• What is the let-down?
• How can I encourage my let-down?
• What inhibits let-down?
• How can I slow down my let-down?
• D-MER (Dysphoric Milk Ejection Reflex)

Nothing for some women!!! They feel nothing, and that is ok. For others it feels like a pulling/dragging/tingling sensation in their breasts, and their breasts feel heavier after it.

It’s normal not to start feeling it until after your milk “comes in”.

Some women feel it so strongly that they dread it a little. For me, it was a very strong feeling that felt like there were strings tied around my milk ducts (which I imagined as balloons) about half way up my breasts and they were being pulled downward together. Just like the big bunch of balloons in that movie ‘Up’.

For the women that don’t feel their let-down, they can tell that it has happened when they tune into their baby’s suck and swallow. The baby starts off the feed with rapid, short sucks and very little swallowing. Once let-down has happened the suck changes to long draws and frequent audible swallows.

Some women may feel the first let down and that’s it. But if you are having a longer feed, you may feel that let down again, but usually less strong.  It’s different for everyone.  As your baby gets older you may stop feeling the let-down, but that doesn’t mean it’s not happening.  You can also have let-downs by just thinking about your baby, or if you’re overdue a feed, and this is why women wear breast pads, though some women never leak (like me… very strong let-down sensation but not a drop leaked…ever!!!).

What is the let-down?

The let-down is also known as the Milk Ejection Reflex. When your baby suckles, it triggers the Hypothalamus and Pituitary Glands in your brain to release Oxytocin and Prolactin into your bloodstream. These hormones work in various ways on your breasts to release your milk and make it available to your baby. Check out my amateur drawing below:

How can I encourage my let-down?

Perhaps you have a slow let-down and baby gets frustrated when he/she latches on? Perhaps you want to illicit more frequent let downs to increase the volumes your baby drinks? Or perhaps you are pumping and wish to maximise your production? Try the following things to encourage your let downs:

1. Try to relax. Take deep breaths and listen to your body.
2. Thing about your baby suckling or even just sleeping. You could look at a photo or videos of your baby feeding.
3. Apply warmth to your breasts for a few minutes. There are warm/cold breast therapy pads that would be ideal for this.
4. Gently massage your breasts, and I mean gently. There is no need to vigorously or deeply massage your breasts. Your milk ducts are very near the surface and can be compressed easily. Use the flat of your hand and massage your breast towards your nipple. You can also roll your nipple gently if this works for you.
5. Try to use the same routine each time you feed/pump. Sit down comfortably in your spot, have your drink to hand, take a deep breath, massage your breast gently and then latch baby/pump on.
6. Switch nurse- after you feel the let-down has subsided on one side and the flow has slowed, switch baby to the other side and back again until baby is satisfied.
7. Use breast compressions while feeding/pumping.

What inhibits let-down?

1. Alcohol can slow the let-down, and reduce the milk volume consumed by baby (Kellymom 2019).
2. Anxiety or stress can both inhibit supply and delay let-down. It is very easy to get into a negative cycle of anxiety if baby fusses due to slow-flow, which can affect supply, which increases anxiety, and the cycle continues.
3. Pain – will make you stressed, even unknown to yourself. Take your painkillers as prescribed by your doctor.
4. Infection – make sure you are feeling well post-delivery. If you are still having copious, bright red bleeding after the first 4/5 days, or you are passing clots larger that your palm, you should contact your GP. Retained placental fragments can cause on-going bleeding and delay your milk coming in in the volumes it should. A course of antibiotics may be all that is needed. Listen to your body and if you feel something is off, tell your PHN/GP/LC.
5. Excessive caffeine use
6. Smoking
7. Feeling cold.

How can I slow down my let-down?

A fast let-down often goes hand in hand with oversupply, which can be a blessing and a curse.  You may notice your baby suckling as normal, then you feel the let-down (or not) and suddenly baby is gulping and struggling with sucking, swallowing and breathing. They may latch off several times gasping for air, then come off the breast and be very unsettled/gassy/screaming.  Women with smaller storage capacity may have a lot more force behind even a normal milk supply, and feeding more frequently should help those women.

If however, you have a large storage capacity and fast let down, you may be noticing that your baby becomes increasingly unsettled and feeding time becomes extremely stressful. Your baby wants to latch on to comfort suck but is being overwhelmed with milk.  If this is you, then consider trying the following:

1. Laid-back position – in this position the baby is sucking the milk against gravity, thereby slowing the flow rate. Click here for my post on Laid-Back position.
2. Nurse on just one side each time – nurse briefly on one side, and if the baby wants more a short time later go back to the same side. This also helps your baby to access the higher fat content and feel fuller for longer. Feeding on one side will slow milk production also.
3. Block-feeding – nurse on one side for as many times as you need to so that your breast is soft.  If your oversupply is severe, you may want to consider nursing from one side only for a set amount of hours (4-6hrs), in order to slow production. If you are feeling very engorged on the other side, then you can hand express until you feel more comfortable.
4. Latch-off and let it flow method – if you are struggling to reduce your supply, or simply don’t want to, you can latch your baby off once the milk lets down and let it flow into a muslin for 2-3 minutes. Then latch baby back on and feed as normal. Some women choose to hand express immediately prior to feeding, and use a silicone collection device to collect their let-down. Then latch the baby as normal.

As with everything, time heals all. As your baby gets older, he/she will cope with the flow better, and learn how to control it.  By 6 weeks your supply should have adjusted, and by 12 weeks your baby should be much more in control of his/her feeding (their mouth is bigger and their lower jaw is starting to move forward, which helps also).

D-MER (Dysphoric Milk Ejection Reflex)

Another aspect of let-downs that is little known or talked about is D-MER.  This is when a woman experiences negative thoughts and feelings (dysphoria) or feelings of nausea and regret, which happen immediately prior to let-down and for 30 seconds to 2 minutes after.  It is not a physical aversion to breastfeeding or postnatal depression.  Women will feel it coming on before their let-down.  It is thought that inappropriate dopamine activity may cause this, which makes sense as dopamine is considered the ‘happy hormone’. Dopamine has to drop so that prolactin can rise, but in these women it drops inappropriately.

Therefore it is a physical/chemical reaction and nothing that the mother can control.  D-MER can be mild, moderate and severe. For more information on how to cope with D-MER, please visit www.d-mer.org.

I have never personally experienced it or worked with someone who has experienced it, but there are women all over the world who have lived with this and thought they were alone. It turns out they are not, and knowing this is probably the biggest hurdle in living with D-MER.

Conclusion

The let-down reflex is a reflex, therefore it is uncontrollable.  Yet there are things we can do to encourage an active let-down.  Everybody is different and no two journeys are the same. You may not feel a let-down with your first 2 children, and then experience it with your 3^rd.  Whether you feel it or not, is not really important, though it can be handy in those early weeks and months to tell when your baby is getting the bulk of your milk without watching for the suck-swallow rhythm. Yet it is good to know what an effective suck-swallow pattern is and what it looks like when your baby is feeding well.  Most importantly, check in with yourself and ensure you are feeling calm and stress-free, and if you are not and are worrying, please link in with your PHN who can tell you about various support groups in the area or your local Lactation Consultant.  Finding your village will enable you to breastfeed your baby with confidence and support.

References

Kellymom (2019) Breastfeeding and Alcohol. Online. https://kellymom.com/bf/can-i-breastfeed/lifestyle/alcohol/ [Accessed on 11/02/2021].

www.d-mer.org