Overactive Milk Ejection Reflex

What should I do if my letdown causes my baby to struggle while breastfeeding?

Overactive Milk Ejection Reflex (OMER) can cause a difficult or frustrating breastfeeding experience for both mom and baby. The forcefulness of the breast milk letdown can sometimes be too powerful for younger babies. Babies whose mothers have an over active milk ejection reflex often cough, choke or pull off the nipple and breast during feeding because the milk is coming down with force and multiple nipple sprays are flowing at the same time.

This problem is caused by a hormonal release of oxytocin, a hormone that causes the milk to be forcefully released from the alveoli (milk-making glands). In some women, the pituitary gland releases large amounts of this hormone, which in turn causes too much milk to be released at one time. This may cause the baby to gag or choke during the feeding. Although you cannot stop the flow of the milk, there are ways to help resolve baby’s discomfort while nursing.

Laying Back Position

• Position yourself lying at a 45 degree angle up against some pillows with your legs stretched out.
• Place the baby on top of your body with their tummy against your tummy and baby’s legs and feet hanging towards the thigh area of the opposite breast. The baby will be looking towards the nipple from above the breast and can latch on easily while resting their head against your upper arm.
• Rest the baby’s head in the area above your elbow.
• Then relax and breathe.
• This position will prevent the fast flow from coming down towards the baby from the breast because the breast is pointed upwards, reducing the force of the flow.

Side-Lying Position

• If you are lying on the left side, have the baby latched to the left breast while they lay on their right side facing the breast.
• This will reduce the force of the flow out of the breast and will reduce the choking and gagging that the infant is experiencing.

Other options for resolving OMER:

• Use a properly fit nipple shield which will allow milk to collect in the tip of the shield and reduce the sprays into the throat.
• Burp or sit the baby up after 3-4 minute intervals during the milk ejection phases.
• Use the single-sided nursing option, as milk flow tends to slow down as the high fat milk drips, rather than sprays, towards the middle or end of the feeding.
• Pump and offer expressed milk in a bottle until the baby is able to manage the fast flow.

Has your baby been choking or struggling to feed consistently at the breast due to a forceful letdown? If you have concerns about OMER, you can connect directly with a Mahmee lactation consultant to receive personalized support.