The Let-Down Reflex (Milk Ejection Reflex)

What is 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 ejection reflex.

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 milk.

What causes 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 each nursing
• 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 enlargement 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.

How can I trigger the let-down reflex and improve my 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 pump.
• 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.

Are there medical alternatives to improve my milk flow?

A synthetic (man-made) form of oxytocin was formerly marketed as a nasal spray known as Syntocinon. The drug was sometimes prescribed for mothers of premature infants who needed help conditioning their milk ejection reflex when using a breast pump. Syntocinon is no longer on the market. However, a compounding pharmacist can make the same drug with a physicians's prescription. Call the International Academy of Compounding Pharmacists at 1-800-927-4227 to locate a compounding pharmacy near you.