In my first reaction, I do think it is possible to deliver too much milk to a
breastfed baby who is just feeding at the breast.  I think so because I
believe babies have different motivations for nursing, including nursing for
comfort and to ease GI distress and to promote sleep (through CCK). Another
reason is that there are those women who make milk just by LOOKING at their
baby (well, I exaggerate, but you know what I mean...).  How about babies who
are coping with a massive oversupply or overactive letdown?

However, I think there are regulatory mechanisms built into the system, and
these are there to help moms and babies cope with the
biological-physiological hands they were dealt.  Spitting up is one such
mechanism.  Isn't that more common in the early weeks---during the time the
milk supply is getting adjusted, 'tuned' to the needs of the baby?  Another
mechanism would be the baby's ability to signal when she wants to begin or
end a feed, and when she wants the other breast.  What age is it that they
are able to indicate to mom that they want the other side?  I think I
remember a crawling-age baby flinging himself across my lap to make it very
clear that he wanted to switch, but I suspect that a 'tuned-in' mother can
tell much earlier than that.  Consider how well a baby held upright at your
shoulder can steer his body to one side or the other just by inclining his
head in that direction; they are so top-heavy that it doesn't take much motor
control of the trunk muscles.  When they wriggle themselves down from
shoulder level to breast level, are they indicating which breast they want by
which direction they wriggle?  Or is it when they latch on and get the fuller
or the less full breast--do they indicate that it's the 'right' one by
staying on or the 'wrong' one by latching off? We need to ask some
experienced nursing moms to observe how their babies communicate with them
about these things.

Autocrine control is a beautiful feedback mechanism, and for the most part it
works fine.  BUT, of course, when the grownups start putting their oars in,
Mother Nature's nice system can get messed up.  If the mother is trying to
get her baby to space feedings, if she is using a strict one-breast-per-feed
or two-breasts-per-feed policy, if she's unavailable at times, if she's
anticipating something coming up ('We're picking up Big Sister from school
later, so we have to nurse NOW while we have the chance...'), if someone has
told her she must follow a rigid system for some non-baby-related reason
(e.g. Ezzo) ...then the system can get messed up.  And I suspect that once
it's out of balance, there are some situations in which things can get a
whole lot worse as the system gets farther and farther off-balance. Example:
the under-fed baby who gets quieter to conserve calories, and thus doesn't
demand nursing often enough to build supply.  The opposite example would be:
the over-fed baby who nurses more often because his belly hurts, and so
stimulates more excess production...especially if his mom thinks he's acting
'hungry' and uses supply-building techniques like switch-nursing.

The people who are supposed to know about breastfeeding--that's us LCs and
mother-to-mother counselors--should really be collecting and analyzing
information about how babies regulate their milk intake: asking the
questions, being integrally involved in real behavioral research. There
probably is more detailed and scientific knowledge available about lab rats'
nursing behavior than about humans' nursing behavior!  And probably more
about...oh, let's see...valuable breeds of dogs, zoo animals, race-horse
foals, and piglets and lambs, any species where money is concerned.

Another question I would like to ask is this:  what happens to the regulation
of milk production and baby's milk intake when a bottle is introduced--even a
bottle of expressed milk?  How does the baby regulate intake then?  What
happens to the feedback system?  How do different bottle and teat systems
work---I've seen some bottle-fed babies chug-a-lug at a horrifying pace!

And here are further questions that I want answers to: how is intake
controlled when the baby is getting partial formula feeds?  Again, does the
baby have the ability to regulate caloric intake?  Is the over-feeding of
formula-fed babies a problem of delivery (the bottle and teat) or substance
(what's in the formula itself and how the baby's body handles it)?  Formula
babies increase their volume intake as they grow, much more than breastfed
babies--is this because they need more or because their feeders encourage
them to take more or because the feeding system of bottle and teat allows
them to take more than they need?  And when the baby is getting partial
breastfeeding, how does this affect the amount of formula the baby takes?
How does bottle feeding and formula use affect the amount of breastfeeding
the baby gets to do, and how does it affect her intake when she does
breastfeed?

The area of partial breastfeeding is to me a huge unexplored territory, yet
we have so many moms at WIC that want to do it, and we actually encourage
this because we think some breastfeeding is better than no breastfeeding at
all.  Is it really?  And how should we counsel moms who want to mixed-feed so
that they preserve the maximum amount of breastfeeding and breastmilk intake?

I look forward to hearing what people think about these complex topics.

Chris Mulford, RN, BSN, IBCLC
working with WIC in Southern New Jersey
working with WABA's Women & Work Task Force globally

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