You’ve got your latch figured out, your baby isn’t biting, but still — hey, that hurts! It’s not something you’ve done wrong: A painful letdown reflex can sometimes be part of your breastfeeding journey.
But the good news is that as your amazing body adjusts to this new role, the letdown reflex should become painless. If not, something else may be wrong. Let’s look at what you should know.
Think of the letdown reflex as an intricate dance in which you and your baby are partners. Your body responds to input from your baby when they begin to feed or cry out in hunger. Sometimes even thinking about nursing them, touching your breasts, or using a pump can begin the process.
When your body gets the signal from your baby it triggers the nerves in your nipple and areola. These nerves send messages to the pituitary gland in your brain signaling it to release oxytocin and prolactin into your bloodstream.
So what do these hormones do? Prolactin signals the alveoli in your breast to remove the sugars and protein from your blood and produce more milk.
Oxytocin makes cells around the alveoli contract and push the milk into the milk duct. Oxytocin also widens the milk ducts so that the milk can flow more easily.
Your milk actually lets down several times during one feeding session, but you’ll probably only feel the first time. Some moms feel the letdown reflex seconds after their baby begins to suck. Some feel it only after a couple of minutes. And some don’t feel anything at all.
Like everything in our bodies, there isn’t an exact timetable or expectation to follow.
Here’s what you might notice:
- A tingling sensation sort of like pins-and-needles. And, yes, it can be disconcertingly intense and even painful. Some moms feel this only in the early days of breastfeeding and then the feeling fades. Others feel letdown during each feed throughout breastfeeding.
- A sudden fullness or warmth.
- Dripping from the other breast. Keep breast pads handy because letdown usually happens simultaneously in both breasts.
- An adjustment in your baby’s sucking rhythm as they change from short, quick sucks to longer paced-out sucks when the milk flows and they start to swallow.
- A sudden thirst.
Researchersaren’t sure why this happens, but it may be due to the release of oxytocin.
There’s a lot going on in your body when letdown happens. Since we’re each unique in our experience of and response to pain, it’s not surprising that some people feel more discomfort than others.
Remember that it can take some time for your body to adjust to the new sensation. Over time, many breastfeeding parents notice less discomfort during letdown.
That said, there are several causes that can make letdown painful. Happily, there are also solutions.
If too much milk flows quickly out of your breast, it can cause pain during the release. Additionally, it can causes issues as your baby will struggle to swallow it all.
Try these tricks to slow down the flow:
- Use your hand or a breast pump to express some milk and capture the first letdown before you settle down to breastfeed.
- Work with gravity. Recline or lay on your back and put your baby on your chest to feed. Your milk flow will be slower with your baby sucking against gravity.
- Alternate breasts at each feeding.
Your body is hard at work learning to produce milk in the quantities your baby needs. Until it learns, you may find that supply exceeds demand. If your breasts are hard and swollen, the letdown reflex can be more painful.
If this is happening to you, consider:
- Expressing a small amount of milk to ease the tenderness. Using a warm compress or expressing milk in the shower can help soften the breasts.
- Applying cold cabbage leaves to your breasts between feeding sessions. Why? It may be that plant compounds in the cabbage have anti-inflammatory effects that can help reduce swelling. Favor green cabbage over purple so that you don’t stain your clothing.
- Feeding regularly. Skipping feeds can increase engorgement.
Clogged milk ducts
Milk that’s trapped in the breast and cannot get out will let you know that it’s there. You may feel pressure and a hard lump in your breast or underarm area where the milk is clogged or blocked.
If you suspect a blocked duct:
- Try to release the blockage with warm compresses, hot showers, and gentle massage.
- Increase your feedings and massage gently at the blockage while your baby is nursing. It works wonders.
- Experiment with different feeding positions to release the clog.
- Begin each feed on the affected breast.
Sometimes, you’ll notice small white spots on your nipples at the end of a milk duct. These “milk blisters” or “blebs” are filled with hardened milk. Just as with clogged milk ducts, you can release the milk using with warm compresses and hot showers.
Noticed red streaks on your breast? Feel like you have flu and that you need some chicken soup? It may be mastitis, a breast infection. Sometimes a clogged duct or other issue can lead to an infection in the breast.
Don’t try to treat this on your own because a breast infection can require antibiotics. It’s important that you see your doctor or midwife for prompt treatment.
In the meantime, you can follow the suggestions above for a clogged duct to alleviate discomfort. Continue to breastfeed and rest as much as possible.
Check that your baby is latching on correctly. If they aren’t your nipples will most likely become red, sore, and cracked. The discomfort from sore nipples can intensify during letdown.
If you’re struggling with sore nipples:
- Promote healing by dabbing some of your breast milk, lanolin, olive oil, or coconut oil onto your nipples after each feed.
- Experiment with different holds.
- Use cool compresses to reduce swelling.
- Seek assistance from a lactation consultant to improve your latch.
This yeast infection is usually caused by a fungus called Candida albicans. It can make nipples appear red or shiny, or they may not look any different than normal. It can also make your nipples crack and hurt horribly.
If you feel burning, itching, or sharp shooting pains, you may have thrush. Since thrush spreads very easily, it’s most likely that your baby has thrush too. Peep into their mouth. A white, stubborn coating on the gums or the inside of your baby’s cheeks will confirm your suspicions. Keep in mind that it is normal to see a thin coating of milk on your baby’s tongue.
Turn to your medical practitioner for help as both you and your baby should be treated with antifungal medication.
Vasospasms can happen in different parts of the body when the blood vessels tighten and go into spasm, preventing the blood from flowing normally. When this occurs in the nipple area, you’ll feel sharp pain or stinging in the nipple.
Vasospasms can happen from exposure to the cold or simply because your baby isn’t latching on correctly.
If you’re feeling vasospasms in the nipple:
- Try warming up your breasts using breast warmers or a gentle olive oil massage.
- Check to ensure you have a good latch. See a lactation consultant if needed.
- Talk to your medical practitioner about supplements or medications that may help.
Giving birth can strain all sorts of muscles, including the chest muscles that support your breasts. This injury can intensify pain felt during the letdown reflex.
We’re back to oxytocin. This multifunctional hormone also makes your uterus contract, especially in the first week or 10 days after birth. The good news is that this is a sign your uterus is returning to its normal size and place. The not-so-good news is that these contractions can get harder and last longer with each subsequent birth.
These contractions can become more painful during letdown. If you’re in pain due to uterine contractions:
- Use a heating pad to reduce discomfort.
- Consider taking acetaminophen (Tylenol) or ibuprofen (Advil).
The hours that you and your baby spend snuggling down to breastfeed are probably some of the most precious hours that you’ll spend together. Here’s what you can do to maximize your comfort.
Easing the letdown reflex
- If you take a warm shower or bath before you breastfeed, you’ll give your letdown reflex a head start. Don’t be surprised if your milk starts dripping before you get dry!
- Short on time? Press a warm, wet towel to your breasts or massage them gently.
- Relax. Sit or lie down and breathe out the stress. You deserve to enjoy this.
- Undress your baby and place them on your chest skin-to-skin with you.
- Cuddle your baby and breathe in that sweet baby smell.
- Condition yourself. Your body will learn to respond to cues that you associate with breastfeeding. Follow a set routine before you start: make a cup of tea, put on some soft music, and breathe deeply.
- It’s hard to time feedings, especially at first. But you can try to take acetaminophen or ibuprofen 30 minutes before feeding time to ease pains.
- Invest in comfortable nursing bras. They’re the tools of the trade and can help avoid pain and clogged ducts.
- Invest in a rocking chair or other comfortable spot to breastfeed.
- Work with a lactation consultant to solve persistent problems.
- Keep a bottle of water handy so you can stay well hydrated.
It’s not just you. At first, the letdown reflex can be a real pain in the breast. Hang in there because this pain should be temporary.
But don’t ignore symptoms or signs that the discomfort you’re feeling could be something more. And don’t forget to slip your breast pads into your bra or else you may find that the front of your shirt is suddenly wet.