Breastfeeding and the Let-Down Reflex

You’ve been anticipating breastfeeding for nine months, but one thing you may not have expected is the let-down reflex. Rest assured, this is a normal response to your baby sucking on your breasts. But you may also experience it at other times, like when you hear your baby cry, or you’re late for a feeding. (It may also occur at less-than-ideal moments, like during a work meeting.) 

Here’s the lowdown on what let down is, common let-down problems and how to make let down be, well, less of a let down when it comes to breastfeeding.

What is breastfeeding let down? 

It’s a reflex, often known as the let-down reflex or the milk let-down reflex, that ensures that your milk is ready to flow. When your baby latches on to your breast to nurse or you use a pump, it stimulates nerves that trigger the release of two hormones, prolactin and oxytocin, into your bloodstream.  

Prolactin helps produce more milk, while oxytocin actually causes milk to be pushed out of your nipples. This makes breastfeeding easier for both you and your baby.

Signs of milk let down

It’s important to know that not all moms experience these signs, and that’s okay. Even if you don’t have a let-down response, you can still nurse your baby adequately and pump milk without any problems. But you may notice these elements of the let-down relex:

• A tingling sensation either before or during a feeding
• A feeling of sudden fullness
• Milk dripping from the breast you’re not nursing or pumping from
• Baby changes from a suck-suck pattern to a constant suck-swallow
• Cramping due to your uterus contracting, which is more common in the first few weeks of nursing a newborn
• Feeling thirsty

Let downs often happen more than once while you feed or pump, but most of the time you only notice the first one. 

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How to stimulate the let-down reflex

Sometimes, Mother Nature doesn’t work as fast as either you — or your baby — would like it too. There are a couple reasons why that can happen. 

Sometimes, stress, anxiety and fatigue (all part of the territory of new moms) can inhibit your let-down reflex. If your milk production has gone down, either because you supplement with formula or when you introduce solids later on, you may also notice that let down takes longer. 

You can try to move things along while you nurse or pump with the following:

• Relax. It may help to do relaxation exercises such as deep breathing. Choose a quiet spot, and listen to music that calms you. 
• Self-massage. You can gently stroke your breast to help stimulate milk let down.
• Apply heat. Place a warm, moist washcloth on your breasts, or take a warm shower before you nurse or pump. 
• Snuggle. A quick cuddle with your baby can help launch let down. If you're pumping and she’s asleep, or you’re away from home, you can look at a photo of her, listen to a recording of her cooing or grab one of her blankies to inhale her smell. This will stimulate your senses, which in turn can encourage let down. 
• Stay the course. If possible, try to keep the same routine before you nurse or pump. Since milk let down is a reflex, your body will actually associate all of these activities with breastfeeding, and respond accordingly. 

What to do about a slow let-down reflex

In general, let down is harder when you pump than when you nurse. But there can be other causes behind a slow let down. These include:

• Stress. When you're anxious, stress hormones such as adrenaline and cortisol pump through your system, which can impact the hormones that affect let down. If your baby fusses because let down is slow, or you are stressed because it takes longer than expected to pump, it can make you tense up, which releases more stress hormones that further slow your let down.
• Cold. If your body temperature drops, it can temporarily slow down your milk ejection reflex. 
• Too much alcohol. An occasional glass is okay while breastfeeding, but heavy drinking can impact your let-down reflex.
• Certain medications, such as OTC decongestants or antihistamines, can also hinder things. 
• Past breast surgery. This may have caused nerve damage that can interfere with let down. 

When this happens, it can frustrate both you and your little one. You can try the following steps:

• Practice kangaroo care. This is where you cuddle your baby, naked except for her diaper, against your bare chest. This can help lower stress hormones, and foster a sense of relaxation that can stimulate your let-down reflex. 
• Pump a little first. You can pump or manually express for a few minutes before each feeding to stimulate your milk supply. 
• Get comfy. Sit in a chair with good arm support and back support, and use a foot stool if that’s more comfortable.
• Ask about Pitocin. In certain cases, your doctor can prescribe a synthetic version of oxytocin, called Pitocin, as a nasal spray. You use it right before you nurse or pump to stimulate let down and get that breast milk flowing.

What to do about an overactive let-down reflex

Sometimes you can have too much of a good thing. If you see that your baby gags, chokes or coughs frequently while she nurses, or she’s gulping as if the milk is coming too fast, you may have an overactive or forceful let-down reflex. 

She may also pull off your breast often while she nurses, or clamp down on your nipple with her little mouth during let down to slow the milk flow. This overflow can also cause leaking and spraying. Ways to slow the stream include:

• Pump for a few minutes first to slow the flow of milk down, then nurse your baby.
• Use the “laid back” position. This is when you lie down with your baby on top of you so that you’re both tummy to tummy. This uses gravity to help slow the reflex. If you can’t lie down, position your baby so that she sits up more, and her head is not below your breast. 
• Try to time let down. Nurse your baby until let down occurs, then take her off of your breast while you catch your milk in a towel. Put her back on once your flow has slowed.
• Treat the underlying problem. The main cause of an overactive let-down reflex is Mom having an overabundant milk supply. There are strategies you can use, such as block feeding, where you only nurse off of one breast for three to six hours at a time in an effort to ramp down your milk supply. You should always do this under the supervision of a lactation consultant, however, because you don’t want to decrease milk production too much. You may also want to consult with your doctor to make sure your milk oversupply isn’t due to a hormone imbalance such as an overactive thyroid.

Sometimes, let down can happen even when you’re not nursing or pumping. This is most likely to happen in those first few weeks of nursing with leaks springing anytime, anywhere, without much warning. 

Keep a stash of nursing pads handy in your diaper bag or purse. Skip ones with plastic or waterproof liners, since they trap moisture and can lead to nipple irritation. You can also wear milk-collection breast shells in your bra to collect the drips.

What to do about painful let down

When it comes to breastfeeding, you were probably expecting only pleasure, not pain. But a painful let down can sometimes happen, especially in the first few weeks of nursing. This is because your milk ducts constrict to force milk out towards your nipple. 

Some women also experience Dysphoric Milk Ejection Reflex (D-MER), or a whole roller coaster of negative emotions such as sadness or anger, at the same time. These feelings usually disappear along with the pain within ten minutes after you start a feeding. As your body becomes more used to breastfeeding, these negative sensations should disappear. Other causes include: 

• Your baby’s latch. She may be clamping down on your nipple instead of suckling. Check her position: She should be positioned so that she faces your breast with your areola — not just the nipple — in her mouth. 
• A yeast infection. You may also notice that your nipples itch, crack or burn, and you may experience shooting pains in your breasts during or after feedings. Your doctor can prescribe anti-fungal cream for you to apply to your nipples and another for the inside of your baby’s mouth. 
• Engorgement. Try using a warm compress to encourage let down before nursing, and apply a cold compress afterwards. Massage your breasts while nursing to really get the milk flowing, and feed baby frequently. If pain is severe, ask your doctor about taking an OTC pain reliever like acetaminophen.
• Mastitis. Sometimes pain can indicate a breast infection. If you have a fever, red streaks on your breasts and feel achy, contact your medical provider. If it is mastitis, you’ll most likely need an antibiotic.

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 that your let down comes more quickly. Over time, it will become just another part of breastfeeding.