sound," and can cause a mother to lose an ample milk supply? Repeated engorgement will lead to plugged ducts and mastitis (breast infection). Un-removed milk produces an enzyme that causes the breast to regress, further reducing mother’s milk supply. Maternal Diet changes There is a strong cultural bias that maternal diet causes colic in her baby. Women needlessly start (or are put on) restricting elimination diets, before other causes have been thoroughly explored, while the baby's symptoms continue or worsen. Complete Drainage of the Breasts Initial oversupply with onset of mature milk production causes some babies to be fussy during the first week. One study talked about complete drainage of the breasts as a treatment for too much milk, In van Veldhuizen-Staas's report, of the 4 cases presented, only one (case 4) was not during the first 2 weeks post-partum when we expect oversupply as a normal part of Lactogenesis stage II Case 1 nine days old Case 2 eight days old Case 3 four days's old Case 4 two months old With severe engorgement present and flowing milk a complete pump-out is something many of us began recommending to prevent a feedback response, (which could severely hamper a mother's milk supply further down the line) during the period when her breasts are laying down prolactin receptors,. But to accept this as a general recommendation for treatment is not acceptable. It is not simply a matter of changing the way your baby is feeding, or managing feedings differently. The entire cluster of symptoms needs to be treated, as a whole, by looking at the individual symptoms and their possible causes. Only then, should recommendations regarding how to proceed be made. Whatever the cause(s) both mother and baby need assistance dealing with the symptoms. If you are a mother or interested lay person please see: Oversupply Syndrome and Colic -- a list of symptoms for moms and babies For professionals see: Lactation Clinic Protocol ~~If you are having difficulty or need more information, please remember, you can contact me anytime at: marie@lactationconsultant.info Marie Davis RN IBCLC ~~~ 1. Andrusiak Frances Michelle Larose Kuzenko, Patricia J. Martens, Linda Romphf, Sandra Yates. THE EFFECTS OF AN OVERABUNDANT MILK SUPPLY AND A FORCEFUL LET-DOWN REFLEX. (Unpublished) 2003
© Marie Davis, RN, IBCLC Index/Home The First 4 Weeks: Baby Questions After The First 4 Weeks Family Issues Breastmilk Expression Storage of EMM (Expressed Mother's Milk) Working And Breastfeeding Other Issues About Me Glossary Works Cited Last Reviewed: Saturday, February 11, 2012 11:14 AM © Marie Davis, RN, IBCLC The First 4 Weeks: Baby Questions After The First 4 Weeks Family Issues Breastmilk Expression Storage of EMM (Expressed Mother's Milk) Working And Breastfeeding Other Issues Index/Home About Me Oversupply Syndrome Colic Symptoms Oversupply colic Oversupply protocol for medical and lactation professionals Two Kinds of Milk? Not really...

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Further comments
on Oversupply Syndrome
AKA
Foremilk - Hindmilk Imbalance

Marie Davis RN IBCLC

UNDER CONSTRUCTION

A Work in Progress

Not proof read--not spell checked!

Tuesday, November 9, 2010 10:42 PM

I have added this page to my site to further explain the issues, share what I have learned from following literally thousands of mother-baby pairs over the past 25 plus years and my “professional opinion” about the whys and wherefores of Oversupply, for the interested mother and professional alike.

Introduction

I spoke on this topic in July 2008 at the International Lactation Consultant Association’s conference. My lecture was entitled “Dealing with Overactive Let-Down.” About 12 hours before my presentation, much to my dismay, I became aware another LC was scheduled to speak on Foremilk - Hindmilk Imbalance on the same day. My own poor choice of an initial title contributed to the confusion. Unfortunately, once the title was submitted, it was written in stone. On the other hand, the conference committee failed to realize that the two lectures were actually one in the same topic. The oversight further confirms that the multiple labels on this group of symptoms confuse lactation professionals and breastfeeding women alike.

Andrusiak (et al) state, "Like the proverbial blind men who were describing an elephant by describing its different parts, this condition may be described differently depending upon perspective." No one has a clear image of the whole and each has an opinion as to what it could be. They continue, "Nevertheless, adding the parts together may result in information that has proven helpful to mothers and babies experiencing the symptoms of an overabundant milk supply and a forceful let-down reflex."

We are desperately in need of consistent terminology, a clear delineation of its symptoms and their possible causes. Then, and only then, can we arrive at proper treatment recommendations. Until we name the thing, we cannot study the thing, and most certainly, we cannot treat the thing. We are pompous, beyond belief, if we think anything different.

I am past the point of frustration with some of my LC sisters. This group of symptoms is over-simplified, downplayed, misattributed, and/or flat out denied into nonexistence. As a result, a large numbers of women and infants receive little or no help beyond feed management techniques from their LC’s. Physicians may not know that the cluster symptoms might be breastfeeding related (physicians actually receive very little if any breastfeeding education), quite another to be blind to the problems as a professional Lactation Consultant (LC).

It is the lack of recognition and care that sends a desperate woman to the Internet for help. She will self-diagnose and treat the problems herself, based on what she has learned from multiple sources. In this case, "a little learning IS a dangerous thing," but when your baby is screaming nonstop, every feeding is a battle, and feeding just makes things worse,she will try just about anything, even if it sounds absurd. There is an inherent danger in the Internet because not everything posted is factual, or logical with much of it based on a study of one. Self-diagnosis and treatment is also fraught with danger. In my opinion, information on most breastfeeding and parenting sites leave much to be desired when it comes to this problem. Many methods to "control" the symptoms defy common sense. Some suggested treatments have the potential for maternal milk reduction, breast infection, weight loss in the baby, early weaning, and more. I am extremely concerned because “treatments” fall back on old wives tales and reveal how lactation physiology (how the breast makes milk) is still misunderstood.

This attitude of "one size fits all" (same problem equals same treatment) is merely a portion of the malignancy eating away at all allopathic medicine, and its many branches, today. I see it everywhere. Medicine is guilty of treating patients using preconceived ideas of what and how the patient is feeling. They make a diagnosis (sometimes even before they see the patient) because it is the 10th time they have seen the same symptoms this week. Or the patient is sliced up and the provided lookes at only their particular "area" of expertise. Things get missed for lack of the whole.

I clearly remember a story of a woman who kept coming back to the emergency room during a flu epidemic with a fever and generalized aches, back and forth she came 3 days in a row. Each time she sent home with over the counter medications. On her last visit, a resident was assigned to this "troublesome" old woman. The resident went to her room and told the woman to undress completely. When he came in she still had her socks on. When he asked her to remove them she said, "But Doctor, my feet are so cold." to which he replied, "Madam, I need to look at ALL of you, I promise they will only be off a moment." The old woman dutifully removed her socks. Finally, the source of her troubles were revealed. She had scratch on her foot that looked severely infected, possibly gangrenous. "Why didn't you mentioned this earlier?" the doctor asked. "It's just a little scratch," she replied, "and no one asked about my feet." Blood work showed she was septic (had bacteria in her blood stream). She lost her leg but not her life.

So how does this relate to oversupply syndrome? A thorough history first, then diagnosis, then treatment. As practitioners we must look at the whole patient. In cases of lactation difficulty, we must look at BOTH mother and child. Separate individuals, with separate histories. However, during lactation they function as a single unit. One cannot "slice up" a mother and see only her breast. Nor can we take the baby's mouth away from the rest of his body. We cannot look at one's set of symptoms without seeing the other's.

There are just too many things that can cause the same symptoms in mom and baby, from "allergy” - to illness - to inborn errors in metabolism. We know that "weird looking," bright green, stools are a sign that baby's digestive system is irritated. However, sometimes green stool, is just green stool. . .

What Is Over Supply Syndrome?

Oversupply Syndrome is most often called "Foremilk - Hindmilk imbalance." This is where I depart from my sister LC's. I believe that "Foremilk - Hindmilk Imbalance" is a misnomer. Taken literally, that particular terminology gives a false impression of how the breast works. In actuality, there is never a point where breastmilk is all foremilk, or all hindmilk—milk is always mixed together inside the breast. By definition, a "let-down" means hindmilk is being produced and is present in the milk. Few women know that hindmilk is only a small fraction of breastmilk. Foremilk contains more nutrients,vitamins and antibodies and represents the largest proportion of infant intake. I am often asked, "how long does it take to get to the good milk?" Proving that many women now believe foremilk is "bad" milk and hindmilk is "good" milk.

Calling the cluster of symptoms an “imbalance,” like many breastfeeding issues, blames the mother for the "problem." (Why are we so quick to accept the premise that women are unable to make the “right milk” for their infants?)

Why have I chosen to call these symptoms "Oversupply Syndrome*" over the objections od my peers? Foremilk- hindmilk imbalance represents only the baby's symptoms, targets only a supposedly seperate portion of mother's milk, and further targets only one element in mother's milk, lactose. So the treatments are limiited. According to my dictionary a syn-drome (noun) -- a group of symptoms that consistently occur together or a condition characterized by a set of associated symptoms (dictionary).

Oversupply manifests in a definite group of characteristic symptoms, that effect both mother and baby. Mom has an ample milk supply, the infant is gaining weight quickly, there are difficulties with breast feedings, baby is uncomfortable most of the day, See for a list of symptoms

After reading about the symptoms of oversupply from my web site, mom’s often write to me asking for information on how to go about treating the symptoms. Treatment suggestions for “Foremik-Hindilk Imbalance” can be found almost everywhere on the Internet, but is deliberately left off my web site. In our clinic we've seen the various treatments backfire, and babies lose weight in a very short time or mom's milk supply is negatively impacted. I firmly believe that It is UNWISE to attempt treatment on your own. I prefer to evaluate your situation first, target symptoms, their possible causes, and then send personalized treatment information. Please request, fill out and return the assessment form..

Some common suggestions and why they may backfire

First and foremost -- These babies almost always have major weight gain in the first 3 months -- normally seen, in these babies, is one pound (or more) weight gain per week. If the baby isn't gaining a lot of weight, oversupply isn't the entire problem.

Pumping some milk off at the beginning of a feeding, will appear to help symptoms at first, but in the long run, it aggravates the problem by driving the overall milk supply higher.

The early aggressive use of a breast pump to increase milk supply so mom has a freezer stash for when she returns to work leads to oversupply. In some mothers. if we calculate the number of ounces her baby needs and the amount she pumps each day, the total equals double or triple the amount her baby actually needs.

Putting a baby on "one breast per feeding" or making recommendations for increasing the duration on "one breast," without treating other problems and/or taking precautions to prevent potential complications, is unwise. For instance, did you know that going longer than 6 hours on one breast is not "physiologically sound," and can cause a mother to lose an ample milk supply? Repeated engorgement will lead to plugged ducts and mastitis (breast infection). Un-removed milk produces an enzyme that causes the breast to regress, further reducing mother’s milk supply.

Maternal Diet changes There is a strong cultural bias that maternal diet causes colic in her baby. Women needlessly start (or are put on) restricting elimination diets, before other causes have been thoroughly explored, while the baby's symptoms continue or worsen.

Complete Drainage of the Breasts

Initial oversupply with onset of mature milk production causes some babies to be fussy during the first week. One study talked about complete drainage of the breasts as a treatment for too much milk, In van Veldhuizen-Staas's report, of the 4 cases presented, only one (case 4) was not during the first 2 weeks post-partum when we expect oversupply as a normal part of Lactogenesis stage II

Case 1 nine days old
Case 2 eight days old
Case 3 four days's old
Case 4 two months old

With severe engorgement present and flowing milk a complete pump-out is something many of us began recommending to prevent a feedback response, (which could severely hamper a mother's milk supply further down the line) during the period when her breasts are laying down prolactin receptors,. But to accept this as a general recommendation for treatment is not acceptable.

It is not simply a matter of changing the way your baby is feeding, or managing feedings differently. The entire cluster of symptoms needs to be treated, as a whole, by looking at the individual symptoms and their possible causes. Only then, should recommendations regarding how to proceed be made.

Whatever the cause(s) both mother and baby need assistance dealing with the symptoms.

If you are a mother or interested lay person please see: Oversupply Syndrome and Colic -- a list of symptoms for moms and babies

For professionals see: Lactation Clinic Protocol

~~If you are having difficulty or need more information, please remember, you can contact me anytime at: marie@lactationconsultant.info

Marie Davis RN IBCLC

~~~

1. Andrusiak Frances Michelle Larose Kuzenko, Patricia J. Martens, Linda Romphf, Sandra Yates. THE EFFECTS OF AN OVERABUNDANT MILK SUPPLY AND A FORCEFUL LET-DOWN REFLEX. (Unpublished) 2003