Common misunderstandings about your letdown or milk ejection reflex

The milk ejection reflex is genetically encoded in placental mammals and actually very difficult to disrupt

Some women feel tingling or warmth in their breasts when their milk lets down, or a sharp or even somewhat stabbing or radiating pain. In the days and weeks immediately after your baby's birth, your womb might feel crampy with a letdown, too. Often women feel thirsty with letdowns.

But many women don't feel their milk letdowns at all, and especially after the first months. Others only feel the first letdown in a breastfeed. These experiences of letdown - from no sensation at all, to uncomfortable sharp sensations - are all on the spectrum of normal.

You can read about the condition of Dysphoric Milk Ejection Reflex, which is different and needs special attention from health professionals, here.

Often women hear that the reason why their baby isn't getting enough milk is because their letdown isn't working properly. But your letdowns, or milk ejection reflexes, are not something you need to worry about. There's plenty of things in breastfeeding that can cause problems, but letdowns are robust. Your letdown or milk ejection reflex is a genetically encoded or hardwired central nervous system and neurohormonal response, very difficult to disrupt. You can trust it. We don’t have to worry about letdowns in the same way we don’t have to worry about getting our stomach acid secretion right when we're eating. It will look after itself.

Our job is to set everything up to breastfeed with a good stable position and no breast tissue drag, and to make frequent flexible offers of the breast, so that over a 24-hour period - regardless of how many letdowns occur in any particular encounter with your breast - baby will transfer the milk he needs.

If your letdowns are inappropriately blamed for baby weight gain or breastfeeding problems, the true underlying issues may not be dealt with

You might be concerned that

1. You're not having a letdown at all

2. You're not having enough letdowns

3. Stress is interfering with your letdown

4. Your baby is fussing at your breast because the milk hasn’t let down

5. Your baby is fussing at the breast your letdown is too strong or is overactive.

There is no evidence to suggest that some women have stronger letdowns overall than others. A fuller breast does have more vigorous letdowns, because it contains a greater volume of milk compared to a less full breast. However, breast fullness is not a sign of how much milk you're producing overall. In fact, if your breasts are running full a lot of the time, this will dial down your supply.

Common concerns about milk letdowns	Why you can be reassured
I'm not having a letdown at all	Many women don’t feel their letdowns, or only feel the first letdown in a feed. You don’t need to worry about whether or not you are having a letdown. There are other much more important ways to know if your baby is getting enough milk – these are the things to focus on. You can find out how to know if your baby is getting enough milk here.
I’m not having enough letdowns	As above
Stress is interfering with my letdown	It is not stress, but the way stress affects your behaviours and body posture, which can interfere with letdown. You might be highly stressed, but your breastfeeding relationship continues to be a source of calm enjoyment for your baby (and maybe even for you, though I know it's not always easy to enjoy things in situations of stress). Whilst the letdown is a reflex that is hardwired and not interfered with by stress, behaviours or actions which result from stress can impact on breastfeeding e.g. feeling under pressure to make sure baby gets enough in a breastfeed, or spacing out feeds. You can find out about stress and letdowns here.
My baby is fussing at the breast because my milk hasn’t let down	Fussing at the breast is typically due to positional instability. A baby who is hungry and is not getting enough milk, but is in a stable position at the breast, will typically 'marathon' feed, suckling for long periods throughout the day and night.
My baby is fussing at the breast because she can’t cope with my strong or overactive letdown	Fussing at the breast is typically due to positional instability. Apart from during the first couple of weeks, babies comfortably manage the range of letdown volumes and strengths, as long as they are positionally stable and the sucking biomechanics are working for them. In the early days after the birth, your tiny baby might pull off the breast coughing and spluttering with the letdown. Just make sure the fit and hold is stable, and bring your newborn back on when you're both ready.

Recommended resources

You can find out more about the neurophysiology of your milk ejection reflex here.