Dear Doctor,

How can I control the amount of breast milk I produce? When I am breastfeeding, it pours out and sometimes, makes it hard to feed my baby. I have tried pumping and storing some. I am happy that I can feed my baby but it has also become an inconvenience to me as I resume work soon and fear to leak in office. How can I get it under control?

Olivia

Dear Olivia,

How old is your baby now? Is your baby exclusively breast fed or do you give any top feed as well?

Lactation starts due to rise in levels of prolactin hormone during pregnancy and after delivery. In the average woman, the milk production is abundant after childbirth, but may decline gradually after six to 12 weeks. Best and safest way to reduce milk production is to let it stop on its own naturally. Milk production is stimulated, every time the baby feeds. Drinking liquids also enhances milk production. 

In spite of its numerous advantages for the mother and baby, breastfeeding becomes a hindrance for many women due to their jobs, or not having adequate help for other household chores, where one has to give time for them as well. If the breast milk is not released, i.e. not fed to the baby, the breasts feel engorged and painful. There is a risk of the residual stagnant milk getting infected, resulting in mastitis. Here, the breasts become red, swollen and painful to touch. Moreover, nursing a baby round the clock is exhaustive work. 

There are several options to reduce breast milk. Pumping and storing milk seems like a good idea. But stimulation of the nipples many times enhances milk production, instead of reducing it.  If the baby is around six months, one time feed can be replaced by top milk feed or other feeds. This will reduce milk production. Gradually, breast feeding frequency can be further reduced.  Feeding only from one breast exclusively for three to five days is also helpful in reducing milk production. Applying cold compresses or cold cabbage leaves or ice gel is useful to reduce the painful swelling. Avoid breast binding, as it tends to clog milk ducts, increasing risk of mastitis. Instead, wear a comfortable, well supporting bra. 

Sage tree contains natural estrogen and is helpful in reducing breast milk production. Peppermint is also beneficial in this regard.  Avoid using excess of garlic, ginger, parsley, and et cetera, as these herbs tend to increase milk production.  One also should avoid drinking a lot of hot milk, tea, or fluids that enhance milk production.  

Estrogen containing birth control pills also help in reducing production of breast milk. Decongestant pills containing pseudoephedrine dry up breast milk as well, like they reduce nasal secretions. But one has to be cautious while using them, as they can cause side effects like excess somnolence and dryness of mouth. Drugs reducing breast milk production like bromocriptine or cabergoline can be used to suppress milk production. Cabergoline is a better choice as it can be used in a single dose, as compared to bromocriptine, which has to be taken twice a week for two weeks.         

 Dr. Rachna   Pande is a specialist in internal medicine.