Have you come across the term ‘Let down reflex’ or ‘milk ejection reflex’ and had no idea what it was? If you’ve never breastfed it will be a completely new concept to you. Learning about it before you start breastfeeding is useful to know what to expect and how to deal milk let down problems.
What is the breastfeeding let down reflex?
In between feeds your body continues to make breast milk and store it within your breast tissue. When your baby wants to feed the milk needs to flow from these tissues to your nipple. Your let down reflex is effectively like someone turning on a faucet.
What causes it?
A baby suckling or breast pump suction will stimulate the nerves in your nipple, triggering the release of hormones. One of these hormones is called oxytocin, which causes your breast tissue to start squeezing the breast milk out.
When does it happen?
In the early days the first let down may take a few minutes to happen. This should speed up the more experienced you become with breastfeeding (or pumping). You will usually experience many let downs during a feeding session, although it is unusual to notice after the first. Many ‘let downs’ ensure your baby receives both the watery and thirst quenching ‘fore milk’ as well as the fatty, calorie laden ‘hind milk’.
Signs of ‘let down’
- Baby changes from short fast sucks to long slow sucks during a feed
- Cramp types in your uterus (for a few days after given birth)
- Tingle or achy sensation in your breasts
- Toe curling sensation
- Milk leaking from the other breast
- Baby gulping
- Seeing milk on baby’s mouth
- You feel relaxed or suddenly sleepy
- Milk flowing into the breast pump (when expressing)
All mothers should notice baby’s change of rhythm during feeding as a sure sign they are receiving milk. You may also experience some of the other sign or none at all. This does not mean your baby is not receiving breast milk. If you are concerned about a low milk supply read our article here for the signs you should look out for.
Signs of a delayed let down
- Rapid sucks from baby without swallowing
- Baby upset or frustrated after a few minutes of feeding
- You feel stressed or tense
Common causes of a slow let down reflex
1. Sore nipples or breasts
If your breasts are sore the thought of putting baby directly on for another feed may fill you with dread. Remember the hormone oxytocin needs to be released for the let down to occur. If you are feeling tense about a feed, you will not release oxytocin for your milk to flow.
Solutions for sore nipples:
- Nipple cream as a barrier between you and baby
- Nipple shields until your nipples heal
- Expressing by hand or with breast pump
- Consultation with a lactation advisor to correct the cause of the sore nipple (usually an attachment or positioning issue)
Your let down may be affected by engorged breasts. Using a warm compress, gentle breast massage and hand expression to soften the breast will help encourage the let down. The feeling of expressing off a little milk when your breasts are engorged is enough relief to make most moms relax enough for a feed.
2. Stress or emotional crisis
Any situation which makes you stressed will severely slow down your let down reflex. The oxytocin is ‘happy’ hormone which is only released when you are stress free and relaxed. On the other hand stressful situations will cause it to ‘hide’. This can be anything from a stressful day, bereavement, relationship issues or even not being given privacy to feed or express milk.
This is particularly common amongst mothers of ill or premature babies due to worry over baby’s condition. If you are expressing over this time, you may notice fluctuation in your milk production, or a temporary decrease in supply.
It is essential to have good support around you during this time, whether that is friends, family or care providers. Unhelpful comments during stressful periods can cause you to give up breastfeeding even if you don’t want to. If you get periods to relax a decrease in milk supply will only be temporary and will increase again. If your baby is still breastfeeding or you are expressing milk, your milk supply will continue.
It can be helpful during these times to speak to other moms who have had a similar experience. Check local mother and baby groups, or charities in your area for peer supporters.
3. Drugs or medication
Certain drugs or prescribed medication may interfere with your let down. It is always best to discuss the use of any prescribed or over the counter medications with your doctor or a pharmacist before using. Always read the leaflets with medications to ensure there are no contraindications with breastfeeding.
Use of illegal drug during breastfeeding is contraindicated as they may transfer over to baby through your milk. If you have issues with drug abuse contact your doctor or an addiction counsellor for advice and help to stop.
4. Alcohol or caffeine
Alcohol and caffeine are substances which can both affect your let down. Usually this is only if taken in excess. If you have issue with your let down it is advisable to monitor your intake and limit these in your diet.
5. Health issues
If you are known to suffer from hormone imbalances (such as thyroid issues) this may also affect your let down. It is best to discuss this issue with your doctor as an adjustment to medication may be required or an alternative.
6. Breast surgery
If you have had any type of surgical procedure on your breasts, there is the possibility of nerve damage. This damage may cause problems with your let down when breastfeeding. This is more common with breast reduction surgery as the nipple is often removed and repositioned. You may wish to speak with your breast surgeon with regards to any issues resulting from your surgery.
7. Pump technique
When you first begin expressing milk, it’s common to have a slow let down . Expressing is a skill which will improve with experience and speed up your let down. Your let down may be affected more by environmental factors such as lack of privacy rather than your technique.
A great tip to stimulating your let down with a pump is to mimic your baby’s suction technique. Start with short, fast pumps and switch to long slow pump when your milk starts to flow. Some breast pumps such as the electric Medela range have this feature pre-installed.
Fast or Forceful Let down
An over-active or forceful let down reflex has the potential to cause problems with breastfeeding and has some consequences for baby. In this situation your let down reflex occurs quickly with force into babies mouth.
Signs a of a quick let down
Signs in baby:
- Gags, chokes, coughs or gasps during the start of a feed
- Pulls away from the nipple often or fusses
- Clamps down on your nipple
- Suffers lots of gas, wind or colic
- Periodically refuses to breastfeed
- Does not comfort feed
- Green stools
Signs for moms include:
- Letdown is painful
- ‘Spraying’ milk
- Excessive leaking
Why does it cause problems?
Due to the force of the milk during the let down, your baby will struggle to swallow quickly enough. Think of it like someone using a jet spray into your mouth and you trying to keep up! It means baby will swallow lots of air in the process, which leads to excess wind and makes them gassy.
The forceful nature is what causes some babies to reject the breast or not want to comfort feed.
If you notice your baby has green stools, this is caused by filling up on too much foremilk. The combination of air and milk will make baby feel full quickly, meaning less room for the fatty hind milk. Foremilk contains much more lactose (milk sugars) which cause green stools when digested in excess.
Usually a baby will adjust to your fast let down over time.
Suggestion for a Fast Let down Reflex
- ‘Laid Back’ breastfeeding position – gives baby more control and gravity help slow the flow.
- Catch the flow – let baby stimulate the let-down, take baby off the breast and catch the initial flow in a cloth. Re-attach baby when the flow slows.
- Try block feeding.
- ‘Burp’ baby regularly to get rid of any excess air in the tummy and prevent wind.
- Ensure your nipple faces the roof of baby’s mouth and not directly pointed to the throat, this prevents choking or gagging.
- Avoid using bottles as much as possible – baby may develop a preference for the controlled flow of a bottle.