Clinical Reference Systems: Pediatric Advisor 10.0
The Let-Down Reflex (Milk Ejection Reflex)
Description of the Let-Down Reflex (Milk Ejection Reflex)
When you breast-feed, your baby's suckling stimulates nerves
in your nipple. These nerves carry a message to your brain,
and the hormone oxytocin is released from your pituitary
gland. 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. This is known as the let-down reflex or the milk
Once your let-down is working well (usually by 2 weeks after
delivery), you may feel a pins-and-needles or tingling
sensation in your breasts when you nurse or pump. Milk will
usually drip from one breast while you are feeding on the
other side. Sometimes your let-down will occur just when
you hear your baby cry or think about nursing your baby. A
well-functioning let-down reflex helps ensure your breasts
get emptied and your baby easily obtains milk.
Sometimes a woman's milk ejection reflex doesn't work as
well as it should. This can cause breast-feeding
difficulties. For example, you may have problems emptying
milk from your breasts, or your baby may not get enough
Causes of a Poor Let-Down Reflex
Several situations may prevent the milk ejection reflex
from working well, such as:
- severely sore nipples that cause you to tense up before
- stress, anxiety, and tension; for example, trying to pump
breast milk during a short break at work
- being separated from your baby; for example, having a
premature infant who is unable to nurse, making it
necessary for you to use a pump to express breast milk
- previous breast surgery that has damaged the normal nerve
pathways to the nipple, such as breast reduction or
augmentation surgery. If you have altered sensation in
your nipple after surgery (that is, your nipple is either
somewhat numb or super-sensitive), it is possible that
nerve damage from the procedure could interfere with your
milk ejection reflex.
Ways to Trigger the Let-Down Reflex and Improve Milk Flow
The following suggestions can help trigger the let-down
reflex and improve milk flow:
- Try to nurse or pump in a place that is familiar,
comfortable, and restful.
- Drink a beverage whenever you sit down to nurse or pump.
- Play soft music or do relaxation exercises before you
nurse or pump.
- Gently massage your breasts before you nurse or pump.
- Have your partner give you a backrub before you nurse or
- Put a warm washcloth or heating pad on your breasts, or
take a warm shower before you nurse or pump.
- If you are pumping because you are separated from your
infant, put a photograph of your baby by the pump.