What To Know About the Breastfeeding Let-Down

The breast milk let-down is an important — but often misunderstood — function. Your let-down is when your breast milk releases from tiny sacs in your breast and “lets down” into your nipple, allowing your baby better access to lifesaving nutrients. But what does a breastfeeding let-down feel like? And how can you make it happen?

Pediatrician and breastfeeding medicine specialist Heidi Szugye, DO, IBCLC, talks about the breast milk let-down and how to trigger it.

What is a breastfeeding let-down reflex?

The let-down reflex, or milk ejection reflex, is a hormonal, automatic chain reaction that happens during breastfeeding. Here’s what occurs during the reaction:

1. Your pituitary gland releases the hormone oxytocin as a reaction to different stimuli, like when your baby starts suckling your nipple, when you see, hear or think about your baby, when you touch your breasts or when you’re hand-expressing or pumping milk.
2. Oxytocin tells your alveoli (grape-like sacs in your breasts) to contract (squeeze).
3. Your alveoli push your breast milk into your breast ducts (tubes that connect to your nipples).
4. Milk flows out of your nipple.

“Without the release of oxytocin, most of your milk stays in your breast,” explains Dr. Szugye. “Once oxytocin starts moving, your breast milk will move, too.”

What does the let-down feel like?

The let-down reflex feels different for everyone. For some people, it’s painful or tingly. Others don’t feel anything. All of these experiences are completely normal.

“Your let-down may feel different from someone else’s and that’s OK,” reassures Dr. Szugye. “How it feels can also change over time as your milk supply changes.”

So, how do you know if your milk is “letting down”? Watch your baby while you nurse.

“Your baby will start taking bigger, stronger swallows,” says Dr. Szugye. “You may also see milk drip or even spray from the other breast during breastfeeding.”

Tips to trigger the breast milk let-down

If your let-down doesn’t come easily, don’t worry. These tricks can make it easier to get your milk flowing:

1. Use relaxation methods

Stress is one of the biggest reasons for a delayed or nonexistent let-down.

“Oxytocin is called ‘the love hormone’ because your pituitary gland releases it when you feel closeness,” explains Dr. Szugye. “Stress can prevent your oxytocin release, so finding ways to manage stress can be helpful.”

Sometimes, it’s not possible to just forget about what’s stressing you out. That’s OK, too. Before you breastfeed, you can help your body shift out of “stress mode” with:

• Deep breathing exercises like pursed lip breathing or diaphragmatic breathing.
• Guided imagery techniques.
• Relaxing music or a podcast you enjoy.

2. Get comfortable

It’s hard to get into a breastfeeding groove if you’re contorted on a hard park bench or a metal folding chair. If possible, find a spot that supports your back and arms where you won’t feel cramped or tense.

“Most nursing individuals have preferred breastfeeding positions that are comfortable for them and their baby,” notes Dr. Szugye. “The right position feels good for the person who’s nursing and makes it easy for baby to access the breast so it’s a win-win. And getting into the same position each time can cue your brain to trigger the let-down reflex.”

3. Focus on your baby

Now that you’re as relaxed and comfortable as possible, focus on your baby. Your oxytocin release and let-down reflex rely upon multiple senses. Use your sight, hearing, smell and touch to coax it along.

“Look at your baby, stroke their back, listen to their coos and smell their head,” suggests Dr. Szugye. “Doing skin-to-skin contact can also help, so try undressing your baby and putting them up to your chest.”

What if you’re pumping and your baby isn’t with you? You can still use your senses to trigger your let-down reflex if you:

• Carry an article of your baby’s clothing with you and smell it before you pump.
• Close your eyes and imagine your baby with you, getting ready to nurse.
• Look at a photo of your baby.
• Watch a video of your baby on your phone.

4. Pump or hand-express for a slow let-down

If you know your let-down takes a few minutes, and your baby hates waiting, get a head-start with pumping or hand-expressing.

“Sometimes, the let-down takes longer, and your baby gets upset when the milk doesn’t come right away,” says Dr. Szugye. “This is stressful for the person who’s nursing and the baby. Avoid this issue by pumping or hand-expressing for about a minute. Then, pick up your baby and start nursing. Your let-down may come easier if your baby is calm before they nurse.”

5. Address any breast or nipple pain

It’s not just stress that blocks the oxytocin release. Pain can inhibit your let-down, too.

“Pain during breastfeeding isn’t normal, and you don’t need to tough it out,” states Dr. Szugye. “If you have sore nipples, apply lanolin ointment after nursing. Breast pain could indicate a condition like mastitis, and requires medical care. If breastfeeding hurts, contact a healthcare provider so they can address the cause.”

6. Massage your breasts

Before you start nursing, give your breasts a gentle massage.

“A light self-massage can trigger your let-down reflex,” Dr. Szugye adds. “You can also try gently tugging or rolling your nipple between your fingers. Don’t use force — this shouldn’t hurt.”

7. Get warm and cozy

Feeling cold can naturally make your body tense up. If you tend to get chilly when nursing, put a cozy blanket over your legs or a warm scarf around your neck.

“Using a moist heating pad or warm washcloth on your breasts before nursing can also help encourage your milk to let down,” Dr. Szugye suggests.

D-MER: When the let-down triggers bad feelings

For most people, oxytocin creates a sense of calmness and peace. But if you have dysmorphic milk ejection reflex (D-MER), you could feel the opposite effect as your milk lets down.

D-MER can cause a sudden wave of unpleasant feelings like sadness, anxiety or dread when your body releases oxytocin. Usually, the emotions come on quickly and go away within one to two minutes. But you may feel them several times during a feeding, as your milk lets down more than once.

“D-MER is a hormonal reaction that has nothing to do with your feelings about breastfeeding or your baby,” says Dr. Szugye. “But if you have D-MER symptoms or a history of pituitary or hormonal conditions, talk with a healthcare provider. They can help you get the care you need.”

You may also be able to combat mild D-MER symptoms and reduce their severity by:

• Cutting back on or eliminating caffeine.
• Trying distraction techniques, like watching a TV show.
• Using relaxation and deep breathing methods.

There’s no ‘right’ way to breastfeed

Breastfeeding is an individual and personal experience. If it’s working for you and your baby, don’t worry about what others are doing (or stress about their unwanted advice).

“It’s easy to compare ourselves to others and think we should be doing something differently,” recognizes Dr. Szugye. “But all that matters is that you and your baby are healthy.”