Why is Let-down Painful when Breastfeeding?

Why is Let-down Painful when Breastfeeding?

Motherhood is full of ups and downs, and this makes the whole experience something exciting and memorable. Looking back at the time while you were pregnant, the joy and glow you had while carrying your baby were balanced out by equal moments of discomfort and pain—especially the ultimate pain of delivering your baby.

While you have climbed the biggest mountain after giving birth, unfortunately, that does not mean you have said good-bye to pain forever. Now you have begun to breastfeed; you may experience another kind of pain.

Normally, breastfeeding should not hurt, but for first-time breastfeeding mothers, there may be discomfort, irritation, or some degree of pain depending on several factors. Things like improper positioning, teething, or possible trauma, or even infection may be to blame. Sometimes the release, or let-down, of milk itself can be painful.

Thankfully, this pain or discomfort will not last forever, and there are ways to alleviate it. If pain persists or increases over time, it may be an indicator of an underlying condition that should be addressed by you and your doctor.

About the let-down reflex

You may or may not already be familiar with this reflex, but breast milk let-down reflex or milk-ejection reflex is your breasts’ natural response when your baby begins to latch on. Similar to a cough or the knee-jerk reaction, the let-down reflex happens automatically without having to control it yourself.

When your baby latches on to your breast and begins to feed, the sensation triggers an upward signal to the area of your brain that makes and releases certain hormones. These hormones are prolactin (pro-lactation) and oxytocin (the same hormone that induces uterine contractions), which come from the pituitary gland.

Normally, reflexes of the body are natural and happen without controlling a muscle or even giving it a thought. The milk let-down reflex is not supposed to cause pain unless other things are going on in the body such as the flu accompanied by body malaise, inflammation of the breast tissue (mastitis), or a backed-up milk duct.

Signs and symptoms and what they might mean:

Normal Let-downMastitisNipple ThrushBreast Cancer
Breast painY/NYYY
Skin changesNNYY
Increased vascularizationNYNY
Leaking breast milkYYYY
Blood in breast milkNY/NY/NY
Discharge from breastNY/NYY
Firmer breastsY/NYNN
Hard massNYNY
Presence of feverNY/NNY/N
Lymph node enlargementNNNY

Note: this table is not meant to be used to diagnose any illness or condition. Consult with your doctor if you experience any of the above signs and symptoms and have concerns about your health.

Should it hurt when your milk lets down?

The short answer is no—pain while breastfeeding is not ideal. However, it is not uncommon. Discomfort at times is expected, but pain is rare and may be a sign of an underlying problem. 

During milk let-down, signs of the let-down reflex include a pins and needles sensation with or without a feeling of warmness in your breasts. Leaking may occur in either breast, regardless if your baby has nursed from it or not. 

The signs of let-down are not limited to the breast area. Some mothers who have recently given birth experience cramping similar to premenstrual symptoms (PMS) or period pains. These feelings are generally mild and tolerable but should not reach the point where they are considered painful.

Why does it hurt when my milk lets down?

Many factors contribute to discomfort and possible pain during milk let-down. One major factor of this is the hormones that are involved in the let-down process. The surge of prolactin promotes the production of milk. The release of prolactin also causes a small spike in estrogen and progesterone, which can cause you to become more sensitive to pain sensations.

Breast tissue has many nerve endings with the highest concentration of these nerve endings located in the nipple and areola. These nerve endings are essential in the let-down reflex as the latching on of a nursing child triggers the release of the hormones mentioned above. However, it also makes the breast more susceptible to pain during milk production, ejection, and feeding.

Progesterone and estrogen induce secretions of prostaglandins as well as sensitize pain receptors, which can make contact and movements that are normally painless feel painful or uncomfortable. Prostaglandins are a type of chemical released by tissues which can cause pain and inflammation and play an important role in controlling bleeding and tissue response after injury. Some studies have shown prostaglandins both promote and suppress milk ejection.

If you produce excess breast milk, this can also cause some pain. Your breasts may be uncomfortably full, leading to eventual leaking of breastmilk and strong let-downs. Breast milk release is usually due to the latching of an infant, and their suck determines the flow, but with milk oversupply, the flow may be too fast, which can be painful. Excess milk not removed from the ducts of your breast can lead to blockage, mastitis, and even affect your baby’s ability to feed.

How long does the let-down pain last?

Fortunately, like most types of pain, let-down pain does not last forever. During the early postpartum phase of breastfeeding, your hormones have shifted from maintaining your pregnancy to nurturing your baby outside of the womb. During your first few breastfeeding sessions, your prolactin levels may go into overdrive, creating an oversupply of milk that eventually leads to forceful let-downs and breast pain.

Within the first few weeks, your body will react and adjust to your baby’s feeding patterns. These hormones may continue to fluctuate for several months, depending on how your body produces and responds to them. Your body’s response is dependent on your baseline and pregnancy hormone levels, and the time it takes to regulate can vary from pregnancy to pregnancy.

Pain associated with milk let-down can be managed and eased over time, even if your hormones levels are still adjusting.

How do you deal with forceful letdown?

The main culprit of engorgement and forceful let-down is an oversupply of breast milk. Like a dam filled with water, the way to relieve the built-up pressure in your milk ducts is to make sure you extract as much volume of milk that is produced.

Ways to release excess milk from your breasts include longer breastfeeding sessions, more frequent breastfeeding, or milk expression using a breast pump. 

Some things you can do to deal with excess milk and reduce the force of let-down include:

  • Keeping your baby close to encourage frequent breastfeeding.
  • Breastfeeding in intervals as short as every one to two hours throughout the day.
  • Hand expressing and using a breast pump to remove and store extra milk in case your baby does not feed frequently enough.
  • Applying ice or a cold compress to the breast in between feeds can reduce swelling and discomfort.
  • Applying a warm compress or taking a warm shower before breastfeeding can help blood flow and ease the let-down of milk once your baby latches on to feed. 

How do I know if my letdown is too fast?

Indicators that you have an excess milk supply and your let-down is too fast:

  • Breasts are engorged, feel overly firm, and may be painful when touched.
  • Milk leaks between feedings or sprays out after your baby stops feeding.
  • Your baby has trouble staying latched onto your breast.
  • Baby has trouble swallowing milk, and often spluttering or choking during feedings.
  • She stops feeding after a shorter amount of time compared to his/her usual.
  • Over time, your baby may gain weight at a faster than the normal rate due to the increased volume of milk he/she consumes.

It is important to establish proper and regular breastfeeding habits for both you and your baby early on to prevent oversupply and engorgement. Engorged breasts not only make breastfeeding painful for you but can also make it more difficult for your baby to latch on and feed—creating a sort of cycle of decreased release and excess supply, which can lead to mastitis if left unmanaged.

Frequent feedings and the use of a breast pump can be a double-edged sword at times because of milk production and the let-down reflex work in a positive feedback loop. This means that the more the nerve endings in the breast tissue— or even the thought of breastfeeding itself— can trigger milk let-down and increase the amount of milk that is churned out.

References

“Effects of Drugs on Milk Secretion and Composition.” Drugs and Human Lactation: a Comprehensive Guide to the Content and Consequences of Drugs, Micronutrients, Radiopharmaceuticals, and Environmental and Occupational Chemicals in Human Milk, by Peter Bennett and Allan Astrup-Jensen, Elsevier, 1996.

Fisher, Evelina. “Oversupply: Symptoms, Causes, and What to Do If You Have Too Much Milk.” Breastfeeding USA, 22 June 2016, breastfeedingusa.org/content/article/oversupply-symptoms-causes-and-what-do-if-you-have-too-much-milk.

La Leche League International. “Pain: General.” La Leche League International, 13 Oct. 2019, www.llli.org/breastfeeding-info/pain-general/.

OpenStax. “28.6 Lactation.” Anatomy and Physiology, OpenStax, 6 Mar. 2013, opentextbc.ca/anatomyandphysiology/chapter/28-6-lactation/.

Murray, Donna. “The Let-Down Reflex During Breastfeeding.” Verywell Family, Verywell Family, 20 Sept. 2019, www.verywellfamily.com/the-let-down-reflex-431588.

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