The Let-Down Reflex During Breastfeeding

Signs, Problems, and Solutions

Mother breastfeeding her child
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The breastfeeding let down, also called milk ejection, is a reflex or involuntary natural reaction that happens in your body as your baby breastfeeds. When your child latches on to your breast and nurses, it sends a message to your brain to release the hormones prolactin and oxytocin. While prolactin is responsible for making more breast milk, it's the oxytocin that tells your breast milk to leave the milk ducts.

This release of milk is the let-down reflex.

The Signs Your Milk Is Letting Down 

When your breasts release breast milk, you may notice these signs of the letdown reflex. 

You may also notice the signs of the let-down reflex at times other than when the baby is at the breast. It can come on quickly and unexpectedly at feeding time, when you hear your child cry, during a warm shower, or during sexual activity.

How Let Down Feels

The let-down reflex occurs many times during a feeding. The first release is usually the only one that is noticeable. When your milk begins to let down, you may feel pins and needles, tingling, burning, or pressure. It could be a little uncomfortable or even mildly painful. For some women, the sensations feel very strong, while others do not feel anything at all.

 

If you do not feel any of these sensations, it doesn't necessarily mean that something is wrong. You may never notice it, or you may feel it in the first few weeks then less over time. As long as you can see the signs that your baby is getting enough breast milk and growing well, you do not need to be concerned. Of course, if you do not feel the let down or you have stopped feeling it, and you do not see any of the signs listed above, it could indicate that your supply of breast milk is low. You should contact your doctor or a lactation consultant for assistance and bring your baby to the pediatrician to be sure she's gaining weight. 

Oxytocin and Other Feelings of Let-Down 

The hormone oxytocin is associated with love and bonding. Your body releases it during childbirth, when you breastfeed your baby, and during sex. This hormone can bring about feelings of peace, calmness, and relaxation. Oxytocin also causes muscle contractions that help shrink your uterus back down after childbirth. So, you may feel uterine cramping as your milk lets down. These uterine cramps are a good sign that breastfeeding is going well. Other effects of oxytocin that you may feel while you are nursing could include sleepiness, thirst, headache, nausea and vomiting, hot flashes, and night sweats.

Possible Problems 

The breastfeeding let down does not always work perfectly. It can be slow, difficult, painful, or hyperactive. Difficulties with the let-down reflex can lead to breastfeeding issues. They can also cause a decrease in your breast milk supply because if your child can only remove a small amount of milk from your breasts at each feeding, your production of breast milk will go down.

A Slow or Difficult Let-Down

When your breast milk is slow to let down, or you have difficulty getting your milk to let down, it can be frustrating to a hungry child. Your newborn may cry, bite down on your breast, or refuse the breast altogether.

There may be a delay in the let-down reflex for many reasons. Here are some of the things that can cause a slow or difficult letdown.

What You Can Do If You Have a Slow or Difficult Let-Down

Here are some tips to help get the breast milk flowing:  

  1. Pump or hand express a little bit of breast milk before each feeding to help stimulate your let-down reflex. Then, put the baby to your breast once your milk begins to flow. 
  2. Place a warm compress on your breasts for a few minutes before feeding time.
  3. Gently massage your breasts before and during each feeding.
  4. Breastfeed or pump in a quiet place away from distractions.
  5. Get into a comfortable position. Use a nursing pillow and a breastfeeding footstool, try to relax, take some deep breaths, and concentrate on your baby.
  6. If you're in any pain, ask your doctor if you can take a pain reliever such as Tylenol or Motrin.
  7. Try a nursing supplementer device.
  8. Don't overdo it on the coffee and soda. 
  9. Drink enough fluids to stay hydrated, and eat a balanced diet.
  10. Stay away from the alcohol and don't smoke. 

A Painful Let-Down Reflex

Sometimes the milk-ejection reflex is painful. Hard, swollen breastssore nipples, or an overabundant breast milk supply are common breastfeeding problems that are known to cause pain during let down. Other pain could be related to uterine contractions which can be intense and very uncomfortable, especially in the first week or so after your baby is born. And shooting pains through your breast could be a sign of thrush.

What You Can If Let-Down Is Painful

A painful let down can make breastfeeding unpleasant, and it can lead to breastfeeding less, a low breast milk supply, and early weaning. Here's what you can do if you have a painful let down:

  1. Treat sore nipples, breast engorgement, or an overabundant milk supply.
  2. Call your doctor if you think you have developed thrush.
  3. Ask the doctor if you can take a pain reliever such as acetaminophen or ibuprofen.

A Strong or Hyperactive Reflex

If you have a strong or hyperactive let-down reflex, it can cause your baby to gag, choke, and cough while he's breastfeeding. Your child may swallow a lot of air as he gulps down your breast milk and tries to keep up with the very fast flow. Taking in all that air can lead to gassiness and fussiness. The baby may also gain weight very quickly and show signs of colic. Mothers with a forceful let-down reflex often have an overabundant milk supply as well.

What to Do If You Have a Powerful Let-Down Reflex

  1. Express some of your breast milk before you begin to breastfeed your child. After the first let-down passes and the milk flow slows down, you can put your baby to the breast.
  2. Try the laid-back nursing position. Lie back and place the baby on top of you so that the baby is sucking against gravity. This breastfeeding position may help slow the flow of breast milk and make it easier for your child to breastfeed.
  3. Burp your baby during and after each feeding to help bring up any air that he may swallow.
  4. Try breastfeeding from only one side each feeding
  5. If your little one begins to choke or gag, you should take her off the breast, remove some more breast milk with a pump or through a hand expression technique, then try breastfeeding again.
  6. Treat an overabundant milk supply.

Stimulating Letdown When Pumping 

Many women pump their breast milk. You may want to pump for an occasional bottle or to build up a stockpile of milk in your freezer. It may be that you have to return to work, or you have a child in the hospital. Whatever the reason, you might find that it is more difficult for your milk to let-down if you're using a breast pump. When you're pumping, some of the things that can interfere with letdown and your breast milk supply are feeling rushed, pumping in an uncomfortable environment, and the stress of having a sick or premature infant.

What You Can Do to Stimulate the Let-Down Reflex When Pumping

To help you relax and get your breast milk flowing, here are some tips:

  1. Go to a quiet, private area to pump.
  2. Try to get comfortable and relax.
  3. Look at a picture or watch a video of your baby while you pump.
  4. Listen to a recording of your baby cooing or crying.
  5. Hold and smell a piece of your child's clothing.
  6. For moms of preemies or hospitalized children, studies show that spending time engaged in kangaroo care with your little one can help you pump more breast milk.

The Importance of the Let-Down Reflex

A reliable let down reflex is one of the keys to successful breastfeeding. It is the trigger that allows your breast milk to flow out of your breasts to your baby. When your breast milk is flowing out to your baby well, your child can get enough breast milk to feel satisfied, gain weight, and grow at a healthy pace. On the other hand, if your let-down is slow, your newborn may not get enough, he may become frustrated and refuse to nurse. A painful let-down can quickly lead to the end of breastfeeding

Breastfeeding should not be painful, and you should be able to make and deliver enough breast milk for your child. If you have any questions or concerns about your baby and the let-down of breast milk be sure to talk to your doctor.

Sources:

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Lawrence, Ruth A., MD, Lawrence, Robert M., MD. Breastfeeding a Guide for the Medical Profession Eighth Edition. Elsevier Health Sciences. 2015.

Leng G, Meddle SL, Douglas AJ. Oxytocin and the maternal brain. Current opinion in pharmacology. 2008 Dec 31;8(6):731-4.

Riordan, J., and Wambach, K. Breastfeeding and Human Lactation Fourth Edition. Jones and Bartlett Learning. 2014.

Stuebe AM, Schwarz EB. The risks and benefits of infant feeding practices for women and their children. Journal of Perinatology. 2010 Mar;30(3):155.