Carie has been told that her milk letdown is too fast for three-month-old Fergus but the real problem is the way he's positioned at the breast

Carey has been told she has an overactive letdown

Carey is worried she has an overactive letdown reflex and high supply because her three-month-old baby often pulls off the breast gagging or coughing, makes big gulping sounds at the breast, pukes after breastfeeds, and is very windy during the feed. Fergus also never goes to sleep with feeds, which makes it hard to get him to sleep.

Carey's lactation consultant advised her to get him with a deep latch by bringing him on with his nose lined up to her nipple, brushing his top lips over her nipple (though she couldn't ever get this), waiting for a very wide gape, and then bringing him on so the nipple was pointing towards the roof of his mouth. She is forever pulling him off due to a shallow latch and bringing him back on.

She also tries to burp Fergus a few times each breast, to deal with the wind from her overactive letdown, but he is still very fussy, back-arching and pulling back, dialling up a lot. She's been spacing out the feeds.

Carey has been told to breastfeed lying back to slow down the flow. She has also been told to feed side-lying, as he'll have better control.

“Ah! But a deck-chair position or side-lying doesn't affect the flow at all,” I explain. “The flow depends on two things: the contraction of the smooth muscles which wrap around the milk glands, and the vacuum your baby is creating in his mouth. Babies of Fergus's age manage a lovely vigorous letdown really well - as long as they are positionally stable.”

You can find out about overactive letdowns and reclining back to breastfeed here.

The real problem is that Fergus doesn't have a stable position when he breastfeeds, and has breast tissue drag inside his mouth

“There's one thing that tells me though," I continued, "that Fergus is possibly not in a stable position when he's breastfeeding. That's all the fussing he's doing when he's on the breast.”

I watch the breastfeed, and I see that this is the case. Fergus is too high relative to Carey's breastfall, and too far 'around the corner'. That is, he is dragging Carey's breast too far off to the side. As soon as a letdown occurs, he pulls back, unable to swallow comfortably when there is so much breast tissue drag and his little neck can't tilt back slightly.

We apply micromovements and suddenly the fussing stops. The change is not always this dramatic - but often enough, it is.

“Oh my God,” Carey says after a while. We watch Fergus breastfeeding with relaxed focus, suck-swallow-suck swallow. Pause. Suck-swallow-suck-swallow. “He's never fed like this before!”

His weight gains have been normal. Apart from the breastfeeds, Fergus is also quite unsettled sometimes during the day, which Carey attributes to overtiredness. She spends a lot of time trying to get him to take naps.

I run through key elements of The Possums Sleep Program with her.

Within a few days, by changing the way she holds her baby during breastfeeds, by offering frequent and flexible feeds, by changing her approach to sleep, and by dramatically increasing the amount of sensory nourishment her little one receives, Carey feels that her life has been transformed. Breastfeeding is easy. Sleep is easy. She loves being out seeing friends and socializing.

She's gone from thinking she'll give up breastfeeding to thinking that she won't stop for a long time, because it makes the days so manageable.

Recommended resources

• You can find out what approaches to fit and hold, which Carey had been using, are avoided in the gestalt method here.

• You can find out about breastfeeding semi-reclined here and side-lying here.

• You can find out about The Possums Baby Sleep Program starting here.

• You can find out about a baby's need for sensory motor nourishment starting here.

• You can find out why the concept of overtiredness is unhelpful here.