Common misunderstandings about your letdown or milk ejection reflex

The milk ejection reflex is genetically encoded in placental mammals and actually very difficult to disrupt

Often women hear that the reason why their baby isn't getting enough milk is because their letdown isn't working properly. If milk isn't being removed from your breasts often enough, repeated experiences of rising pressure in the milk glands will quickly dial down your supply.

You might hear that you need to keep your letdowns working well by keeping to a routine around feeding, by using relaxation exercises, warmth, avoiding others looking on, and distraction if your letdown seems slow to start. All of this misunderstands how letdowns work, and might cause you a lot of unnecessary worry!

Your letdowns, or milk ejection reflexes, are not something you need to worry about. There's plenty of things in breastfeeding that can cause problems, but letdowns are robust. Your letdown or milk ejection reflex is a genetically encoded or hardwired central nervous system and neurohormonal response, very difficult to disrupt. You can trust it. We don’t have to worry about letdowns in the same way we don’t have to worry about getting our stomach acid secretion right when we're eating. It will look after itself.

If your baby breastfeeds with a good stable position and no breast tissue drag, and you make frequent flexible offers of the breast (and other breastfeeding problems have been sorted out), then over a 24-hour period - regardless of how many letdowns occur in any particular encounter with your breast - your baby will transfer the milk he needs.

Baby's fussy behaviour at the breast doesn't tell you anything about your letdowns or your supply

Breastfeeding women are often wrongly told they have a letdown problem or poor milk ejection reflex as an explanation for why their baby isn't getting enough milk or is fussing at the breast. You might even be told that feeling stressed inhibits your letdown.

Whilst there are many reasons why your baby may not be gaining enough weight or fussing at the breast, such problems won't be due to a failure of your letdowns, and it won't be because stress has slowed down your letdowns, despite what you might hear.

When your baby fusses at the breast, it is not a sign that she can't cope with your letdown, or that she is frustrated because you are not having a letdown! It is also not a sign that you don't have enough milk.

A baby who is positionally stable manages lovely vigorous letdowns with ease (particularly after the first couple of weeks of life). A baby who is hungry but who is positionally stable stays on the breast suckling for long periods, and is likely to marathon feed, not pull off. The baby's behaviour does not tell you anything much about your supply or letdown. Of course, you can see the pattern of suckling move into something close to a suck-swallow-suck-swallow-suck-swallow with the letdown, and you'll hear the active 'k-k-k-' sounds of the swallow too, with the jaw dropping. But a breastfeed is much more than the letdown, and milk is being transferred by vacuum generation even during the 'suck-suck-suck-suck-suck-swallow'. People call this non-nutritive sucking. But this is a mistaken term, because it makes you think that the in-between times with less vigorous swallowing is not an important part of the breastfeed. It's when the baby catches his or her breath and draws out small volumes. It meets the baby's powerful biological need to suckle and be close to you for a time.

If your letdowns are inappropriately blamed for baby weight gain or breastfeeding problems, the true underlying issues may not be dealt with

You might be concerned that

1. You're not having a letdown at all

2. You're not having enough letdowns

3. Stress is interfering with your letdown

4. Your baby is fussing at your breast because the milk hasn’t let down

5. Your baby is fussing at the breast your letdown is too strong or is overactive.

There is no evidence to suggest that some women have stronger letdowns overall than others. A fuller breast does have more vigorous letdowns, because it contains a greater volume of milk compared to a less full breast. However, breast fullness is not a sign of how much milk you're producing overall. In fact, if your breasts are running full a lot of the time, this will dial down your supply.

Common concerns about milk letdowns	Why you can be reassured
I'm not having a letdown at all	Many women don’t feel their letdowns, or only feel the first letdown in a feed. You don’t need to worry about whether or not you are having a letdown. There are other much more important ways to know if your baby is getting enough milk – these are the things to focus on. You can find out how to know if your baby is getting enough milk here.
I’m not having enough letdowns	As above
Stress is interfering with my letdown	It is not stress, but the way stress affects your behaviours and body posture, which can interfere with letdown. You might be highly stressed, but your breastfeeding relationship continues to be a source of calm enjoyment for your baby (and maybe even for you, though I know it's not always easy to enjoy things in situations of stress). Whilst the letdown is a reflex that is hardwired and not interfered with by stress, behaviours or actions which result from stress can impact on breastfeeding e.g. feeling under pressure to make sure baby gets enough in a breastfeed, or spacing out feeds. You can find out about stress and letdowns here.
My baby is fussing at the breast because my milk hasn’t let down	Fussing at the breast is typically due to positional instability. A baby who is hungry and is not getting enough milk, but is in a stable position at the breast, will typically 'marathon' feed, suckling for long periods throughout the day and night.
My baby is fussing at the breast because she can’t cope with my strong or overactive letdown	Fussing at the breast is typically due to positional instability. Apart from during the first couple of weeks, babies comfortably manage the range of letdown volumes and strengths, as long as they are positionally stable and the sucking biomechanics are working for them. In the early days after the birth, your tiny baby might pull off the breast coughing and spluttering with the letdown. Just make sure the fit and hold is stable, and bring your newborn back on when you're both ready.

Recommended resources

Do you have Dysphoric Milk Ejection Reflex?

What causes Dysphoric Milk Ejection Reflex?

You can find out more about the neurophysiology of your milk ejection reflex here.