Please help: Oversupply? Constant green poos

[Toomuchmilk]

I'm a first time mum to a newborn baby girl who is now 5 days old and only breastfeeds. I'm concerned I have oversupply but I've never breastfed before and also she is so young!

She passes loose light greeny yellow stool more times than I can count, literally half a dozen or more times in the space of an hour when I repeatedly change her nappy around / between feeds to settle. As soon as she is changed I hear her poo again, and again after 10 minutes. And again during her change, often twice. Also during her feeds. Some are small or just watery light green stains but many are quite large volume (at least, I think). The poo doesn't smell milky, it's not nice and almost reminds me of citrus. It's not frothy though.

For several days she has had a really sore rash around her anus, not on the rest of her buttocks, and no spots. It's getting worse even after lots of airing time and using treatment metanium cream consistently.

When she feeds my other breast drips. Sometimes (but not too often) she coughs or even vomits on the breast during a feed. I haven't seen milk actually squirting though. Occasionally it overflows her mouth but not most of the time. She gulps at rocket speed and you can hear the milk loudly gurgling down her. She doesn't seem distressed during feeds though. She doesn't tend to push the nipple out, and will fall asleep by the end of the feed. My let down is quite painful, I'm sure it isn't the latch - the midwife said it was perfect and my nipples aren't sore. Also the rest of the feed is very comfortable for me.

She frequently has a large posset right after feeding. She burps and hiccups a lot.

There are times when she wants to feed and feed repeatedly: on the breast she falls asleep happily but then when I take her off to sleep she will cry before rooting and feeding all over again. She might do this 4-8 times in a row. These feeds are often short, only 10 minutes, but the total "session" can last many hours of on /off feeding and nappy changes. Though there have also been periods of time when she just feeds once for half an hour and has then been satisfied and sleeps for 3 hours. Just normal cluster feeding maybe?

No matter how long or often she feeds my breast is never empty. I can always give the nipple a light squeeze after she has come off and more milk will come out easily. I haven't done any expressing more than a tiny bit of massage where I am getting sore lumps in my breasts. I did hand express in pregnancy and produced copious watery milk almost like I was already lactating.

I do try to offer her the same breast again and again until she properly falls asleep and then the next time she wakes I try the other breast. The exception is if a session is going on for ages and she seems to want to switch (by ending her feeds after only 2-3 minutes). If either breast is unused for about 3 hours it becomes hard and sore, but softens very rapidly even after the first time she feeds on it.

I asked the midwife about what to do for the nappy rash and about oversupply, but they weren't able to recommend anything extra. Said I was already doing everything I could for the rash. They were just thrilled that she latches well and has almost regained her birth weight at D5. I couldn't engage them about oversupply.

The occasional coughing and possets and the constant feeding at times doesn't bother me. Especially as she seems comfortable during feeds. But the nappy rash looks so sore. I don't see how it can get better when she is producing constant poo that sits there. I can't change her any more than I am doing. I can only do air time with her when I am awake and don't think I can feasibly increase this that much.

I have read about block feeding and I'm sort of doing this a tiny bit by sticking with one breast per "session" as much as possible. But she's so young and I don't want to sabotage my supply. I don't know what else I can do to reduce the frequency of her poos or improve her poor sore bottom.

There are several days to go until I can get to a breastfeeding support group.

If any experienced breast feeders out there can help me I'll be so grateful!

It sounds like you're doing really well. I went through this with my DS and I was so stressed out! All I can recommend is keeping your DD on your breast as long as possible for each feed. I'm sure you know how breastmilk flows and basically is sounds like she's only getting foremilk for her feeds which will cause the green stool. If you can really try to keep her on for longer, she will get the hindmilk and her stools will even out and become the mustard colour that is normal.

BUT don't despair if she doesn't get to the hindmilk because the foremilk is fatty and nutritious and she will flourish and grow regardless. It sounds like you're doing a wonderful job OP.

Also I had a massive problem with oversupply and it had me really upset but it's far better to produce too much milk than not enough. Your DD will adjust and so will you.

I wouldn’t be too concerned about your breast not being empty at this stage, nor what you produced while pregnant being an indicator of anything.

I would question an oversupply diagnosis without ruling other things out first - some of the things you describe could be an overactive let down (which can come with or without oversupply), some could be that’s she’s not getting to the hindmilk, it could be oversupply or it could be an intolerance or something else entirely. Hard to diagnose via internet. Could you try gentle hand expressing into a Muslin until after let down to see if this makes her feed more comfortably?

Block feeding shouldn’t impact your supply - feed on one breast until the feed (or cluster of feeds) has finished and she’s had a reasonable break/sleep. This will help rule out the hindmilk/foremilk concern. Ideally the cluster feeding should be confined to one part of the day - the rest of the time you should feel she is having a decent feed then a decent break/sleep before feeding again.

Difficult to tell from your post whether it’s always lots of very frequent poos, or whether it’s a drawn out poo that you’re changing part way through (with good reason due to sore bum). I’ve found that my babies bums both reacted better to different creams - metanium for my first and sudocrem for my second, so maybe keep alternating until it starts to help. Exactly what you’re doing with lots of fresh air will help - also perhaps try reuseable wipes - I appreciate they can be more faffy but they are so much more gentle on sore skin especially when you’re wiping so much

I’d want to understand your lumpy parts of the breast more - this could indicate blocked ducts which again could point to an ineffective latch - the breastfeeding help you get soon should easily be able to identify that.

I have the same problem and still powering/suffering on through at 4 months
Yes to green stools constant poo and red bottom!
Emma Pickett has a great blog and has been helpful to read there are different positions to try which might help . I block feed and hand express my let down off and it’s helpful.

It could be CMPA
See www.allergyuk.org/information-and-advice/conditions-and-symptoms/469-cows-milk-allergy
And dilanandme.com/2018/01/15/cmpa-faqs-1/

Definitely go to a breastfeeding drop-in when you can. You could also look up lactation consultants at www.lcgb.org/find-an-ibclc/

Thank you so much for your thoughts and support.

We are only using cotton wool and water to clean. And we only dab gently. But we did start off with wet wipes (which I now really regret!).

The feeding pattern probably is normal clustering because there have been long stretches where we've had the most beautiful 3 hour rests between decent 25 minute plus feeds. And then the constant on/off feeding has occurred at roughly the same time on 3 occasions, now that I think of it. I think I'm just so anxious that everything is alright!

The lumpy parts aren't a problem really. I apply pressure to them when she is feeding on the breast and they go right away. Only if I am trying to stick with the same breast, and the non-feeding breast is particularly lumpy have I massaged the lumps and they also disappear or soften as a little milk comes out.

I am basically already trying to stick to one breast at a time unless she literally refuses the same breast over and over after only 2 minutes (seems to happen toward the end of her clustering). But I could take it even further and try to feed on the same side for longer. But I fear the other side would become very very engorged.

Maybe the horrible green poos will just go away in their own time? She doesn't seem bothered by her bottom but it looks so horrible, like the skin has come off. I can hardly get cream to stick to it. I can try switching to sudocrem.

The constant pooing seems to be all or most of the time. Although I'm not sure how often when we are both sleeping, her nappy is always full of poo when I come to change it. And then when I am awake, she seems to make a poo sound at least every 20 minutes and once or twice during every (or almost every) change. It just seems to be so much more than "normal".

Metanium helped DS when his nappy rash was bad.
Also for nappy free time, we put him on folded towels in the bathtub, damage limitation in case of wees or explosive poos.

When she feeds can you feel little butterfly sort of suckles? I mean really sort of light tickly sensation - that's what it feels like when they get the hindmilk.

My 1mo dd has suspected CMPA and the symptoms sound similar, very similar. I've been mixed feeding and had to change to a special formula and cut dairy out of my diet. However, I don't have an ample supply like you, in fact quite the opposite, hence the formula.

Oh forgot to say see your GP about the nappy rash we have been given a cream to use on prescription which clears it up v quickly.
I’ve also worried about CMPA and seen a paediatrician specialising in GERD and allergies we cut out dairy but no improvement. I’m not 100% convinced yet that there isn’t something she’s sensitive too but the symptoms really overlap so on his advice we are eating normally and watching and waiting - weaning will be interesting

It does sound like CMPA with the citrus smell & sore bum but at that young it could also be the switch from colostrum to milk.

With regards to cutting out dairy it takes 6 weeks to fully leave your system so isn’t an instant reaction.

It sounds just like my daughter with her dairy intolerance. I cut out dairy completely from my diet and began seeing changes within days. By two weeks no more constant pooing and no more rash. It could be worth a try changing your diet and seeing. Obviously could be completely unrelated but it sounds so like classic cmpa symptoms.

When mine did green poos the advice I got was to not offer both breasts & make sure that after the initial thin milk (more sugar) from the first breast she had enough of the thicker milk (more fat) to balance her tummy. Also to wake her up to make sure she has a sufficiently long feed to ensure this rather than fall asleep in 5 minutes. Not sure how right this was but it worked and as her feeds increased her poos settled. If green poos re-appeared id just go back to the same advice and it would revert to runny yellow poos again (normal). Worth trying I suppose...

The nappy rash your describing sounds exactly the same as my daughters was, including the almost constant poo. The creams we tried either didn't stay on the area as you said or I felt like I was constantly wiping it off with the next poo anyway. We did manage to clear it, We used cotton wool and water instead of wipes and then followed with baby lotion. Any other cream seemed to make it redder. Then we used baby powder to completely dry it out and left the nappy off as much as possible. It was much better almost instantly.

Thank you everyone for taking the time to offer me advice and support.

I think it was maybe a whole lot of worry too soon! I haven't done anything much differently but for some reason she has in the last 24h started feeding far longer and has a longer "sleepy" portion of feeding where yes, for the first time she makes these little fluttering sucks!

This seems to have come alongside her poos turning more yellow and seedy, and much less frequent. Her rash still has a way to go but hopefully it will be able to get better now.

Also at the end of these long sleepy feeds around her mouth and on her lips it feels all creamy. I'm guessing this is the hind milk at last!

If there is a lactation consultant in the hospital try to get an appointment, they will help with all your q's.

The green poo suggests she is getting too much foremilk, the liquidy part of the milk and not enough hind milk, the fatty part of the milk.

I agree that block feeding (only using one breast per feed) will help reduce your supply but it will also settle a bit over the next few days/weeks as your body adjusts.

The second breast having a 'let down' and dripping is very normal at the start, just pop a towel under it to catch the milk.

Keep an eye on the poos, continual green poo can also be a sign of dairy intolerance but in this case it sounds like over supply is the cause.

Good luck, it sounds like your baby is doing well :-)

Can I just add that fluttery sucks are not active feeding - after letdown the feeling should be more of slower rhythmic pressure - with swallows (you’ll hear a click or see the jaw move near the ear when they swallow). The fluttery/tickling feeling is normally either to stimulate letdown or half asleep feeding to keep the milk flowing but it isn’t active feeding

Glad the poo has changed though