I find this part of breastfeeding (the anatomy and physiology) incredibly fascinating 🤓. The mechanisms that go into breastfeeding are incredible.
The let-down reflex is an integral part but like anything else, there can be issues. Read through this post to learn more about this and possible solutions.
- Some women feel the let-down reflex and this can feel like tingling, burning, or a feeling of fullness.
- Some women don’t feel it at all.
- Most women notice a change in their baby’s sucking pattern as the milk begins to flow, from small, shallow sucks to stronger, slower sucks.
- The let-down reflex generally occurs 2-3 times a feed or pump. Most women only feel the first, if at all.
- This reflex is not always consistent, particularly early on, but after a few weeks of regular breastfeeding or pumping, it becomes an automatic response.
Problems with Let-Down Reflex:
- The let-down reflex doesn’t work perfectly all the time. If you are having trouble with your letdown, it can decrease your milk supply so take a look at these:
SLOW/DIFFICULT LET-DOWN REFLEX:
- There are many potential causes for this:
- Alcohol, caffeine, cold temperature, fatigue, pain, previous breast surgery, smoking.
- When you have a slow let-down, your baby can get frustrated at the breast (bite down, scream, or refuse to breastfeed).
Encouraging a Let-Down
If you are having trouble with your let-down reflex, here are a few things to try:
- Pump or hand express a little bit of breast milk before each feeding to help stimulate your letdown reflex.
- Put the baby to your breast once your milk begins to flow.
- Place a warm compress on your breasts for a few minutes before feeding time.
- Massage your breasts gently before and during each feeding.
- Ensure a good latch or properly fitting flanges
- Feed or pump in a familiar/comfortable environment away from distractions.
- Try different methods to help you to relax: calming music, warm shower or a warm washer on the breast, some slow deep breathing, or a neck and shoulder massage.
- Look at and think about your baby.
- If you are away from your baby, try looking at a picture of your baby.
- Avoid smoking and alcohol. Decrease caffeine intake.
- A let-down is partly a conditioned reflex and is a result of repeated “training.” Remember Pavlov? (And Pavlov’s dogs?)
- So for breastfeeding, use a “let-down cue” just before you nurse or pump.
- Ex: sitting down, deep breathing, drinking water). Your milk then lets down in response to baby nursing.
If you have problems with slow or difficult letdowns, try to establish a letdown cue and this will aid in the conditioned reflex. (you’ll respond to the letdown cue regardless of pumping or nursing).
Encouraging a Let-Down while Pumping:
- Start out in let-down (quick sucks) mode, then once you start to get a letdown switch it to a slower mode (expression mode).
- Once your milk stops flowing or has slowed down, put it back in let-down mode. Switch back and forth between these modes throughout your pumping session to encourage at 2-3 let-downs.
- Use warm compresses before and during your pump.
- Massage your breasts before and during your pump.
- Try a lactation massager.
- Relax as much as you can and try and make it as fun as possible.
- Do something you enjoy while pumping like watch a TV show you’re into, read a book if you can.
- Cover the bottles with baby socks if you get anxious about milk production when pumping.
Strong or Overactive Let-Down
- An overactive let-down reflex causes too much milk to flow quickly out of the breast.
- You may notice the baby pulling off your breast, gagging, coughing, choking, or clamping down on your breast.
- The baby can also take in a lot of air while trying to keep up with the flow/gulping which can lead to fussiness, gassiness, and colic.
- Many times if you have an overactive let-down, you’ll also have an oversupply of milk.
Tips for Strong/Overactive Let-Down
- Express some of your breast milk before you begin.
- Put your baby to the breast after the first let-down passes and the milk flow slows down.
- Burp your baby and after each feeding to help bring up any air that he may swallow.
- Try breastfeeding from only one side per feeding (AKA block feeding).
- Try the laid back nursing position (so baby is working against gravity).
- Treat your oversupply if that’s the issue
Dysmorphic Milk Ejection Reflex (DMER)
- This occurs in a small percentage of breastfeeding women and is a result of dopamine dropping in response to the letdown reflex.
- The symptoms of DMER include sadness, a sense of doon, agitation, anger, anxiety, panic, dizziness, depression, restelessness.
- Knowing that DMER is a physiological phenomenon and not something you’re making up is important in being able to get through it more easily.
- This usually only lasts during the letdown and not more than 10 minutes. Always discuss these issues with your PCP or IBCLC for further management.