A let-down is a conditioned reflex in which your body releases or ejects milk from your breasts.  A let-down makes milk removal more efficient.

A Deeper Look:

When your nipple is stimulated, your body releases two hormones: prolactin and oxytocin.  The oxytocin release causes the muscle-like cells around the milk-making cells to contract, sending milk down the ducts.

When you have a let-down, it may feel like an ache, pins and needles, a tingling sensation, or a sudden feeling of fullness in your breasts.  However, not all mamas feel their let-downs.  For those that do, they may start to feel their let-down in the first few weeks after giving birth as regular pumping establishes the let-down reflex, but they may begin to lose the sensations after several months of EPing.  Even within a pumping session, a mama may feel her first let-down strongly but each subsequent let-down may be less noticeable.  Accompanying the sensations of a let-down may be feelings of warmth, relaxation, sleepiness, or sudden thirst, hunger, or itchiness near your breasts.  You may also see milk start to drip, leak, or spray if you are not already pumping.  If you have recently given birth, a let-down may result in feelings of uterine cramping, which can encourage the movement of vaginal blood flow.

A let-down can happen multiple times during a pumping session and it’s often suggested that EPers should aim for 2-3 let-downs during a pump session.  However, some mamas may have many more within a short time period.  Without a let-down, you are not removing the most amount of milk possible from your breasts, which may signal to your body to stop producing as much milk.

So what triggers a let-down? Many things can!  A let-down may occur unbidden in response to your baby crying, thoughts about pumping, and even showering.  In contrast, a let-down may not occur if you are uncomfortable pumping. Perhaps you are you are at work and are worried someone may walk in on you, or maybe you are in pain while pumping.  Other common let-down inhibitors include: ill-fitting flanges, poor pump suction, stress, cold, anxiety, fatigue, excessive caffeine use, an untreated medical condition (such as a thyroid condition), smoking, and prior breast surgery.   

When you are hooked up to your pump, you can encourage a let-down by using the stimulation mode on your pump.  To encourage a let-down, start pumping using your pump’s stimulation mode until you see milk start to flow (approximately 2-3 minutes), then switch back to expression mode.  When you see your milk start to slow, switch back to stimulation mode to stimulate another let-down then switch back to expression mode.  Massage and compression can also trigger a let-down while you are pumping.  For more information on using massage and compression while pumping, click here. 

Other tips besides massage and compression to encourage a let-down:

• Try a heat pack or hot shower before pumping
• Pump near your baby or if your baby is not around, try viewing pictures or videos of your baby or smelling something that belongs to them, like a blanket
• Indulge in self-care—do something that relaxes you, such as watching a favorite show or drinking a cup of you favorite tea
• Try to pump somewhere you are comfortable—somewhere with good back support and a comfortable temperature
• Make sure you have a quality pump that is strong enough and cycling enough to encourage a let-down
• If pumping causes you pain (it should not), address the cause of the pain.  For more information on troubleshooting pain while pumping, click here.

Between 6 and 12 months postpartum, some women notice their let-downs take longer.  This could be a sign of a dwindling milk supply.  You may consider using a higher speed and suction as time goes on and employing tactics known to increase milk production. For more information, click here.

There are also some tougher aspects of achieving a let-down, for example:

Dysphoric milk ejection reflex (D-MER):

• a syndrome that may occur just before a let-down, that causes some mothers to experience negative emotions that may last up to two minutes.  For more information, visit www.d-mer.org.

Feelings of nausea when pumping:

• Nausea brought on by milk removal is thought to be a gastric hormonal response—eating something before nursing may help prevent nausea

• Often the nausea decreases as pumping is established and usually disappears within 8 weeks of giving birth 

Lactational headaches:

• Headaches that occur with a let-down.  Sometimes this disappears by 8 weeks other times it only resolves after weaning.  However, because headaches could be an indication of many different issues, it is best to consult with your healthcare professional to determine the exact cause.

The EP&Me Take:

Honestly, this let-down business is tough!  If I had to pick one thing that I truly believe helped me to successfully EP for a year it would be that I maintained a consistent pump schedule the first few months.  I did not know until after I had weaned from the pump that my strict schedule was conditioning my body to let-down at particular times of the day, nor did I realize that my routine of hooking up to the pump (which was exactly the same every time—from how I assembled the pump parts to the order I placed them on my breasts) was another way I was conditioning my body to respond. 

With the first let-down of my pump session I always experienced nausea, sudden thirst, and itchiness on my breasts near my armpits.  The feelings of thirst and itchiness usually stopped about 5-10 minutes into pumping, but the feeling of nausea usually lasted through my second let down (about 17-20 minutes).  Around 9 or 10 months postpartum, the nausea lessened and stopped altogether, but the thirst and itchiness continued until I weaned from the pump.  In my case, eating food prior to pumping did not help the nausea, and I actually think it made things worse.  I usually just tried to combat the nausea by drinking small sips of water, which helped with the sudden thirst too, so that was a win-win!  

Although I did not usually struggle with achieving a let-down on normal days, when I was sick, things went haywire!  Being the type of sick where you have chills and you feel alternately hot and cold makes pumping MISERABLE.  Pumping is such a weird icky sensation when you are feverish.  Generally, when I was sick my first let-down still occurred quickly, but trying to get a second and third let-down (which were not a problem normally) took much longer.  It was on those days that I was most negative about the fact that I had to pump.  I don’t know if it was my attitude, or being sick, or being stressed over the craziness that ensues when your family—and infant!—are sick that caused the delayed let-downs, but I wish I had thought to try using a heat pack or hot shower to see if that helped.

As far as needing to increase the amount of suction the longer you pump, I found that similar to conditioning your body to let-down, you can also condition your body to express milk at lower suctions.  I started off EPing at the recommended suction—one step below discomfort.  By the time I was 6 months postpartum, I was approximately five levels below discomfort, and honestly, pumping was much more relaxing at this slower pace.  I consistently used massage and compression techniques to aid in milk removal, and I think the combination worked well for me.  My best advice is to assess your needs and goals, then inform yourself with the tools you need to achieve those goals and give a new technique a go!  If it works for you, great!  If not, try something else.  For those of you that have a goal of EPing for a year, that is a long time to pump under conditions you may deem “fine.”

One last thing, while I certainly leaked milk the first few months postpartum, I still continued to leak at least a few drops of milk here and there until I was fully weaned.  For me, investing in quality breast pads were a must and I never once had an issue with milk leaking through into clothing.  I loved these. Although they were certainly not the most fashionable item, they washed well, were durable, absorbed well without making me feel moist, stayed put in my bra, and were soft against my skin.  What more could you ask for? Good luck getting those let-downs mama!