No letdown when pumping

Let-down Reflex: Too slow? • KellyMom.com

By Kelly Bonyata, BS, IBCLC

Is my let-down functioning properly?
Possible causes of slow let-down
Let-down as a conditioned reflex
Let-down cues that have proven helpful
Additional Information (links)
Relaxation and Visualization Exercises (links)

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 subtly wiggling.

Occasionally, mothers will also experience other symptoms during let-down, including itching, nausea, headaches, or negative emotions.

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.
One study has shown that the moms of hospitalized babies who listened to guided relaxation or soothing music while pumping had an increased pumping output. When mom listened to a recording that included both music and guided relaxation while pumping, in addition to looking at photos of her baby, pumping output was increased even more. In this study, the interventions led to moms producing 2-3 times their normal pumping output. Milk fat content also increased for these moms in the early days of the study. (Reference: Keith DR, Weaver BS, Vogel RL. The effect of music-based listening interventions on the volume, fat content, and caloric content of breast milk-produced by mothers of premature and critically ill infants. Adv Neonatal Care. 2012 Apr;12(2):112-9.)

Additional Information

Marmet technique of manual expression by Chele Marmet. Scroll down to “Assisting the Milk Ejection Reflex”
Fennel is sometimes used to help elicit let-down

Relaxation and Visualization Exercises

Relaxation Techniques for pumping, by Diane O’Brien Juve, from the Working Cow website
Elicitation of the Relaxation Response from the Mind Body Medical Institute
Progressive muscular relaxation script from the Centre for Clinical Interventions (Australia)
Relaxation and desensitization scripts by David Ross, College of Lake County

4 Reasons You're Getting Little or No Milk When Pumping

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Home » Pumping Tips » 4 Reasons You’re Getting Little or No Milk When Pumping

Created On: April 8, 2020 &nbsp| Updated: May 1, 2021 | By Amanda | 45 Comments

Are you trying to pump breastmilk and finding that nothing is coming out? There are a few different reasons why this can happen. Here are some answers to the question “why won’t milk come out when I pump,” and what you can do about it!

This post may contain affiliate links, which means that if you click a link and take action, I may make a small commission at no additional cost to you. I only recommend products I love! More info here.

Here are four scenarios where you might find that hardly any milk comes out when you pump. Each has an individual cause with different strategies you can take to fix the issue.

1. You feel engorged, but little or no milk comes out when you pump

When you can feel the milk in your breasts but can’t get it to come out, the issue is often getting a letdown.

A letdown is the release of of milk from your milk ducts. (Milk doesn’t flow out of them all the time, aside from the occasional leak – usually only when you’re nursing or pumping.)

Letdown is a conditioned response, which means that your brain is trained to let your milk down in response to certain stimuli. If you’re an exclusively pumping mom, it could be the sound and sensation of your breast pump. (It can also be the sound of your Playstation booting up.)

If you’re a nursing mom, it’s more likely that this would be your baby suckling or the sound of your baby crying.

So what do you do if you’re struggling to get a letdown with your pump?

Many women find that watching videos of their baby helps trigger the conditioned response. You could try taking a video of your baby as you start to nurse to capture all of the sounds and what you normally see when you letdown. Then try playing it when you start your pump, and see if that works.

Some other things you can try include seeing if vibration helps (you can start with an electric toothbrush, and then get a lactation massager if you find it works for you), trying a warm compress, or seeing if you can achieve a letdown by hand expressing first. More ideas and info here.

(*Note: LaVie makes two lactation massagers – a smaller one with just vibration and a warming massager that has heat AND vibration. They are both super helpful – use the code EPUMP on their website for 10% off!)

2. You just had your baby and you aren’t pumping any milk

If you’ve had your baby within the last week or so and you’re not getting any milk when you pump, the issue could be that your milk hasn’t come in yet.

In the late stages of pregnancy and in the days immediately after birth, your body produces a type of breast milk called colostrum. Colostrum is a concentrated milk that provides everything your baby needs after birth. After 2-3 days (though it can take up to a week), milk production generally begins to increase, and the milk that is produced transitions from colostrum to more mature milk.

Colostrum ready to be fed via syringe

If you are pumping before your milk comes in, you may be getting little to no milk. This can be for two reasons:

Because colostrum is very concentrated and your baby doesn’t need much of it, your breasts don’t produce very much
Colostrum is very thick and seems to be more difficult to pump

If you need to pump before your milk comes in and find that you’re pumping little to no colostrum, try hand expression (you can find videos on YouTube that might be helpful) or using a Haakaa. Both of these seem to be more effective for expressing colostrum than a breast pump.

3. Your baby nurses fine, but you can’t seem to pump much milk

It’s not uncommon for breastfeeding to be going well while you’re on maternity leave, but then you go back to work and your milk supply drops.

Why would this happen?

Unfortunately, some women don’t seem to respond as well to the breast pump as others.

(You might have heard that your baby is far more effective at getting milk out than a breast pump – while I don’t think this is true for all women, I do think it’s true for some.)

If this is the case for you, the milk is there – your breast pump is just not as effective at removing it. So the question is not how to increase your milk supply, but how to pump it out.

Often, the issue can be the same as discussed in #1 – getting a letdown. If you struggle to get milk to come out at the start of your session, try some of the strategies listed above.

However, if it’s more that once you get a letdown, you’re not getting much when you pump, there are a few things that you can try:

Try using different settings. The vacuum strength should be set to the highest speed that is comfortable for you. If your pump has the ability to change the cycle speed (most Medela pumps do not; most Spectra pumps do), play around with the number of cycles per minute and find what’s best for you. More on settings here.
Make sure you’re using the right breast shields. Some pumps only come with one size flange, but that might not be the best size for you. Using the wrong one can affect your output. More on how to measure to get the correct breast shields here.
Do breast compressions while you pump. Massaging while you pump can help you push out more breastmilk.
If you see milk stop spraying, that might not mean you have no more milk. Keep pumping for another 5 minutes or so to see if you can get a second letdown.
Consider replacing your breast pump parts. Breast pump parts stop working as well over time, and this can affect the suction of your pump. I have been shocked at the difference in output that I got after changing valves.

4. You are currently feeding your nursing and supplementing with formula, and not able to pump much

In this case, the issue might be your milk supply. There are quite a few strategies that that you can use to increase milk supply – this article describes each of them in the order that I would suggest trying them.

Have you struggling with getting no milk when pumping? Tell us your experience in the comments!

Stressed about establishing or increasing your milk supply while exclusively pumping? Always worried there is something else you should be trying? Check out my milk supply guide here (use code SUPPLY for 10% off)!

References

Bonyata, Kelly, IBCLC. “When will my milk come in?” https://kellymom.com/ages/newborn/when-will-my-milk-come-in/

posted in: Increasing Milk Supply, Pumping Tips

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Smartphone Digma CITI Z530 3G, 80 reviews

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(4 stars)

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General characteristics

Class	Smartphone
Case type	Monoblock
Technology GSM 850
Country of origin:	China

About the OttoBokk A-200 electric wheelchair

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