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Let-down Reflex: Too slow?
By Kelly Bonyata, BS, IBCLC
Is my let-down functioning properly?
It is normal
for let-down not to feel as strong as your baby gets older. Some
mothers never feel let-down, and some stop feeling the let-down
sensation as time goes by. This does not necessarily indicate that
let-down is not taking place.
Reliable signs of a healthy, functioning let-down include:
- In the first week or so, mother may notice uterine cramping
during letdown.
- Baby changes his sucking pattern from short and choppy (like
a pacifier suck) at the beginning of the feeding to more long,
drawing, and rhythmic a minute or so into the feeding.
- Mother may have a feeling of calm, relaxation, sleepiness or
drowsiness.
- Mother may have a strong sensation of thirst while breastfeeding.
- Baby is swallowing more often. A swallow sounds like a small
puff of air coming out the baby's nose and you can usually see
the muscle moving in front of the baby's ear, giving the baby
the appearance of his earlobes subtley wiggling.
Possible causes of slow let-down
It's quite normal for a mother to have a harder time letting down
when pumping than when nursing. The milk may be there, but you may
have a hard time letting down and "releasing" the milk.
Some mothers also have a let-down which is not functioning properly
when baby is nursing.
Many things can be the cause of a slow or inhibited let-down: anxiety,
pain, embarrassment, stress, cold, excessive caffeine
use, smoking,
use of alcohol,
or the use of some medications.
Mothers who have had breast
surgery may have nerve damage that can interfere with let-down.
In extreme situations of stress or crisis, the release of extra
adrenaline in the mother's system (the "fight or flight"
response) can reduce or block the hormones which affect let-down.
Sometimes a cycle is created, where baby fusses and pulls off because
the let-down is slow, which makes mom tense up, which makes the
let-down even slower, etc. You can use relaxation techniques and
let-down cues to break this cycle.
Let-down as a conditioned reflex
Let-down is partially a conditioned reflex, or one
acquired as a result of repeated "training." The pioneer
of research into what he called conditioned reflexes was the Russian
neurophysiologist Ivan Pavlov.
A typical experiment of Pavlov's was as follows: On numerous occasions
a bell is rung just before a dog is fed. The dog salivates as usual
on receiving its food. Then the bell is rung without any food being
presented. The dog salivates in response to the bell ringing.
Let's put this in terms of nursing. Use a "let-down
cue" just before you nurse (for example, deep breathing or
drinking a cup of tea). Your milk then lets down in response to
baby nursing. Once you have established a conditioned reflex, you
will begin to let-down in response to the let-down cue, without
baby needing to nurse (or nurse as long).
In Pavlov's terms:
- the food (nursing) is an unconditioned stimulus
- the salivation (let-down) in response to the food (nursing)
is an unconditioned reflex
- the sound of the bell (let-down cue) is the conditioned stimulus
- the salivation (let-down) to the stimulus of the bell (let-down
cue) alone is the conditioned reflex.
Pavlov also found that:
- It is much easier to form a conditioned reflex if the unconditioned
stimulus follows the conditioned one (i.e. the food follows the
bell)
- It is easier to form a conditioned reflex if the conditioned
stimulus (bell) occurs very close in time to the unconditioned
stimulus (food)
- The intensity of the stimuli is important - a dog salivates
more if trained on larger pieces of food; and it also salivates
more in response to a louder bell
Transferring this to nursing and let-down, we can surmise that:
- Your let-down cue should be used directly before and
just as you begin nursing.
- Intensity makes a difference: Using a couple of different nursing
cues at the beginning of nursing (for example, sitting down, getting
a drink of water, and doing some deep breathing) should work better
than just sitting down to nurse.
While you're having problems with let-down, it may be helpful to
try to nurse in as close to the same setting and same circumstances
every time, or have at least one thing that you do that's the same
every time you nurse (deep breathing, visualization, the same drink
in the same cup, etc.). If you begin routinely using a few of these
let-down cues, your let-down should kick right back in.
Let-down cues that have proven helpful
Use all of your senses to facilitate let-down. Concentrate
on the sight, sound, smell and feel of your baby. Have a certain
beverage that you drink (the sense of taste) at the beginning of
every nursing session, have a certain song that you listen to, etc.
Directly
before nursing:
- Take a warm shower or bath prior to nursing.
- If you are in any pain, consider taking some Advil or Tylenol
about 30 minutes before you expect to nurse. Pain can cause stress
and inhibit let-down.
- Choose a calm, less distracting setting for nursing.
- Turn on some music that you enjoy.
- Undress baby to his diaper and yourself from the waist up to
increase skin-to-skin contact.
- Get something to drink, like a glass of water or a cup of tea.
- Sit in a comfortable chair with arm support and good back support
or better, nurse while lying down.
- Get in a warm bath with baby and nurse there.
- Before putting baby to breast, massage your breasts and do some
nipple rolls and gentle tugging. Moist heat on the breasts should
be helpful, too. See "Assisting the Milk Ejection Reflex"
in this information on the Marmet
technique of manual expression.
- Reverse
pressure softening helps let-down for some moms.
During nursing:
- Deep breathe or use other relaxation techniques at the
beginning of a feeding, like the techniques that are taught for
childbirth
- Singing or humming can also speed let-down.
- Use visualization. Take several deep breaths and close
your eyes as you begin. Try to visualize and "feel"
what the let-down response feels like for you (if you normally
feel anything). Some women imagine their milk flowing or use images
of waterfalls. Some women concentrate on looking at baby's soft
little hand moving at mom's breast, with fingers curled under.
Some women use visualizations such as being on the beach or any
other relaxing place. Use all five senses; imagine the sights,
smells such as the salt air, sensations such as the feel of the
sand under you or the warmth of the sun on your skin, imagine
tastes and what you might hear too. An excellent book on visualization
techniques is Mind
Over Labor by Carl Jones.
- The opposite can also be helpful: watch TV, talk on the phone,
read a book, etc. - whatever will relax you and get your mind
off it.
- Place a heating pad on your shoulders and back. Get someone
else to massage your back and shoulders before and while you nurse.
- Switch nurse: move baby back and forth frequently between breasts
until let-down occurs
- Continue to massage and use breast
compression as you nurse.
Additional suggestions if you're pumping while separated
from baby:
- Look at a picture of your baby (nursing, if possible).
- Try listening to a tape recording of your baby fussing before
nursing and/or feeding sounds. Use a portable tape player with
headphones if needed. Or just visualize what he sounds like when
he's ready to nurse.
- Put a sleeper or t-shirt or blanket that baby has worn in a
ziplock bag. Open it up when ready to pump - smell and touch it.
Page last modified:
10/10/2005
Written: 05/18/2001
Additional Information
Relaxation and Visualization Exercises
