Melissa Clark Vickers
(From LEAVEN, September-October 1995, pp. 72)

For some women leaking is little more than an occasional drop or two during breastfeeding; for others it may be copious amounts--sometimes at anything but opportune moments. Many times mothers are given mixed messages about leaking. If a new mother is leaking milk, we reassure her that she has plenty of milk. We routinely suggest that mothers can stop leaking by putting direct pressure on the nipple, as if nursing mothers can expect to leak. Moreover, how many times do we hear from mothers who are sure that their milk supply has decreased because they no longer leak?
There are products on the market today, from pads to special shells, designed specifically to help with leaking "problems." Sometimes the products themselves contribute to the problem if they apply continuous pressure on or around the nipples. However, the question remains, is milk supposed to leak?
Research on over-active letdown raise questions about leaking. One begins to wonder whether leaking might signal potential problems or whether there are times when women should, even need to, leak milk. The search for more information begins with THE WOMANLY ART OF BREASTFEEDING:

A common occurrence while you are breastfeeding is for milk to drip from one breast when baby starts to nurse on the other. If your breasts are very full or engorged, there is good reason to let the milk come out rather than hold it back. It is a great way to relieve that full feeling.

Two important points are made: first, that if the breast is very full, something should be done; second, leaking is a "good" solution. Perhaps this is the physiological basis for leaking.
Jan Riordan and Kathleen Auerbach put it this way in Breastfeeding and Human Lactation: "Leaking milk in the early postpartum period may serve as a 'safety valve,' since many women who have recurrent mastitis often report never having spontaneously dripped or leaked milk." THE BREASTFEEDING ANSWER BOOK also makes the connection between the value of leaking and preventing mastitis. Counseling the Nursing Mother says, "Milk leaking from the breast can be caused by let-down, overfull breasts, too much stimulation of the nipple, over-production of milk or hormone imbalances." Note that with the exception of letdown, all other causes are not routine, acceptable reasons.

Often, leaking accompanies let-down, especially in the early weeks of breastfeeding "while mother and baby are becoming adjusted to one another and until harmony develops between supply and demand." A mother with less storage capacity for milk in her breasts may also leak more as her body attempts to produce the quantity of milk demanded by her growing baby.
Perhaps leaking is helpful for the new baby who is still learning how to nurse efficiently. The release of the milk provides multi-sensory input to remind him why he is there. He may see the milk drip, it may dribble in his mouth, he may smell it, or feel the wetness. Sensory input is especially helpful for the sleepy or reluctant nurser.
What about leaking when a mother is shopping and hears another baby cry? In a natural setting, baby would be with his mother, so he could signal that it is time to nurse. Of course, the reality today is that many babies are not with their mother every time they want to nurse, so women are likely to leak. However, it could be argued that this still is not a situation that is supposed to happen. There are some situations that cause mothers to make, and consequently, leak copious amounts of milk. Certain hormonal imbalances, pituitary tumors, even medications can put milk production in high gear. These require careful investigation to discover the cause.
So, what does this entire matter mean in our role as Leaders helping mothers? First, we need to identify whether the leaking is bothersome. To some women, leaking is reason enough to wean. Those feelings need to be acknowledged before giving her any suggestions on how to cut down or eliminate the leaking. Second, it is important that we look at how we cover the subject of leaking at meetings, especially when pregnant and new mothers are present. It is reasonable to explain that many women do leak and that it varies in duration and amount. Let mothers know that if the leaking bothers them, they are experiencing; it is a good idea to seek help. There are suggestions that might eliminate most of a mother's leaking. Mothers need to know that it is not necessary to leak in order to have a good milk supply, and conversely, if they stop leaking, it is not always an indication that the supply has dwindled. It may be a sign that mother and baby are in accord with one another, especially if the baby is healthy, growing and contented.
Third, if a mother calls and mentions leaking, it probably is bothering her. Using a combination of HRE skills, breastfeeding basics and immediate management techniques that include pressure on the nipple and breast pads, we acknowledge her feelings, educate her and give her help. If a mother complains of truly excessive leaking, then she may have a more serious medical condition that requires input from her health care professional.
So, is milk supposed to leak? The more I think about it, the more I am convinced that the answer to that question is "probably not." A more useful question might be, is milk supposed to be able to leak. The answer to that one is a definite "yes." Leaking can serve useful purposes: encouraging the reluctant baby to breastfeed, releasing excess milk, reminding a mother that she needs to feed her baby. Helping a mother understand why she is leaking and giving her coping suggestions might make for a much happier nursing couple.

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