Understanding the Let-Down Reflex
Have you ever shot your baby in the eye with breastmilk? Or has your baby ever beat impatiently on your breasts like Congo drums at the start of a feeding? Have you ever started leaking milk just from looking at pictures of your baby? Have you ever wondered why? Well, wonder no longer! All of these occurrences are caused by something called the let-down reflex.
If you are a new mom or if you are new to breastfeeding, the let-down reflex may be a new concept to you. Your body is going to produce milk for your baby and the let-down reflex will happen whether you know it or not, but learning more about it may help you avoid potential issues in your breastfeeding journey. For example, an overactive let-down may lead to your baby resisting the nipple and you spraying breastmilk everywhere. To avoid getting breastmilk on your shirts, pants, furniture, and even the dog (yup, it happens), let’s take a deeper look into the let-down reflex.
What exactly is the let-down reflex?
The let-down reflex, or the milk ejection reflex, is essentially the release of the stored milk in your breasts. In between feedings, your body acts like a factory and continues to manufacture milk and build a supply of milk in your breasts. However, this factory is shaped like a broccoli with the florets higher up on your breast and the end of the stalk at your nipple. The milk is produced at the alveoli cells (the buds of the broccoli) and stored there until a hormone called oxytocin (or better known as the love hormone!) gets released and the alveoli contract to squeeze the milk out. Then down into the ducts the milk goes to reach its final destination – into your baby’s mouth or a pump.
Signs of the let-down reflex.
- A tingling pins and needles sensation
- A feeling that your breasts are suddenly full of milk
- Milk dripping (or shooting) from the other breast
- Baby changes from short, fast sucks to long, slow sucks
- Cramping in your uterus (for the first few days after you give birth)
Sometimes, let-down happens when you are not feeding your baby. It may happen when you hear another baby cry, when you look at a photo of your baby, or even during sexual intercourse. In the beginning days of breastfeeding, my let-down was always triggered after a nice, hot shower (not that I got many of those), and I remember always running for my breast pads and bra after drying off quickly to avoid getting milk on the floor.
Signs of overactive or forceful let-down.
You may have an overactive, or forceful let down if your baby is experiencing the following:
- Chokes, coughs, or gasps a few seconds or minutes after the start of a feed
- Pulls away from the nipple (often followed by milk spraying)
- Has excessive gas from swallowing too much air and may spit up frequently
- Clamps down on your nipple in attempt to slow down the flow
- Periodically refuses to nurse
- Has green stools due to foremilk/hindmilk imbalance.
My baby actually had a strong preference over which side she wanted to feed on due to overactive let-down. My left breast tends to have a heavier flow, making it difficult for her to feed, and often she refuses to nurse on that side. Therefore, when I was dealing with an overactive let-down, I would feed her on the right side first, and switch her over to the left side after some milk had ejected during the let-down.
You may also notice that your let-down is painful. When I was engorged, I remember telling my husband that when I fed my baby, it felt like someone was stabbing at my breasts with a small knife. After my milk supply regulated, the pain went away.
Tips on handling overactive let-down.
Breastfeeding is all about supply and demand. To slow down your milk flow, you need to decrease and regulate the amount of milk in your breasts. It may take several days before you can see any improvement, so be patient and continue with the following tips until your supply regulates.
- Completely empty one breast per feeding to ensure that your baby is getting enough hindmilk. Do not switch to the other breast until time for the next feeding (at least 2 hours after the beginning of the first feeding). The key to this block feeding method is that you have to remember which breast you fed on last. To do so, you can use a safety pin on your bra strap, a ring on your hand, or a hair tie on your wrist to represent the side that you just nursed with. Or in this digital age, use a nursing app to keep track!
- Place a cabbage leaf on the breast you are not feeding on if you start feeling engorged or too full. The cabbage leaf will help with reducing milk supply and providing pain relief.
- Gently remove your baby from your breast when you feel the let-down reflex and catch the shooting milk with a towel or a bottle. Latch your baby back on when the flow slows down.
- Let gravity do the work! Try nursing in the laid-back position while reclining on your couch or bed. Place the baby on top of you so you are tummy-to-tummy with your baby with his/her head over your breast. The milk will have to go “upstream” in order to reach your baby’s mouth, which will help slow down the flow.
It may be tempting to pump whenever you feel engorged to relieve the pressure, but refrain from doing so frequently. Every time you trigger the let-down reflex, your body thinks that your baby needs more milk and will increase your milk supply to keep up with your baby’s demand, making your oversupply issue worse. Therefore, pump or manual express only if the pressure is uncomfortable, but only extract as much milk as necessary for you to feel relief and decrease the number of times you pump as your supply regulates.
Signs of delayed let-down.
Sometimes, especially when you are lacking sleep or feeling a lot of stress or anxiety, you may have trouble releasing the milk from alveoli. This causes delayed let-down, which may frustrate your baby because they do not want to wait long for the precious milk! Your baby may:
- Fuss and pull off the breast.
- Beat your breasts with his/her hand in attempt to trigger the let-down.
- Continue sucking without swallowing.
Tips for handling delayed let-down.
Many things can cause delayed let-down. When stressed or anxious, your body releases adrenaline, which counteracts the oxytocin necessary to initiate the let-down. The use of excessive caffeine, smoking, alcohol, and certain medications may also inhibit let-down. To help trigger the let-down reflex, you can try the following:
- Nurse in a relaxing setting with soothing music playing in the background.
- Increase your milk supply by increasing feeding or pumping frequency or try taking certain herbs like fennel.
- Look at your baby while nursing or look at a picture of your baby while pumping to encourage release of oxytocin.
- Gently massage your breasts before and during a nursing session.
- Hold your baby skin-to-skin while breastfeeding.
- Take a hot shower or bath prior to nursing.
- Take a warm bath with your baby and nurse him/her in the bathtub.
If you are having trouble with your let-down reflex and your baby is not gaining the appropriate amount of weight, contact a health professional immediately for assistance. There are other health conditions that may be associated with an overactive or delayed let-down. If you are experiencing a painful let-down reflex, it’s possible you may have thrush, which is a yeast infection that can develop in your baby’s mouth and your nipples, or mastitis. It is not normal to experience pain while breastfeeding, and you should address any issues with an IBCLC lactation consultant who can support you through your breastfeeding journey.
What does your let-down reflex feel like?