Let Down Reflex and Breastfeeding: What New Moms Should Know

By Dr. Kenosha Gleaton, OBGYN

What is the Let-Down Reflex?

Breastfeeding is possible due to naturally occurring hormones in the body. Two hormones that play an important role in breastfeeding are oxytocin and prolactin. [1] The letdown reflex is actually another name for the oxytocin reflex, and describes the response from the body that causes breast milk to flow from the milk ducts. [1] Oxytocin begins working when a lactating person is expecting to feed as well as when a baby is suckling on the breast. Over time, the letdown reflex becomes more conditioned to certain sensations and feelings, allowing milk to flow into the breast more easily. 

Signs of a Healthy Let-Down Reflex

What some people don’t realize is that you may actually be able to feel a change when the let-down reflex is active. Many lactating people will experience the following [1]:

• Tingling sensation in the breast
• Milk flowing or leaking from the breast as a result of certain stimuli
• Milk flowing from both breasts when nursing
• Feeling thirsty
• Uterine pain or contractions (especially during the first few weeks postpartum)
• Slow and deep sucking and gulping or swallowing by the baby

If you don’t notice many of these signs, the reflex may still be working. Some symptoms aren’t as noticeable to some people. Another helpful way to ensure you are producing enough milk and your let-down reflex is active is if your baby is gaining weight at a healthy level, doesn’t seem to be hungry immediately after nursing, and has multiple wet diapers throughout the day. [2]  Learn What Foods Increase Milk Supply. 

Common Issues with the Let-Down Reflex

Breastfeeding isn’t always an easy process and there are a number of different conditions and problems that can impact the ability to breastfeed. In some cases, the let-down reflex may be slower, overactive, painful, or even dysphoric. [1,3-5] It’s important to remember that everyone’s body works differently, and it’s okay if you run into a few issues. Don’t be afraid to reach out to a healthcare provider for guidance if you’re concerned about breastfeeding.

Slow Let-Down 

Some people will struggle with a slow let-down reflex, meaning there is a delay in milk flow. There are many reasons for slow let-down, including stress, infections, thyroid conditions, C-section delivery, and more. [3] It’s also common for milk production to be a bit slower in the first few days after giving birth. Colostrum is the type of milk the body first produces in the first few days after delivery and usually your baby will only need a small amount. [3] 

Overactive Let-Down 

Forceful let-down, also known as overactive let-down, oversupply, etc. is another issue that can impact lactating people and is related to having too much milk in the breast. [4] In circumstances of overactive let-down, milk flow is so strong that the baby cannot handle the volume of milk. Signs of forceful let-down include your baby choking, gagging, or pushing off of the breast shortly after beginning to nurse. [4] 

Painful Let-Down 

Some people report having painful let-down when breastfeeding. There are many different reasons breastfeeding may be painful or uncomfortable, so it’s important to determine when exactly the pain is happening and what the cause may be. It’s important to note that some abdominal cramping or pain is common while breastfeeding, especially during the first few weeks postpartum. [1] This is caused by the hormones released while breastfeeding, which also cause the uterus to contract to reduce bleeding. [1] Other potential causes of pain when breastfeeding could be clogged milk ducts, breast engorgement, incorrect latch, infections, and so on. It’s normal to have some pain when you first begin breastfeeding, the nipples may even become dry or cracked. If pain is ever too severe that you’re unable to continue breastfeeding, be sure to speak to a healthcare provider. 

Dysphoric Milk Ejection Reflex (D-MER) 

Dysphoric milk ejection reflex (D-MER) is a slightly less common condition, thought to impact anywhere from 5% to 9% of lactating people. [5] D-MER is characterized by sudden or intense negative emotions that occur before or during the let-down reflex. Typically D-MER will only last a minute or so but can lead to intense and unpleasant emotions any time milk is released, either accidentally or when pumping or nursing. [5] Research is still limited on this condition, but it’s thought to be related to hormones and can be managed with various coping strategies. D-MER isn’t specifically related to postpartum depression or anxiety, however many people experiencing one of these conditions will also experience D-MER. [5] 

Tips for Stimulating the Let-Down Reflex

The let-down reflex becomes conditioned over time as certain sensations and feelings are followed by breastfeeding. Examples include touching, smelling, or seeing your baby, thinking lovingly about your baby, hearing your baby crying, and so on. [1] Oxytocin is also released through pleasant forms of touch, one of the many reasons skin-to-skin contact between parent and baby after delivery is so important. [1] 

If someone is in pain or is upset, the oxytocin reflex can become inhibited. If you’re hoping to stimulate the let-down reflex, it’s important to find ways to relax, stay calm, and avoid stressful or painful stimuli. 

Relaxation Techniques

Relaxation techniques may be useful if you’re hoping to stimulate the let-down reflex. Find a quiet, comforting space when attempting to nurse or pump to better support the release of oxytocin. You may want to meditate for a few minutes, read a book, drink warm tea, listen to relaxing sounds, or even use relaxing aromas to support a calm environment. While more research is still needed, some studies have shown that using relaxation techniques may improve milk supply and the overall breastfeeding experience. [6] 

Shop Calming Magnesium Plus Drink Mix

Physical Stimulation

Physical stimulation is another important piece of the puzzle. When a baby suckles on the breast, oxytocin is released and the body should allow milk to flow freely. [1] You may also find that hand expressing or pumping can stimulate the let-down reflex. Gently massaging the breasts and rolling the nipple between your fingers may help encourage milk flow. 

How Natalist Can Support Your Breastfeeding Journey

Natalist is proudly led by a team of moms, doctors, and parents who understand the ups and downs of fertility, pregnancy, and postpartum life. We know that breastfeeding doesn’t always come easily and that it may not be the right choice for everyone. If you are breastfeeding or recently postpartum and are interested in nutritional support, check out the Postnatal Vitamin. Experiencing dry or cracked nipples? We’ve got you covered with breastfeeding-safe Nip & Lip Balm. 

References:

1. Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Geneva: World Health Organization; 2009. SESSION 2, The physiological basis of breastfeeding. Available from: https://www.ncbi.nlm.nih.gov/books/NBK148970/
2. How Much Milk Your Baby Needs. WIC Breastfeeding Support, U.S. Department of Agriculture. Accessed July 2023. URL. 
3. Breastfeeding and Delayed Milk Production. Johns Hopkins Medicine. Accessed July 2023. URL. 
4. Overactive Let-Down. Johns Hopkins Medicine. Accessed July 2023. URL. 
5. Dysphoric Milk Ejection Reflex (D-MER). Cleveland Clinic. April 2023. URL. 
6. Mohd Shukri NH, Wells JCK, Fewtrell M. The effectiveness of interventions using relaxation therapy to improve breastfeeding outcomes: A systematic review. Matern Child Nutr. 2018;14(2):e12563. doi:10.1111/mcn.12563