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What You Should Know About Your Let Down Reflex

Written by WebMD Editorial Contributors

Reviewed by Dan Brennan, MD on March 17, 2021

In this Article

• How Does the Let Down Reflex Work?
• What Are Signs of a Good Let Down?
• Complications of the Let Down Reflex

When your baby first latches on to nurse, they don’t actually get much milk at first. Instead, their suckling sends a message to your body to release the milk stored in your breasts. The strength and timing of the let down reflex, also called the milk ejection reflex, varies from mother to mother. 

How Does the Let Down Reflex Work?

If milk came out of your breasts instantly when your baby latched on, you’d probably leak constantly. Instead, your breasts store the milk until it’s needed. Most often, your let down reflex is triggered by a particular suckling motion your baby makes to stimulate milk production.

The let down reflex is a physiological response to your baby’s sucking. They stimulate small nerves in the nipple, which causes prolactin and oxytocin to produce milk and let down milk, respectively. The reflex is often accompanied by a tingling sensation in the nipple, but not all women experience that.‌

If you pay attention to your baby’s nursing patterns, at first their suckling will be faster and shallower to stimulate the release of milk. Once your milk lets down and your baby is drinking, their suckles will be deeper and longer. If they nurse longer and need more milk, they may adjust how they suck to stimulate more milk flow. 

Other let down triggers. Since your brain is wired to care for a newborn, other things may trigger the let down reflex. If your baby cries, or if you hear any baby cry, your milk may let down in response. If you go too long without nursing and your breasts get too full, your let down reflex may trigger to relieve the pressure.

Strong emotions may also trigger a let down of milk. If you are feeling intensely stressed, angry, or sad, your body may take that as a sign that you need to nurse your baby or release milk to alleviate pressure.

If your milk is not letting down, you can physically stimulate the nipple to allow let down. Try gently rolling your hand down your breast toward the nipple, then massage gently. It can also help to relax and think about your baby.

What Are Signs of a Good Let Down?

Breastfeeding is wonderful for your baby, but it is often full of doubts and questions. Are you producing enough milk? Are you doing it right? This extends to the let down reflex, too. You may wonder if your let down is strong enough or too strong. 

Here are signs of a healthy, functioning let down response:

Uterine cramps. You may notice that your uterus cramps during a let down in the days following birth. This is natural and nothing to be concerned about. As with menstrual cramps, for some the cramps are mild and barely noticeable, while for others the contractions can be more painful.

Change in sucking pattern. You may notice a change in your baby’s sucking pattern during a nursing session. Their suckle will go from being short and fast to long and slow once milk lets down. If they need more milk, their sucking may change again to encourage another let down.

Your feelings. Moms often report that they feel very relaxed and even sleepy when their milk lets down. This is a side effect of the oxytocin released during let down. You may also feel suddenly thirsty, which is your body’s way of preparing to replace the milk being removed during a nursing session.

Complications of the Let Down Reflex

Oversupply milk ejection reflex. A powerful let down is often accompanied by an oversupply of milk, sometimes called oversupply milk ejection reflex (O-MER). When your let down happens, you may notice that your baby sputters, coughs, and even chokes on your milk. Your baby may bite down to slow the milk flow. You may leak when not nursing or notice that your baby has more frequent but short feedings if you have an oversupply.

If this happens, keep a bib or cloth handy to catch your milk when it first lets down so that your baby doesn’t choke. After a moment when the let down slows, you can try latching your baby again. You can also restrict your milk flow by squeezing your areola during breastfeeding.

Talk to your doctor about safe ways to decrease your oversupply so that your let down is less strong.

Dysphoric milk ejection reflex. In some women, breastfeeding can create a negative physiological response, leading to negative emotions like guilt, anxiety, depression, and sadness. It is usually an isolated response that occurs only when you first let down your milk and into the first few minutes of breastfeeding. This is called dysphoric milk ejection reflex (D-MER) and is different from postpartum depression. 

There is still more research needed on the causes and effects of D-MER. Talk to your doctor if you are struggling with negative emotions during breastfeeding. 

Weak let down. You may have a weak let down if your baby seems frustrated while nursing. They may not be getting enough milk, or they may not be getting milk as fast as they want it. Using a breast pump can supplement less successful nursing sessions.‌

When pumping, look at photos and videos of your baby to try and encourage a let down. And just as you do when breastfeeding, try to relax. Take deep breaths and think about your little one, letting go of any stress.

Breast milk production | Baby's needs

Did you know that the amount of breast milk adapts to your baby's needs? In this article, you will learn amazing facts about breast milk production in the first days, weeks and months.

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Your body is capable of producing breast milk for your baby at every stage of development. Understanding how milk production “turns on”, what happens to milk when you feed your baby, and why production adjusts to his needs as he grows, will help you start this amazing process in the right way.

Day one: milk production at birth

The baby is usually ready to breastfeed from birth. When he grabs the breast and begins to suck rhythmically, the milk-producing cells “turn on” and the formation of the first breast milk, colostrum, starts. ¹ Try to feed your baby as much as possible in the first hour of his life, and then as soon as he shows interest in feeding. This will help lay the foundation for good milk production later on. ²

The first days: the arrival of milk

At this stage, your body's level of progesterone, the
pregnancy hormone, which begins to fall after the placenta comes out, is reduced, and the hormones responsible for milk production - prolactin, insulin and hydrocortisone - are included in the work. These hormones will help start milk production. ³ Around the third day of your baby's life, milk will begin to come in and you will feel that your breasts have filled up and become noticeably firmer. ¹

First month: shaping milk production

During the first weeks, your body will be especially sensitive to the amount of milk produced as it learns to produce the right amount. Prolactin levels increase dramatically each time you empty your breasts, thereby helping shape the lactation process. It also contributes to the maturation of your milk in terms of composition. At this stage, transitional milk is produced and the amount continues to grow. ^3.4

For good long-term milk production, it is very important that you are close to your baby during the first few weeks. The more often you breastfeed, the more milk will be produced. This process resembles the law of supply and demand. Each time after emptying the breast, whether it is feeding the baby or pumping, even more milk will be produced.

Remember that it is normal for newborns to eat frequently, perhaps even every 45 minutes, and this does not mean that they are not getting enough milk. Frequent feedings help shape milk production, so feed your baby on demand, not on a schedule.

“In the first few weeks you may feel like you don’t have enough milk because your baby will be feeding all the time, but that’s okay,” says UK mom-of-two Jo, “We tend to think that the baby wants to eat every few hours, but that is not necessarily the case."

Don't forget that babies also breastfeed for comfort. Breastfeeding helps them calm down and adjust to their new life outside the womb. In addition, feeding helps to establish a connection between you.

Stable milk production in the first month

If you follow your baby's needs and feed him as often and for as long as he wants, milk production should adjust. ⁵

Some mothers try to increase the period between feedings so that the breasts can produce more milk during this time, but this should not be done, as this may have the opposite effect. ²

If you are unable to breastfeed directly for the first two weeks, express your milk to build and maintain your milk supply during this critical period and beyond.

Did you know that feeding your baby extra formula unnecessarily can reduce your milk production? The chest will not receive a signal to increase production, because it will not be emptied. In addition, if the baby sleeps longer after formula, he may miss his usual next feeding time.

This is a kind of “supplementing trap”. After three to four days of formula supplementation, during which the breasts have emptied less, the body will receive a signal that breastfeeding has stopped, and the amount of milk produced will begin to decrease. As a result, the baby will remain hungry and will need additional formula supplementation. And so on in a circle ... As a result, this will lead to really low milk production, and the baby will eat mainly the mixture.

Breast milk production after six weeks

After a month of breastfeeding, post-feeding bursts of prolactin secretion begin to decrease, milk matures, and the body gets used to producing as much milk as your baby needs. In fact, the chest begins to work "on autopilot." ⁴ You may also notice at this time that your breasts are softer and your milk flow has stopped.

At this stage, women often have fears of "losing milk".
However, this only means that milk production has been established and now fully meets the needs of the child. It is noteworthy that although the baby continues to grow, he will consume approximately the same amount of milk both at six weeks and at six months. You may notice that the baby began to suckle the breast longer, but less often. On some days he may eat a little less than usual - his appetite changes in the same way as an adult.

Now your body will produce exactly the amount of milk,
as much as your baby needs. Therefore, the more milk the baby
drinks (or you express), the more it will produce.

How does this happen? The reason for this is thought to be the so-called "feedback lactation inhibitor" that controls milk production. The more milk in the breast, ² the higher the inhibitor level, so a full breast produces less milk than one that has been emptied.

What is the rate of milk production?

Mothers often worry about their milk supply and think about how to increase it. However, if the baby is healthy and growing well, problems usually do not arise.

“I was worried that my newborn daughter was not getting enough milk as she was feeding very quickly and always from one breast even though I offered both,” says Marjorie, mother of two in the UK, “But when I pumped from using a breast pump, I was surprised at how much milk I produced, and calmed down. I just had to keep feeding her little and often.”

Keep in mind, however, that not all mothers are able to express a lot of milk right away. You can also try hand expressing milk and see if there is a change in breast fullness.

If you're worried about your milk supply, read our tips for symptoms of too little or too much milk.

Literature

1 Pang WW, Hartmann PE. Initiation of human lactation: secretory differentiation and secretory activation. J Mammary Gland Biol Neoplasia 2007;12(4):211-221. - Pang, W.W., Hartmann, P.I., "Lactation initiation in the lactating mother: secretory differentiation and secretory activation." G Mammary Gland Biol Neoplasia. 2007;12(4):211-221.

2 Kent JC et al. Principles for maintaining or increasing breast milk production. J Obstet Gynecol Neonatal Nurs . 2012;41(1):114-121. - Kent J.S. et al., "Principles for Maintaining and Increasing Milk Production". F Obstet Ginecol Neoneutal Nurs. 2012;41(1):114-121.

3 Ostrom KM. A review of the hormone prolactin during lactation. Prog Food Nutr Sci . 1990;14(1):1-43. - Ostrom KM, "Review of the role of the hormone prolactin during lactation." Prog Food Nutr Sai. 1990;14(1):1-43.

4 Cox DB et al. Blood and milk prolactin and the rate of milk synthesis in women. Exp Physiol. 1996;81(6):1007-1020. - Cox D.B. et al., Effects of blood and milk prolactin on milk production in women. Exp Physiol. 1996;81(6):1007-1020.

5 Kent JC et al. Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics. 2006;117(3): e 387-95. - Kent J.S. et al., "Amount and frequency of breastfeeding and fat content of breast milk during the day." Pediatrix (Pediatrics). 2006;117(3): e 387-95.

Signs of lack of milk | Improving lactation

Many mothers are concerned about insufficient milk production, but it is not always easy to find out if milk is really low. Read our article to understand if this is true and what can be done about it.

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“Do I have enough milk?” - a question that is often asked by young mothers. If your baby is healthy and growing well, there is no reason to worry. However, if you are still worried about milk production, it is best to consult a specialist as soon as possible. If everything is in order, he will be able to calm you down. In addition, you will not needlessly feed the baby formula, because of which milk production can really decrease.

Causes of insufficient milk supply

Some mothers do not produce enough breast milk for medical reasons, which include:

approximately three days after birth). ¹
• Polycystic ovary syndrome, diabetes, thyroid dysfunction or other hormonal disorders. In some cases, such diseases lead to low milk production. ²
• A rare medical condition called "mammary hypoplasia" in which there is not enough glandular tissue in the breast to produce milk. ³
• Breast surgery or injury. However, many mothers who have had breast surgery successfully breastfeed in the future. ⁴

If you have any of the conditions listed, contact your lactation consultant or healthcare provider.

How milk is produced

With the advent of milk, the breast begins to work on the principle of supply and demand. Each time after it is emptied, whether it is feeding the baby or pumping, even more milk will be produced.

This is why milk production may be reduced if you give formula to your baby - your body will not get the signal to produce more milk because it will remain.

The way your baby eats also affects milk production. The more often and better he sucks the breast, the bigger it will be. If your baby eats only a small portion at one feeding, it is necessary to express milk regularly to maintain the level of its production. Read more about this below.

Signs that the baby is not getting enough milk

Although low milk production is rare, the baby may have difficulty feeding in the first few weeks, but for other reasons. You may not be feeding him often enough or for enough time, especially if you're trying to stick to a specific schedule. The baby may not latch on properly, or it may have features that make it difficult to take in milk.

The following signs indicate that the baby is not getting enough milk:

• Poor weight gain. In the first few days of life, newborns normally lose 5 to 7%, and sometimes even up to 10%, of their birth weight. However, after that, they should gain at least 20–30 g per day and regain their birth weight by 10–14 days. ^5,6,7 If your baby has lost 10% or more of their weight in the early days, or has not started gaining weight by 5-6 days, you should contact your doctor immediately.
• Not enough wet and soiled diapers. A good indicator of whether a baby is getting enough milk is the number of diapers used per day. Check out our article detailing the norm for wet and soiled diapers in Breastfeeding Your Newborn: What to Expect in the First Week. Seek medical advice if something bothers you or you notice that the number of soiled diapers has begun to decrease.
• Dehydration. If your baby has dark urine, dry mouth or jaundice (yellowing of the skin or eyes), or baby is lethargic, has lost appetite, and may be dehydrated. ⁶ Dehydration can be caused by fever, diarrhoea, vomiting or overheating. If you notice any of these symptoms, seek medical attention as soon as possible.

Misconceptions about lack of milk

Newborns usually eat very frequently, about 10-12 times a day or every two hours. This does not mean that they do not have enough milk. Keep in mind that breastfeeding is also about comfort, so it's hard to tell how much milk a baby eats at each feed as the amount can vary.

You have enough milk even if:

• the child wants to eat often;
• the child does not want to be laid down;
• the child wakes up at night;
• feeding is fast;
• feeding takes a long time;
• after feeding, the child takes another bottle;
• Your breasts are softer than in the first weeks;
• milk does not leak or has stopped leaking;
• You cannot express much milk;
• You have small breasts.

What to do if your milk supply is low

If you suspect that your baby is not getting enough milk, contact your lactation consultant or your doctor. He will determine if you have enough milk and check how the baby is latch-on and if he is getting enough milk. He may also suggest changing the feeding position or the way the baby is attached to the breast to make it easier.

Also try holding your baby close to you more often to increase skin-to-skin contact before and during feedings. This stimulates the production of the hormone oxytocin, which promotes milk flow. Use relaxation techniques, such as listening to your favorite soothing music, to reduce anxiety that can negatively impact milk production. ⁸

With the right support, most under-lactating mothers are able to breastfeed their babies at least partially, and some manage to normalize production.

If your baby is unable to get enough milk directly from the breast (perhaps because he was born prematurely or has special needs), you need to express milk to support his production. Your doctor may prescribe you special drugs that stimulate lactation.

If you are unable to express enough milk, you will need to supplement your baby with donor milk or formula. This should also take place under the supervision of a physician. The Supplemental Nursing System (SNS)* is a great way to help your baby get all the milk he needs at the breast.

How to increase your milk production with a breast pump

If you need to increase your milk production in the first five days after giving birth, you can use a dual electronic breast pump with lactation start technology, such as the Medela Symphony**. Such a breast pump imitates the sucking of the breast by a child and helps to increase milk production in the future. ⁹

After your milk comes in, double pumping allows you to get more milk in less time. ¹⁰ This method helps to better empty the breast, which also improves lactation.

Although every mother is different, it is often recommended to express milk immediately or one hour after a feed. This may seem strange, since it is usually easier to express milk from a full breast. However, the pumping session should be seen as an "investment in tomorrow."

You will probably only be able to express a little milk at first, but don't be discouraged - if you express regularly, your milk supply will increase. Try to empty your breasts - by putting your baby to your breast or expressing milk - 8 to 12 times a day, including one nightly session, when your levels of prolactin (the hormone responsible for producing milk) are highest. The more often you empty your chest, the better. After two to three days of regular pumping, you will notice a significant increase in milk production. For tips on how to get more milk with every pump, see Tips for Using a Breast Pump.

Pumping with massage to get more milk

If your baby is not lating at all or you are not yet able to express enough milk for him, a technique called “massage pumping” may be helpful. It helps mothers increase the amount of milk they get in one pumping session. ^11.12 The whole process takes about 25-30 minutes. Remember that the better you empty your breast, the faster milk is produced in it.

A few simple steps are required:

• Massage your breasts.
• Perform a double pump while wearing a special bustier top that allows you to keep your hands free.
• While expressing, squeeze the chest with all fingers for a few seconds. Release and repeat. Squeeze both breasts until the milk flows in a thin stream.
• Massage your chest again.
• Express milk manually or with a single breast pump, squeezing each breast in turn to empty them as completely as possible.

When your baby starts to gain weight and milk production increases, you can switch to exclusive breastfeeding.

Literature

1 Pang WW, Hartmann PE. Initiation of human lactation: secretory differentiation and secretory activation. J Mammary Gland Biol Neoplasia. 2007;12(4):211-221. - Pang, W.W., Hartmann, P.I., "Lactation initiation in the lactating mother: secretory differentiation and secretory activation." J Mammary Gland Biol Neoplasia. 2007;12(4):211-221.

2 Vanky Breastfeeding in polycystic ovary syndrome. Acta Obstet Gynecol Scand. 2008;87(5):531-535. - Wanky, I. et al., "Breastfeeding in the setting of polycystic ovaries." Acta Obstet Ginecol Scand. 2008;87(5):531-535.

3 Neifert MR et al. Lactation failure due to insufficient glandular development of the breast. Pediatrics. 1985;76(5):823-828. - Neifert M.R. et al., "Inability to Lactate Due to Deficiency of Glandular Breast Tissue". Pediatrix (Pediatrics). 1985;76(5):823-828.

4 Neifert M et al. The influence of breast surgery, breast appearance, and pregnancy-induced breast changes on lactation sufficiency as measured by infant weight gain. Birth. 1990;17(1):31-38. - Neifert M. et al., "Influence of breast surgery, breast appearance, and pregnancy-induced breast changes on milk supply as measured by weighing the baby." Bers. 1990;17(1):31-38.

5 C Tawia S, McGuire L. Early weight loss and weight gain in healthy, full-term, exclusively-breastfed infants. Breastfeed Rev . 2014;22(1):31-42. - S. Tavia S., McGuire L., "Natural Weight Loss and Gain in Healthy, Exclusively Breastfed Full-Term Infants." Brestfeed Rev (Breastfeeding Review). 2014;22(1):31-42.

6 Lawrence RA, Lawrence RM. Breastfeeding: A guide for the medical profession. 7th ed. Maryland Heights MO, USA: Elsevier Mosby; 2010. 1128 p . - Lawrence R.A., Lawrence R.M., "Breastfeeding: A guide for healthcare professionals." Seventh edition. Publisher Maryland Heights , Missouri, USA: Elsevier Mosby; 2010. P. 1128.

7 World Health Organization. [Internet]. Neonatal Care . 2012;12(2):112-119 - Keith D.R. et al., "Effects of listening to music on the amount, fat content, composition and calorie content of breast milk in mothers of premature and seriously ill children." Adv Neonatal Care. 2012;12(2):112-119

9 Meier PP et al. Breast pump suction patterns that mimic the human infant during breastfeeding: greater milk output in less time spent pumping for breast pump-dependent mothers with premature infants. J. Perinatol. 2012;32(2):103-10. - Meyer P.P. et al., "Pumping patterns that mimic breastfeeding behavior: more milk and less time for constantly pumping mothers of preterm infants." J Perinatol (Journal of Perinatology). 2012;32(2):103-10.

10 Prime DK et al. Simultaneous breast expression in breastfeeding women is more efficacious than sequential breast expression. Breastfeed Med . 2012;7(6):442-447. - Prime D.K. and co-authors. "During the period of breastfeeding, simultaneous pumping of both breasts is more productive than sequential pumping." Brestfeed Med (Breastfeeding Medicine). 2012;7(6):442-447.

11 Stanford University School of Medicine [Internet]. Stanford, CA, USA: Maximizing Milk Production with Hands-On Pumping; 2017. [ Accessed 04/30/2018]. - Stanford University School of Medicine [Internet]. Stanford, CA, USA: "Increased milk production from hand expression"; 2017. [Page accessed 04/30/2018].

12 Morton J et al. Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. J. Perinatol. 2009;29(11):757-764. - Morton J. et al., "Manual pumping combined with an electric breast pump increases breast milk production in mothers of preterm infants.

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