Breastfeeding: Let-Down Reflex

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KEY POINTS

• Your baby's sucking triggers nerves in your nipples when you breastfeed. Tiny muscles to start the flow of milk. When this happens, it’s called the let-down reflex or milk ejection reflex.
• When your let-down reflex is working well, your baby easily gets milk and your breasts drain well. Your let-down reflex may not work well if you are stressed, separated from your baby, or had previous breast surgery.

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What is the let-down reflex?

When you breastfeed, your baby's sucking triggers nerves in your nipples. These nerves carry a message to your brain, and a hormone called oxytocin is released. Oxytocin flows through your bloodstream to your breasts, where it causes tiny muscles to start the flow of milk. When this happens, it’s called the let-down reflex or milk ejection reflex.

Once your let-down is working well, usually by 2 weeks after you give birth, you may feel a pins-and-needles or tingling sensation in your breasts when you nurse or pump. Milk usually will drip from one breast while you are feeding on the other side. Sometimes your let-down will start when you hear your baby cry or when you think about nursing your baby. When your let-down reflex is working well, your baby easily gets milk and your breasts drain well.

What causes a poor let-down reflex?

Several things may keep your let-down reflex from working well.

• You are stressed, anxious, or tense. For example, you may have sore nipples or be trying to pump breast milk during a short break at work.
• You may be separated from your baby. For example, your premature baby is still in the hospital.
• You may have had previous breast surgery, such as breast reduction or enlargement surgery, that damaged the normal nerve pathways to the nipple. You smoke. Cigarette smoking interferes with the let-down reflex.

How can I improve my milk flow?

To help trigger your let-down reflex and improve milk flow:

• Try to nurse or pump in a place that is familiar, comfortable, and restful.
• Drink water or herbal tea whenever you sit down to nurse or pump.
• Play soft music or do relaxation exercises before you nurse or pump.
• Gently massage your breasts before you nurse or pump.
• Have your partner give you a backrub before you nurse or pump.
• Put a warm washcloth or heating pad on your breasts, or take a warm shower before you nurse or pump.
• If you are pumping because you are separated from your baby, put a photograph of your baby by the pump.

What is an overactive let-down reflex?

Some mothers have a forceful let-down that causes too much milk to flow out of the breast too quickly. You may have sharp, shooting pain, and your baby may gulp, cough, and sputter while feeding. This happens most often within the first month of breastfeeding. To decrease your milk flow:

• Nurse your baby on just one breast per feeding to decrease the amount of milk your breasts make.
• Do not stimulate your breasts by pumping them or taking long hot showers.
• Put cool cloths on your breasts for 15 to 30 minutes between feedings.

To help your baby deal with forceful let-down:

• Hold your baby upright, with his bottom much lower than his head. Support him in this position while he nurses.
• Lie back and place your baby’s tummy on your tummy. This laid-back nursing position lets gravity slow down the flow of milk.
• Burp your baby often if he swallows a lot of air.
• Nurse your baby when he is relaxed and sleepy. His gentler sucking will keep your milk from flowing so fast.
• You can wait until let-down starts, take your baby off your breast, and let some milk collect in a towel or diaper before continuing to feed your baby.
• You can hand express or pump your breasts when your breasts first let down to relieve the pressure, and then put your baby on your breast.