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What's a Letdown?

What's a Letdown?

When you start breastfeeding, there's a whole new set of terminology to learn. Colostrum, engorgement, hindmilk and foremilk, and galactagogue are just a few. 

But one that you absolutely should know: letdown. Letdowns are critical to getting your baby your breast milk. Here's how they work. 

Letdowns: The Basics

Breastfeeding letdown is what happens when your breast milk begins to flow during a nursing or pumping session. More scientifically, it's known as the letdown reflect or the milk ejection reflex (MER). It's the biological reaction to nipple stimulation and subsequent release of prolactin (responsible for making milk) and oxytocin (responsible for the letdown itself) hormones. 

Common Signs of Milk Let-Down

Some—but not all—breastfeeding moms can feel an impending letdown. Signs include:

  • Warm, tingling, pin-and-needles sensation 
  • A feeling of fullness or pressure in your breasts
  • Cramping in your uterus
  • Leaking or spraying milk from opposite breast

You'll also know that you're having a letdown by how your baby is nursing—you'll be able to hear them gulping and swallowing milk. You might also see milk leaking out of their mouth. 

Letdowns can be unexpected, too, happening when you hear your child cry, take a warm shower, or even during sex.

Not everyone has strong signs of their letdown, though. New mothers might have more noticeable signs as their bodies adapt to breastfeeding, and if you end up breastfeeding for an extended period, you might notice your letdown less and less. 

As long as your baby has enough diapers and is growing well, it's unlikely you need to worry.

The Letdown Reflex

One of the cool things about your letdown is that it’s what's known as a partially conditioned reflex. That means that you can help trigger them through training and practice. This can be something as simple as drinking a cup of tea just before nursing or looking at a picture of your baby while pumping. Many moms find that having a self-care ritual built into their breastfeeding routines—especially if it involves pumping—positively impacts their letdown. 

Here are some other ways you can encourage your milk flow. 

  • Apply moist heat to your breasts before nursing or pumping, like taking a shower or applying a breastfeeding comfort pack
  • Use breast massage before feeding or pumping. You can use hand massage, a roller, or a lactation massager
  • Make your nursing or pumping environment as comfortable and quiet as possible. Less stress and more relaxation=better letdown
  • Have skin-to-skin contact with your baby

The key: Do the same thing each time so your mind and body associate the activity with your letdown. 

Common Letdown Challenges

Breastfeeding can be challenging, and letdowns don't always do what we want them to do. If you feel like your letdown reflex isn't working right, it's important to get help as soon as possible so you don't develop problems with your milk supply. 

Slow Letdown

Whether you're nursing or pumping, slow letdowns are frustrating. If you're nursing, a hungry baby might become too upset to feed. And no mom wants to spend more time than needed at her breast pump. Thankfully, there are lots of ways to speed up slow letdowns.

  • Pump or hand express some milk before feeding. This will decrease the time you need nipple stimulation before your letdown begins. 
  • Use breast massage and/or warm compress (see above) before or during breastfeeding.
  • Make sure your baby isn't overly hungry before feeding.

A variety of factors can cause slow letdown: Alcohol, caffeine, pain, dehydration, stress, exhaustion, and cold temperatures can all affect how your letdown reflex works. Make sure you're well-hydrated, well-rested, and taking care of your own needs.

Strong or Hyperactive Reflex

Lots of breastmilk is generally something moms—and babies—appreciate, but when you have a hyperactive letdown, too much milk is definitely uncomfortable. 

Hyperactive letdown, also called forceful or strong letdowns, cause your baby to gag, choke and cough during breastfeeding. They might also swallow too much air, which leads to gassiness and fussiness. 

Slow your flow by:

  • Pumping or hand expressing a bit of milk before breastfeeding. Then offer your baby your breast once you've had your first letdown. 
  • Adjust your nursing positions. The laid-back nursing position works well for slowing milk flow because your baby has to suck milk upwards.  
  • Feed from just one side each nursing session

As you find the best solution for your letdown, keep your baby comfortable by burping them during and after feeding and, of course, unlatch them if they choke or gag due to a strong letdown reflex.  

Dysphoric Milk Ejection Reflex (D-MER)

Less common, but still important to mention, is D-MER. Some lactating women may experience unexpected dysphoria or negative emotions in connection with their letdown. This response doesn't last more than a few minutes but can be profoundly disconcerting to mothers. 

D-MER isn't a postpartum mood disorder, nor is it breastfeeding aversion or a general dislike of breastfeeding. It can happen whether nursing or pumping. Thankfully, moms can manage it through education, lifestyle changes, and, in more severe cases, prescription treatment.  

Painful Letdown Reflex

Painful letdowns are usually a sign of another breastfeeding issue. Engorgement, sore nipples, oversupply, thrush, and mastitis can lead to pain during letdowns. Treating the source of the problem should resolve the issue. 

Pumping and Your Letdown

If pumping is part of your breastfeeding journey, you may find that triggering your letdown can be more difficult. This is especially the case when you're pumping outside the home, whether at work or in a hospital environment. Discomfort, stress, time limits, and being away from your baby all contribute to the challenge. 

To improve your letdown when pumping, here are a few tips: 

  • Find a private area to pump. If background noise is distracting, bring earplugs or noise-canceling headphones. 
  • Have pictures or videos of your baby available. Audio records are also helpful.
  • Bring a piece of your baby's clothing or a blankie to smell while pumping.
  • Practice visualization and deep breathing to help you relax. 
  • Massage your breasts. Either using your hands, a roller, or a lactation massager are all helpful techniques.