CLINICAL PRACTICE GUIDELINE
Breastfeeding Challenges
- Oversupply SCOPE (Area): Maternity Unit, Emergency Department, Paediatrics
SCOPE (Staff): Medical, Midwifery & Nursing
DESIRED OUTCOME/OBJECTIVE
To provide effective treatment and prevent further complications from oversupply of breast milk –
blocked ducts, full breasts and engorgement – during lactation.
DEFINITIONS
Full breasts: common and considered normal when the milk supply first establishes between day
three and seven postpartum. Mothers should be reassured that the breasts will settle down in a few
days time.
Oversupply: at the onset of lactation, supply commonly exceeds demand but usually soon adjusts.
Some mothers may continue to over-produce and are uncomfortable.
Blocked ducts: presents as a breast lump which may be a tender and sometimes reddened area. If
the blockage causes milk to build up behind the blockage, causing inflammation of the surrounding
breast tissues, breast inflammation may worsen and flu-like symptoms may occur.
Engorgement: The breast is overfilled with both milk and tissue fluid. Venous and lymphatic
drainage are obstructed, milk flow is hindered, and the pressure in the milk ducts and alveoli rises.
The breasts become swollen and oedematous. This may occur when a baby does not sufficiently
drain the breast or have unrestricted feeding. Breasts are hard, distended and painful, the skin is
stretched and shiny and superficial blood vessels clearly distended. The ‘letdown’ reflex may also
be inhibited.
ISSUES TO CONSIDER
Causes
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Poor breast drainage
→ Poor attachment
→ Sleepy baby
→ Use of nipple shields
Delayed or missed feeds
Constricting clothing
Pressure in one area – holding breast too tightly during feeds, particularly if the mother is
holding the breast away from the baby’s nose.
White spot on nipple causing occlusion.
CPG/B028: Breastfeeding Challenges – Oversupply (2009)
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Prevention of oversupply problems
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Unrestricted breastfeeding from birth – 8-12 times in 24 hours.
Optimise breastfeeding technique – correct positioning and attachment and good sucking
action. Seek advice from an experienced midwife or lactation consultant if there are any
concerns with breastfeeding.
Avoid constrictive clothing and bras. However, some women will need the support of a bra,
ensure that it is not to tight, suggest a singlet or loose crop top as an alternative.
Remove the bra completely during feeds – this will assist in adequate breast drainage by
relieving any restriction.
Avoid long intervals between feeds
Encourage baby to drain the first breast completely before offering the second. Alternate
which breast a feed is started on.
Avoid dummies and complementary feeds.
Eat a well-balanced diet – drink plenty of fluids, and ensure adequate rest.
Good hand hygiene.
Differentiating between full breasts and engorgement
Full Breasts
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Breast(s) feels hot, heavy and hard
No shininess, oedema or redness
Milk usually flows well
Easy for infant to suckle and remove milk
Engorgement
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Enlarged, swollen and painful breast(s)
May be shiny and oedematous with
diffuse red areas
Nipple may be stretched flat
Milk often does not flow easily
May be difficult to attach the infant as
the nipple is often flattened.
PROCEDURE
Management of Blocked Ducts
Women should be advised to check breasts often to identify any blocked ducts and to begin
treatment as soon as any blockage is noticed. Management should follow the principles of
prevention as outlined above. Additionally, women should be advised to:
ƒ Empty the affected breast by feeding frequently or expressing.
ƒ Apply warmth to the affected area before and during feeds.
ƒ Gently massage the affected area towards the nipple during feeds, and whilst showering or
bathing.
ƒ Alternate feeding positions. If able, point the baby’s chin towards the blockage, this may help
relieve the blockage.
ƒ Administer analgesia for comfort if required. Consider paracetamol and an anti-inflammatory
(eg. ibuprofen).
ƒ Request review of blocked duct by a lactation consultant. Observe a full feed – ensure breast
is draining and milk transfer is occurring.
ƒ Seek medical advice if the blockage has not begun to clear in 8-12 hours or if flu-like
symptoms appear.
CPG/B028: Breastfeeding Challenges – Oversupply (2009)
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Management of Full Breasts / Oversupply
Management of uncomplicated breast fullness or oversupply should follow the principles of
prevention as outlined above. Additionally, women should be advised to:
ƒ Express a small amount before feeds to soften the areola ONLY if they are unable to latch
baby to the breast.
ƒ Continue to demand feed, imposing no restrictions on length of time at the breast. Ensure that
adequate drainage of breast is occurring each feed.
ƒ Alternate feeding positions.
ƒ Only offer the second breast to the baby if the first breast has been well drained.
ƒ Gently express enough milk to ease the pain only if the second breast remains uncomfortably
full.
ƒ Apply warmth to breasts prior to feeding to assist with flow and cold after feeding to provide
relief.
ƒ Check breasts after feeding to ensure no lumps are present. If there are lumps then advise the
woman to follow the blocked duct management.
Management of Engorgement
If breast fullness is not managed properly and the breasts are not effectively drained, engorgement
may result. Management of engorgement should include all of the measures outlined under
prevention of oversupply problems. Additionally, women should be advised to:
ƒ Express a small amount before feeds to soften the areola
ƒ Continue to demand feed, imposing no restrictions on length of time at the breast.
ƒ Alternate feeding positions.
ƒ Apply warmth to breasts prior to feeding to assist with flow and cold after feeding to provide
relief.
ƒ Complete the Full Breast Regime
1. Feed the baby on one side only
→ Express the same side by hand or pump until the breast is drained.
→ Express the second side for comfort if needed – express only enough milk to ease
the pain.
→ Any milk expressed can be kept and given to the baby as a top-up.
→ Breasts should only be expressed once in a 24 hour period.
2. Next feed, repeat step 1 on the opposite side.
3. Continue to feed one side only at each feed, utilising the other measures listed until the
supply settles down.
→ Do not express again unless advised to do so by a lactation consultant.
4. Once the fullness/engorgement has settled down advise the mother to start offering both
sides again, allowing the baby to determine length of feeds.
ƒ Educate mother about signs and symptoms of mastitis and advise them to seek early
treatment if suspected.
CPG/B028: Breastfeeding Challenges – Oversupply (2009)
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RELATED DOCUMENTS
Internal
CPG/B029 Breastfeeding the Healthy Term Newborn
CPG/B026 Breastfeeding Challenges: Mastitis & Breast Abscess
CPG/E017 Expressed Breast Milk: Methods of Expressing
REFERENCES
Daly, S.E.J., Owens, R.A. & Hartmann, P.E. (1993). The short-term synthesis and infant-regulated
removal of milk in lactating women. Experimental Physiology, 78: pp. 209-220.
Glover R. (1998).The engorgement enigma. Breastfeeding Review, 6(2): pp. 31-34.
King Edward Memorial Hospital. (2005). Clinical guidelines Section B: 8.6 Breastfeeding
challenges: 8.6.4 Engorgement / Full lumpy breasts. Accessed 21 October, 2008, from:
http://www.kemh.health.wa.gov.au/development/manuals/sectionb/8/5105.pdf
King Edward Memorial Hospital. (2005). Clinical guidelines Section B: 8.6 Breastfeeding
challenges: 8.6.5 Blocked Ducts. Accessed 21 October, 2008, from:
http://www.kemh.health.wa.gov.au/development/manuals/sectionb/8/5106.pdf
King Edward Memorial Hospital. (2005). Clinical guidelines Section B: 8.6 Breastfeeding
challenges: 8.6.6 Oversupply. Accessed 21 October, 2008, from:
http://www.kemh.health.wa.gov.au/development/manuals/sectionb/8/5107.pdf
Royal Women’s Hospital. (2004). Breastfeeding: Best practice guidelines. Accessed 20 October,
2008, from:
http://www.thewomens.org.au/uploads/downloads/HealthProfessionals/CPGs/Breastfeeding_Guidelines_2004.pdf
Hopkinson, J. & Schanler, R.J. (2005). Up-to-date: Common problems of breastfeeding in the
postpartum period. Accessed 21 October, 2008, from:
http://utdol.com/online/content/topic.do?topicKey=neonatol/21625&view=print
World Health Organisation. (2000). Mastitis: causes and management. Accessed 21 October, 2008,
from : http://whqlibdoc.who.int/hq/2000/WHO_FCH_CAH_00.13.pdf
Reg. Authority: CEO, Executive Directors – Nursing, Medical, Allied
Health & Psychiatric Services. Clinical Director – Women & Children’s
Health, Service Director – Women & Children’s Health
Review Responsibility: Maternity Unit
Original Author: ---Updated by: BFHI Working Party (2009)
CPG/B028: Breastfeeding Challenges – Oversupply (2009)
Date Effective: April 2009
Date Revised:
Date for Review: April 2012
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