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The low down on “let-down” and what new moms need to know
After the milk is synthesized, it needs to be removed from the breast by the baby or pump.
The body uses the Milk Ejection Reflex (MER) also known as the “let-down” reflex for this purpose. During MER, milk is flowing through the ductwork of the breast and is waiting and ready for the baby (or pump) or remove the milk from the many openings on the nipple.
Is it different when I breastfeed vs. when I pump?
The pump, no matter how efficient, will never replicate the nursing relationship between breastfeeding mother and baby. Therefore, it is not uncommon for MER to be slower, sluggish and challenging with pumping, but this can occasionally happen with nursing as well.
Should I be able to feel it?
Women may or may not be aware of their MER as it happens. Some women feel a “pins and needles” tingling feeling. Lack of feeling MER does not indicate a problem. Some women notice it in the early weeks and then are no longer as aware of it as lactation progresses. Women who do feel MER may be more aware of it when they are due to nurse or pump and experience a trigger such as the baby crying.
For the nursing mother, during let-down you may notice the baby’s sucking and swallowing pattern change as the milk is rapidly being transferred to the baby. For the pumping mother, during let-down, you may notice the milk streaming or spraying into your collection container.
Are there things I can do to accelerate it, or things I should avoid doing that can make it harder? What can I do if I’m having trouble with my let-down?
A hungry baby can quickly get frustrated by a slow milk flow. Fitting pumping into your day is challenging enough without a slow MER taking up half of your break. If your MER is inhibited, slow or sluggish, you may wonder what you can do to overcome this. Pain, worry, emotional discomfort or previous procedures to your breast can all inhibit your MER. As you walk to the place you’ll pump or nurse, practice some brief relaxation with deep breathing. If you have time to get a cup of tea or water just prior to nursing or pumping, make yourself as comfortable as possible by sitting in a comfortable chair or listening to your favorite music. This type of relaxation just before nursing, combined with a minute or two of gentle massage may help your MER to activate.
It is normal to have more trouble with MER when pumping versus nursing. Your lactation hormones are tied into the feelings of warmth and love you feel for your baby. Hearing your baby cry, feeling him nuzzled at your breast, etc. are all the things that help stimulate MER to allow the milk to flow. The baby still has to effectively remove the milk.
Is there any way to improve let-down?
If you are still struggling with MER when away from your baby and pumping, know that what works is very individual. You may need to try a quiet room to pump with photos of your baby, music, baby’s blanket to get you thinking about your baby and get your milk flowing.
Another challenge is forceful MER or fast MER. The baby may have to keep up with a fast flow of milk and comfort nursing can become nonexistent. Forceful MER often goes hand in hand with oversupply. Working with an IBCLC to understand specialized positioning at the breast and slowly regulating a mother’s supply over several weeks can typically help this problem.
Don’t let your let-down get you down. Almost everything with lactation (and motherhood) gets more manageable with time! There is an expected period of the milk supply “evening out” to the baby’s needs about 6 weeks post-partum. If you are still concerned about your let-down reflex, seek one on one consultation with an IBCLC.