What is the let-down reflex?

The let-down reflex, or milk ejection reflex, is what makes breastmilk flow. It's an important part of breastfeeding and what happens when your baby suckles.

When your baby sucks at your breast, tiny nerves are stimulated. This causes the hypothalamus and pituitary glands in the brain to release 2 hormones into your bloodstream:

1. prolactin
2. oxytocin

Prolactin helps make the milk, while oxytocin causes your breast to push out the milk. Milk is then released, or let down, through the nipple.

How do I know that my let-down reflex is working?

Each person feels the let-down reflex differently. You may not feel anything when your let-down reflex happens. However, you might notice that:

• your breasts feel full
• your breasts feel tingly
• you feel thirsty
• while feeding or expressing from one breast, milk drips from the other

You'll also notice a change in your baby's sucking pattern when the let-down reflex happens. As the milk begins to flow, their small, shallow sucks will become stronger and slower.

Your let down reflex can be affected by stress, pain and tiredness. It can take time and practice for your let-down reflex to become consistent.

When does the let-down reflex occur?

Your let-down reflex can occur:

• in response to your baby sucking at your breast
• hearing, seeing or thinking about your baby
• using a breast pump, hand expressing or touching your breasts or nipples
• looking at a picture of your baby
• hearing your baby (or another baby) cry

The let-down reflex generally occurs 2 or 3 times a feed. Most people who breastfeed only feel the first let-down.

The let-down reflex can also occur with stimulation of your breasts, such as by your partner.

What can I do to encourage my let-down reflex?

The let-down reflex is not always consistent, particularly early on in breastfeeding. It takes time for you and your baby to practice and get used to feeding.

It can help to get into a breastfeeding routine. A routine will help establish cues that your body will recognise. This will help to encourage your reflex. It takes around 2 weeks after birth for your milk supply to become established. After a few weeks of regular breastfeeding or expressing, your let-down reflex should become automatic.

Try to breastfeed in a comfortable familiar place. This is not always possible — but there are things you can do to help feel more comfortable.

If you are near others, it's okay to ask for some space. It may be easier to breastfeed without other people looking on. If you are with family, friends, your partner or other support, they may also be able to:

• help with other tasks
• help you relax

You can distract and relax yourself during breastfeeding by:

• breathing steadily and slowly
• let your shoulders drop
• put your feet up
• have a warm, non-caffeinated drink
• play some relaxing music
• think about your baby — if you are away from them, you can look at photos or videos of them

You can also have a warm shower or place a warm cloth on your breast for a few minutes before you breastfeed.

Encouraging milk let-down by hand

You can also encourage your let-down reflex by hand:

• gently massage your breasts
• roll your nipple between your fingers
• gently massage your breast towards the nipple using a finger or the flat of your hand

This can be helpful if you find your baby's suckling too painful to trigger the let-down reflex.

Why has my milk let-down changed?

There are some things that can affect your let-down reflex, such as

• anxiety
• pain or discomfort
• tiredness
• caffeine and alcohol
• cigarette use
• self-consciousness, which can happen when you are trying to breastfeed outside your home

Stress hormones can interfere with oxytocin. There are many things to try if you are having trouble breastfeeding. Try not to think about the let-down reflex.

How do I manage a fast let-down?

You may also have a fast let-down reflex. This is when your milk let-down is forceful. Milk might spray out if your baby is not latched on. This doesn't necessarily mean that you have oversupply of breastmilk.

You can manage a fast let-down reflex by:

• expressing before breastfeeding
• letting the first flow of milk into a nappy or cup before reattaching your baby
• reclining and allowing your baby to control the speed of the flow
• burping your baby after the first few minutes of breastfeeding

How do I deal with an unexpected let-down?

Many sensations and thoughts can trigger your let-down reflex. Leaking breasts should usually stop once breastfeeding is fully established, or once your child grows older.

To manage leaks, you can:

• apply firm pressure to your breasts when you feel the first sensation of let-down
• use breast pads
• wear clothing that disguises milk stains

Change your breast pads when they are wet, so your nipples don't become irritated.

Resources and support

If you need help and advice, or are having problems with breastfeeding, you can contact:

• your maternal child health nurse
• a lactation consultant (your maternity hospital might be able to help)
• Australian Breastfeeding Association on 1800 686 268