The Let-Down Reflex During Breastfeeding

Definition, Signs and Feelings, Problems and Solutions

Mother breastfeeding her child
How can you tell if your breast milk is letting down?. Tetra Images/Getty Images

What Is the Let-Down Reflex?

The let-down of breast milk also called milk-ejection is a reflex or involuntary natural reaction that occurs when your baby breastfeeds. The infant suckling at your breast 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.

Let-down is one of the keys to successful breastfeeding. It allows your breast milk to flow out of your breasts to your baby. Without a good let-down, your newborn will only receive a small amount of foremilk, so he may not grow at a healthy pace — or he may become frustrated and refuse to breastfeed.

How to Tell if Your Milk Is Letting Down: The Signs

  • You feel tingling, pins and needles, or a burning sensation in your breasts while your baby is breastfeeding.
  • The breast that the baby is not nursing on is leaking or spraying milk.
  • You can hear your baby gulping and swallowing.
  • There is breast milk dripping out of your baby's mouth.
  • You feel menstrual-type cramping in your uterus, especially in the early weeks following childbirth.
  • Your baby is gaining weight, having at least 6 to 8 wet diapers a day, and appears content after breastfeeding.

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 when you hear your child cry, it's getting close to feeding time, you take a warm shower, or during sexual activity.

What Does the Let-Down of Breast Milk Feel Like?

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, and it could be a little uncomfortable or even mildly painful. Some women feel the sensations very strongly while others do not feel anything at all.

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

If you do not feel any of these sensations, it doesn't necessarily mean that something is wrong. 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. But if you do not feel 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.

Problems with the Let-Down Reflex

The let-down of breast milk does not always work perfectly.

It can be slow, difficult, painful or hyperactive. Difficulties with the let-down reflex can lead to feeding issues. They can also cause a decrease in your breast milk supply because if your child can only remove a small amount of breast milk from your breasts at each feeding, your production of breast milk will go down.

A Slow or Difficult Let-Down of Breast Milk

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 let-down.

  • Cold Temperatures

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

A Painful Let-Down Reflex

Sometimes the milk-ejection reflex is painful. Hard, swollen breasts, sore nipples, or an overabundant breast milk supply, are breastfeeding issues 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 often, a low breast milk supply, and early weaning. Here's what you can do if you have a painful let-down:

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

A Strong or Hyperactive Let-Down 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

  • Express some of your breast milk before you begin to breastfeed your child. Allow the first let-down to pass before putting your baby to the breast.
  • 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.
  • Burp your baby during and after each feeding to help bring up any air that he may have swallowed.
  • Try breastfeeding from only one side each feeding. 
  • If your little one begins to choke or gag, take her off the breast, remove some more breast milk with a pump or through a hand expression technique, and then try breastfeeding again.
  • Treat an overabundant milk supply.

Pumping and Your Let-Down Reflex

Many women need to pump breast milk because they have to return to work, or they have a child in the hospital. The stress of having a sick or premature infant, feeling rushed while pumping, or pumping in an uncomfortable environment can interfere with your let-down reflex and your breast milk supply.

What You Can Do To Stimulate the Let-Down Reflex When You're Pumping

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

  • Go to a quiet, private area to pump.
  • Try to get comfortable and relax.
  • Look at a picture or watch a video of your baby while you pump.
  • Listen to a recording of your baby cooing or crying.
  • Hold and smell a piece of your child's clothing.
  • 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.

 

Sources:

American Academy of Pediatrics. New Mother’s Guide To Breastfeeding. Bantam Books. New York. 2011.

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.

Newman, Jack, MD, Pitman, Theresa. The Ultimate Breastfeeding Book of Answers. Three Rivers Press. New York. 2006.

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

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