Breastfeeding and the Let Down Reflex

Signs, Tips, Problems, and Solutions

Mother breastfeeding her child
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The breastfeeding let-down reflex, also called the milk-ejection reflex (MER), is an automatic natural reaction that happens in your body as your baby breastfeeds. When your child latches on to your breast and begins to suck, it sends a message to your brain to release the hormones prolactin and oxytocin. Prolactin is responsible for making more breast milk, and oxytocin triggers the let-down or release of your breast milk. Here you will learn about the signs of a letdown, how it feels, the tips for stimulating the flow of breast milk, and how to deal with a slow or painful letdown.

The Signs of Milk Letdown  

When you're breastfeeding, and your breasts release breast milk, you may notice these signs of the let-down reflex. 

  • You feel tingling, pins and needles, or a warm sensation in your breasts.
  • You see breast milk leaking or spraying out of the breast that your baby is not breastfeeding on. 
  • You hear your baby gulping and swallowing milk.  
  • You see breast milk dripping out of your baby's mouth.
  • You feel menstrual-like cramping in your uterus, especially in the early weeks following childbirth.
  • Your baby is gaining weight, having at least six to eight wet diapers a day, and appears content after breastfeeding.

You may also notice the signs of milk letdown when you are not breastfeeding or pumping. It can come on quickly and unexpectedly at feeding time, when you hear your child cry, during a warm shower, or during sexual activity.

Tips to Stimulate Let-Down

The let-down reflex is so important since it's one of the keys to successful breastfeeding. It's what allows your breast milk to flow out of your breasts to your baby. When it's working well, your child can get enough breast milk to feel satisfied, gain weight, and grow at a healthy pace. So, here are some tips to help encourage and stimulate milk letdown. 

  1. Take a warm shower or apply a moist, warm towel to your breasts before you breastfeed.
  2. Gently massage your breasts for a few minutes before you begin feeding and continue as you nurse.  
  3. Sit or lie down and get comfortable in a quiet area away from distractions.
  4. Try to relax your body and your mind, so you are feeling calm and free of stress.
  5. If you are still in pain from childbirth, you can take Tylenol or Motrin about 30 minutes to an hour before feeding time. 
  6. Place your baby on your chest in direct skin-to-skin contact.
  7. Look at, touch, and smell your baby.
  8. Keep the same routine before each feeding session. Milk letdown is a reflex that you can condition or teach your body to do at a specific time. You just have to be consistent, so your body can recognize the signals that mean you are getting ready to breastfeed. 

How Let Down Feels

The let-down of breast milk occurs many times during a feeding. The first release is usually the only one that is noticeable. When your milk lets down, you may feel:

  • pins and needles
  • tingling
  • warmth
  • burning
  • pressure

It could be a little uncomfortable or even mildly painful. The sensations are very strong for some women, while others do not feel anything at all.

Not Feeling Milk Letdown

If you do not feel your milk letting down, 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 don't have to worry.

Of course, if you don't feel your milk letting 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. In that case, 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 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. It's the reason 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 experience while you are nursing could include:

  • sleepiness 
  • thirst
  • a headache
  • nausea and vomiting
  • hot flashes
  • 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

Many things might lead to a delay in the let-down of breast milk. Some of the causes of a slow or difficult letdown are:

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

When your breast milk is slow to release, it can be frustrating to a hungry child. Your newborn may cry, bite down on your breast, or refuse the breast altogether. Here are some tips to combat a slow or difficult milk letdown.

  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 alcohol and don't smoke. 
  11. Be sure to breastfeed your child long enough at feeding since it may take a few minutes for your milk to let down. If your child falls asleep at the breast or stops breastfeeding before the let-down, he may not get enough breast milk. Plus, you could also end up with overfull breasts that could lead to painful breast issues such as breast engorgement or plugged milk ducts. 

    A Painful Letdown Reflex

    Sometimes the milk-ejection reflex is painful. Hard, swollen breasts, sore nipples, or an overabundant breast milk supply, and thrush 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. 

    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 letdown.

    1. Treat sore nipples, breast engorgement, or an overabundant supply of breast milk.
    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

    A strong or hyperactive let-down reflex causes too much breast milk to flow quickly out of the breast. You may notice your baby pulling off your breast and gagging. You may also see milk spraying or leaking heavily out of your breast. Mothers with a forceful let-down reflex and fast flow of breast milk often have an overabundant milk supply as well.

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

    When you have a strong or hyperactive letdown, your baby may 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. To help slow the flow you can:

    1. Express some of your breast milk before you begin to breastfeed. 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.

    Letdown and 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 to stimulate the let-down if you're using a breast pump. 

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

    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. 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.

    Stopping Let-Down

    When you're breastfeeding your child or pumping, you want to see the signs of the let-down reflex. But, there may be times when you don't want your milk to let-down such as when you're dressed up for a night out or in a meeting at work.

    You can wear breast pads to protect yourself and your clothes from sudden embarrassing leaks, but you can also try to stop the milk from letting down. If you can, put direct pressure on your nipples. If you are in front of other people and cannot do that discreetly, you can try putting pressure on your breasts by crossing your arms tightly over your chest. 

    Phantom Let-Down

    Phantom let-down is the sensation of the let-down reflex that continues after breastfeeding has ended. Women who have breastfed, but are no longer nursing sometimes feel that familiar tingling in their breasts when they around infants or hear a baby cry. It is usually in both breasts and only lasts for a moment. It may feel like breast milk is about to leak out, but there is no milk in the breast.

    The phantom sensation of letdown can occur long after weaning, and it's typically nothing to worry over. However, if the production of breast milk has ended and all of a sudden there is fluid coming from the nipple, you should see your doctor for an exam. 
     

    A Word From Verywell

    In the early days of breastfeeding, your milk may let down within a few seconds, or it could take a few minutes. If it's taking a little while to get the milk flowing, don't worry. As the days and weeks go on, your body will learn to recognize the signs of feeding time, and you will notice your let-down coming more quickly. Before you know it, you will be feeling the sensation of let-down from just the thought of your baby or hearing her cry. 

    Of course, sometimes there are problems with let-down. But, breastfeeding should not be painful, and you should be able to make and deliver enough breast milk for your child. Therefore, you should talk to your doctor if you have any concerns or questions about your baby and the let-down of breast milk. 

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