It is normal for let-down not to feel as strong as baby gets older. Some of us 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. Remember, just because you don’t feel it or it feels different over time, or any mean it’s not happening.
Signs of let-down include:
• Uterine cramping during letdown in the first week postpartum
• Baby’s sucking pattern changes from a quick suck-suck to a rhythmic suck-swallow pattern as milk begins to flow
• Feeling of calm, relaxation, sleepiness or drowsiness.
• Sudden thirst
• Leaking from the other breast
• Tingling, pins and needles sensation, itching, nausea, headaches, or negative emotions
Things that can be the cause of a slow or inhibited let-down:
• Anxiety, pain, embarrassment, stress, cold
• Certain medications
• History of breast surgery where nerve damage that can interfere with let-down.
• In extreme situations of stress or crisis, the release of extra adrenaline in can reduce or block the hormones which affect let-down from a fight or flight response
• 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.
• It’s normal to have a harder time letting down for the pump than baby.
Later into your breastfeeding journey, you may notice it takes longer to trigger a let-down. This is common and what works early on may change over time.
Check for possible causes:
• Worn pump parts that need replaced. Replace the valves and membranes often. Check for worn tubing.
• Make sure you’re pumping with the correct flange size. Nipples may become more elastic over time and a different size may be used.
• Starting your period or are you possibly pregnant? Both can decrease milk production and impact let-downs.
• New hormonal birth control or medication? These may impact supply.
• Check your body. Tension, pain, cold, fatigued or anxiety may block the neurochemical pathways required for milk let-downs.
Tips to trigger let down:
• Try a different pump or flange size
• Use heat, breast massage/compressions, or vibrations to prompt milk flow
• Orgasm. The same hormone released during orgasm also causes let down. Studies show having an orgasm can help let down
• Relax. Use slow, deep breaths and meditation
• Singing or humming can also speed let-down
• Gently massage your breasts. Stroke your breast towards the nipple with the flat of your hand or edge of a finger. Gently roll your nipple between your fingers
• Watch videos of your baby. Smell their clothing. Remember the feeling of let down
• Use all of your senses to facilitate let-down. Concentrate on the sight, sound, smell and feel of your baby.
• Take a warm shower or bath prior to nursing
• If you are in any pain, consider taking a pain reliever about 30 minutes before you feeding. Pain can cause stress and inhibit let-down.
• Choose a calm, less distracting setting
• Turn on music or a tv show that you enjoy
• Skin to skin contact with your baby: Undress baby to their diaper and yourself from the waist up. Stay like this for 1-2 hours prior to a feeding
• Eat a favorite snack and drink a comforting beverage like warm tea
• Get comfortable. Sit in a comfy chair or lay in bed. You should be in a comfortable position
• Switch nurse: move baby back and forth frequently between breasts until let-down occurs
• Nurse in a warm bath
• Reverse pressure softening helps let-down for some moms.
• 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). Imagine milk flowing or use images of waterfalls. An excellent book on visualization techniques is Mind Over Labor by Carl Jones.
• Distraction: watch TV, read, talk to a friend, don’t watch the pump bottles.
• 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.)