Let-down Reflex: Too slow?

August 19, 2011. Posted in: Supply worries

By Kelly Bonyata, BS, IBCLC

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

Relaxation and Visualization Exercises

Related Posts Plugin for WordPress, Blogger...