Parentpedia

What Experts Say^*

You've just taken your little one out for his first trip to the mall and you hear another baby cry. All of a sudden, it's as if your breasts have sprung a leak. Not the best timing, for sure, but the good news is you have a well-tuned "let-down" reflex.

Your let-down, or milk-ejection reflex, makes your milk available to your baby by propelling it into the ducts and the nipple. Marianne Neifert, M.D., also known as "Dr. Mom," explains how it happens: "When you breastfeed, your baby's sucking stimulates nerves in your nipple. These nerves carry a message to your brain, and a hormone, called oxytocin, is released. Oxytocin flows through your bloodstream to your breasts, where it causes tiny muscle cells around your milk glands to squeeze milk out of the glands and into the milk ducts. A well-functioning let-down reflex helps ensure your breasts get emptied and your baby is easily getting milk."

Five Things You Need to Know about Your Let-Down

• The feeling of your milk ejecting may surprise you! You may notice a tingling, pins-and-needles sensation, cramping, or nothing at all as your milk lets-down. This is thought to be due to dilation of the milk ducts as milk flow increases. First-time moms often experience a stronger sensation in the early weeks. If milk ejection is painful, massage your breasts just before a feed, allowing your milk to begin flowing before nursing.
• If you don't feel your milk let-down, how will you know it happened? Milk typically lets-down several times during a feed. Even if you don't feel your milk let-down, you will notice that your baby's sucking slows and swallowing (gulping) increases, to keep up with the flow of your milk. You might see milk in the corners of your baby's mouth. Women often feel a sense of relaxation and they may be thirsty. As your milk ejects, it may drip or spray from your unused breast. If you pump, milk droplets turn to sprays as your milk lets down.
• Sore nipples, anxiety, and separation from your baby can inhibit let-down. With sore nipples, correct positioning and healing will usually do the trick. Relaxation techniques, warm compresses, and gentle breast massage, which activates your milk-ejection reflex, can get the oxytocin flowing. If you are pumping away from your baby, looking at her picture can also help stimulate let-down.
• Your milk might let-down during sex. The same hormone involved in milk production is also released during lovemaking. To help reduce the chance of spraying your partner, try nursing just prior to making love, wear a bra with nursing pads to bed or have a towel nearby to catch the flow.
• You're not at the mercy of your leaky breasts. You can still go out in public, and even attend an important business meeting. You just need to learn a few tricks. First, dress appropriately. Absorbent nursing pads (make sure they have a breathable backing) can stop leaks in their tracks. A printed or dark top will help camouflage wetness. If you feel your milk let down, fold your arms across your chest and firmly press into your breasts with your forearms. Nobody but an experienced nursing mom will have a clue you're stopping your milk flow!

Safety Notes

• Breast surgery can damage nerve pathways to the nipple and may interfere with let-down. If you've had surgery, keep a close eye on your baby's diapers and get frequent weight checks.
• If you're worried your baby is not getting enough milk, count wet and poopy diapers. By day three, your baby should wet at least five to six disposable diapers and have at least three to four (quarter-size) bowel movements each day. (After six weeks, breastfed babies often have fewer stools.) If output isn't in this range get a weight check to be sure your little one is gaining normally.
• Excessive caffeine or alcohol, as well as some drugs, can inhibit let-down. Try decreasing your caffeine or alcohol consumption, and talk to your doctor about your medication's possible effect on milk ejection.