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I remember googling “painful letdown” at 2 am before I really knew what that meant. All I knew was that every time I breastfed, about 5-10 minutes after my nursing baby latched, I would feel an intense, stabbing pain in my breast followed by the surge of milk. I only knew about the rushing of milk because my baby would become so overwhelmed that he’d unlatch, and milk would proceed to fly in all directions, smothering my baby, my clothing, and oftentimes whatever surface was behind me. (Once it hit my husband in the face while he was silently sleeping next to us; whoops). Does anyone else’s milk ducts spray in ALL directions? If I were my baby, I’d unlatch, too. This painful letdown was affecting us all.
If this is such a universal feeling, and I learned later that it was, why aren’t we given a heads up? In all the breastfeeding consulting I’ve been offered after the births of my four children, I don’t ever recall being told how that might feel. And perhaps more importantly, that the feeling is actually a really good thing. And that it can happen every time we breastfeed. Other things happen, too, when the letdown hormones are released. We often feel stomach cramps and a wave of anxiety. But why?
What is the breastfeeding letdown?
“The letdown, also known as the milk ejection reflex, is what makes breast milk flow through the ducts. It is prompted when your baby sucks at the breast, stimulating your nerves, causing the release of two hormones– prolactin and oxytocin – into your bloodstream. Prolactin helps make the milk, while oxytocin causes the breast to push out the milk. As the letdown occurs, the high fat, hindmilk is forced through (and down) the milk ducts. The letdown allows the baby to receive the fat content of the milk. When your body releases oxytocin, your uterus contracts, creating a contraction / cramp-like feeling in your abdomen. This contraction forces milk down through your milk ducts to the openings in your nipple, becoming available to your baby. At first, there is an increase in the pressure of milk flow which lasts for a short time, and then the flow will ease up, sustaining the pace until the baby stops suckling. Having a letdown is a great sign that your body is releasing prolactin and oxytocin, increasing production and volume of milk.”
Forceful letdown reflex
In my experience, the cramping and intense pain associated with the letdown of milk eased up the older my babies got. It also didn’t happen every time I nursed. I could feel the letdown and listen for the little gulping noises that confirmed my baby was swallowing, but the pain itself did subside. According to Chatterjee, this is pretty normal and a sign of a healthy postpartum recovery. “Signs of milk letdown during the first week postpartum are uterine contractions/cramping. This is to support the uterus to return to its pre-pregnancy state.”
While the pain of the letdown was often intense, what felt even worse for me was the opposite – no letdown at all. The times my baby would be intensely hungry, I’d sit down to nurse, and nothing would come out for him. He’d be screaming, I’d be crying. (I also googled “what to do when there is no breastfeeding let down” at 2 am). Turns out that was my first lesson in calm mothering. Heightening anxiety, nerves, and stress would stop my body from producing milk. Which was super fun to practice while holding a screaming baby and likely answering 1200 questions from a couple of toddlers. But calming my mind and relaxing my body worked every single time to bring on the letdown.
Chatterjee agrees. “Take a mindful mama moment (do meditation, step outside or do something calming), relax and rest. Stress and fatigue can prevent the release of oxytocin (the love and relaxation hormone).” She also recommends stimulating the nipple to release the hormones needed to encourage the letdown.
So, to the mothers who are googling at 2 am: We see you. And it’s ok that you might not remember the last time you showered, or when you last ate a normal meal, let alone ate the milk stimulating foods you “should” be eating; but it will be ok. And in this moment of Google frenzy, you are meant to be right where you are. Breathe. Slow and deeply. Your body knows what to do. Let it lead you. You are not alone.
A few more tips from Chatterjee on surviving the letdown:
- Meet with a lactation consultant to share your history of becoming pregnant, your labor and delivery experience, and any other concerns that may be contributing to the painful or overactive letdown.
- If you experienced a long and unexpected labor, excessive bleeding, retained placenta, or was separated from your baby, there could have been a delay of your let down. That’s ok!
- If nothing is working to stimulate the letdown, know this: It is possible you may not feel the letdown occurring. Monitor your baby for a definitive answer. How many wet and dirty diapers does your baby have a day? We are looking for one wet diaper per day of life, and by day five, we are looking for five or more diapers. When you hand express or pump milk, are you seeing a gradual increase in your supply?
- If the pain is too much, you can use a warm pack and take a child’s pose to stretch your pelvic floor and low back, relieving tension in your uterus, and sending energized blood flow to the area for healing. Drink a cup of warm herbal tea. You can also take Ibuprofen (NSAIDs) to manage the discomfort (speak to your doctor before taking medications).
- When you are ready to begin cessation of milk ejection (otherwise known as weaning) you can begin by stopping nipple stimulation, wearing a form-fitted bra and using ice. If you need to stop quickly, you can use cabbage leaves for weaning 2-3 times/day for 20 minutes on both breasts. Cabbage releases an enzyme that inhibits the release of prolactin. You should only need to do this for one day. Be sure to let your loyal customer (the baby) know your plan. There will be no milk for them to get drunk on :-).