The Let-Down Reflex

Article updated: 5 April, 2019


What Is a Let-Down?

When your baby suckles at the breast, the tiny nerves in your nipple are triggered; these nerve impulses will cause Prolactin and Oxytocin to be released. The Prolactin will increase milk production while the Oxytocin helps to push the milk out, assisting with the flow of milk. Oxytocin does this by widening the milk ducts, making it much easier for the milk to flow through them. It also causes the alveoli to contract and squeeze the milk out. The release of Oxytocin may also cause headaches, nausea, lethargy, and thirst. 

You will only start to feel a let down once your mature milk has come-in between day 3 and 6. 

Most mothers experience a weird pins-and-needles feeling in their breasts when let down occurs.  Other mothers say that they experience a painful letdown! 

Most mothers will feel a breastfeeding letdown reflex after two minutes of nursing. A let down can occur more than once during a feeding and will usually occur in both breasts at the same time. Most mothers will only notice let-downs during the first few weeks after birth. 

It is not uncommon for a mother to have a milk let down when she hears or sees her baby, especially when her baby cries. Yes, milk will start to flow, even though her baby is not at the breast. 

A milk let down reflex is a natural function, but sometimes it can cause a few breastfeeding problems when the flow of milk becomes too forceful or too slow.

What you need to remember, is that before 6 weeks postpartum, your body is getting accustomed to the needs of your baby and things should start improving; then your baby should also begin to drink more aggressively, which will help to normalize the milk flow.

let-down reflex, illustration of let down reflex.Illustration of let down reflex.


What If You Have No Let-Down Reflex?

There are those who say they do not feel a let down at all. As long as your baby is happy, is gaining weight and producing enough wet diapers, you don't need to worry. 

The signs that your baby is getting enough breast milk.


The Signs of a Let-Down

  • A tingling feeling (pins and needles feeling)
  • A sudden feeling of fullness of the breasts.
  • A burning sensation or pressure.
  • Milk may start dripping or spraying from the left breast if nursing from the right breast and vice versa. 
  • Rhythmic sucking and swallowing. 
  • You may feel menstrual-like cramping during the first few weeks when a let down occurs. Oxytocin is released during a let down, and this hormone is responsible for the contraction of the uterus; this will help your uterus return to its original size


Overactive Let-Down and Breastfeeding

What is a forceful let down?

It is when a mother’s milk is spraying out of the nipple too quickly, often causing her baby to become fussy or to choke at the breast. Your baby may struggle to stay on the breast. You may leak as well as spray your baby in the face. Mothers with forceful let-downs often have an oversupply of milk too. 

Your baby may swallow a lot of air while nursing and this can lead to excessive gassiness and fussing. Your baby may also gain weight quicker than most. If your baby has runny, explosive, green stools and is showing colic symptoms, a foremilk/hindmilk imbalance may be to blame; this is when your baby is taking in too much lactose. Once the oversupply issue has been fixed, all these other problems should come to an end also. 

NB- Do not try to reduce your milk supply if your baby is younger than 6 weeks. It is normal for babies younger than this to have temporary issues and for your milk supply to be increasing rapidly. You need to give your body a chance to regulate the amount of milk required. 

A forceful let down will most certainly have reduced before the baby turns six months.


Ways to Handle an Overactive Ejection Reflex May Include the Following:

  • If you start to feel a let-down, you can gently remove your baby from the breast and allow some of the milk to flow out into a cup or cloth, until the flow subsides, then put your baby back on the breast.
  • Make sure that your baby is calm before breastfeeding
  • Do not try to stop the flow with pressure as this could cause a blockage.
  • Make sure your nipple is facing the roof of your baby’s mouth, instead of the back of his/her throat. This prevents choking.
  • Burp your baby often during a feeding as well as after a feeding to help release any air that may cause bloating and pain. 
  • If you have an oversupply, you can try block feeding. You can do this by breastfeeding from only one side for 6 hours, then breastfeed from the other breast for six hours. Pump to relieve some pressure if need be. The idea is to decrease demand, which will reduce supply. Do not limit the time your baby spends on the breast, breastfeed on demand but from that one breast during that specific time period. 
  • Cold compression between feedings can reduce blood flow and therefore milk production too. 
  • Avoid any extra breast stimulation such as pumping, compressing your breasts while nursing, hot showers or wearing breast shells.

For additional ways to handle hyperlactation, see oversupply and breastfeeding



Breastfeeding Positions to Reduce Gas    

The laid-back nursing position or side-lying position will make it easier for your baby to nurse. Gravity is acting against the flow of milk; therefore the baby is less likely to struggle with the fast flow. 

Another helpful breastfeeding position for older babies would be to allow your baby to straddle your leg and sit him/her upright while breastfeeding, hold his/her back and neck for support.


Under Active Let-Down Breastfeeding

Is your milk flow too slow? Do you feel like you have no let down reflex?

Your baby may seem extremely frustrated, fussy and may cry when your milk takes too long to start flowing. A baby may begin to reject the breast or bite while nursing. 

This will cause a baby to fuss and a mother to stress, and anxiety will decrease milk flow even further.

What causes a slow milk let-down reflex?

  • low milk supply.
  • Excessive alcohol intake during breastfeeding.
  • Smoking while breastfeeding.
  • Certain medications.
  • Being anxious or upset. Any emotions that promote the release of adrenaline into the system may hinder a let down reflex. 
  • Being overly tired.
  • Being in pain.
  • Not having your baby directly at the breast. Mothers who are pumping exclusively or pumping at work may struggle. 
  • Previous breast surgery.
  • Fatigue.


How to Encourage a Let Down

  • Express some milk, once your milk begins to flow, you can put your baby at the breast. 
  • Keep distraction to a minimum while nursing.
  • If you are pumping, look at pictures of your baby to encourage a let down or listen to a recording of your baby's voice. 
  • Gentle breast massage is a great way to stimulate a let down and to ensure that you drain the breast well. Stroke your breasts from the outer edges of the breast towards the nipple with a flat hand. Rolling your nipple between your fingers may also help. 
  • Take a warm shower or apply a warm compress or warm face cloth to increase milk flow. 
  • Some mothers have found that meditation can help them relax just before a feeding or pumping session. Visualizations (imagine that your milk is flowing like a waterfall) and deep breathing may help.
  • A study proves that listening to music while breastfeeding or pumping can significantly increase milk supply and increase the fat content of milk. (1)
  • Skin to skin contact will lead to a let down and has many other fantastic benefits. 
  • Ensure that your baby is latched on well, a shallow latch will not stimulate a let down and will not allow for optimum milk removal. 
  • Use breast compressions while nursing

Get help if you need to, a lactation consultant can assess the situation and advise accordingly. 

let-down reflex, beautiful breastfeeding


A Phantom Let-Down

This is when the sensation of a let down occurs even after the breastfeeding relationship has ended. It is nothing to worry about, however, if you suddenly start producing milk months or years after weaning, you will want to contact your doctor about it. 

Reference

1. www.ncbi.nlm.nih.gov

The effect of music-based listening interventions on the volume, fat content, and caloric content of breast milk produced by mothers of premature and critically ill infants.



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