Letdown, also knows as milk ejection reflex, is the physiological process by which the breast releases milk from the milk producing glands into the milk ducts for access by the baby. Many women feel a tingling or squeezing sensation when this occurs. The absence of this feeling does not mean that milk is not letting down – some women feel nothing. As long as you can tell letdown is occurring by seeing the baby's sucking pattern deepen and slow, and the baby is gaining weight at an acceptable rate, don't let it alarm you. However, on the other end of the spectrum, letdown can sometimes be quite painful, especially early in breastfeeding.
When I was learning to breastfeed my first daughter, we had a slow start due to poor latch and my milk never came in properly. I was somewhat high strung because of this, and was pumping a lot and feeding back the expressed milk each feeding. When the milk finally came in strong, I found that I would have almost excruciating pain when my milk let down at the start of a feeding. Subsequent letdowns hurt, but less each time. I mentioned it to my pediatrician, who was monitoring our progress carefully, and she diagnosed the pain as likely thrush. This turned to be incorrect.
I think that it is important to know that it is within the range of normal for letdown to be painful, especially during the early months as the milk supply adjusts to your baby's needs. In my experience, nipple trauma or soreness increased the amount of letdown pain. This seemed to pan out when there was nipple trauma later in nursing and the painful letdown returned temporarily. In my case, at least, the pain faded as my nipples healed and milk supply settled in. It's worth mentioning though, that while in my case, the pain did seem to be normal, an experience like that can signal thrush, so if you have access to a lactation professional, it would be worth running it by them.
With my second baby, we had a strong start, and as soon as engorgement hit, I found that I had that same awful pain again. But this time, I knew that it was normal, and by not further traumatizing my nipples with unnecessary treatments, the pain faded more quickly. Painful letdown may occur along with overactive letdown (see my articles on this topic in related links below), and may fade about the same time.
Even two years later, I still experience a very slight pressure that signals letdown. It's actually nice to know that the milk is still letting down. As my milk supply decreases, the letdown often takes longer to materialize, and I sometimes have to help it along (see my article Stimulating Letdown in related links below), but I can still feel it when it does.
I wish I could point you to more scientific information on painful letdown, but to be honest, I've not found really any discussion on this on other sites. So my assertions here are really more anecdotal from my own experiences and those of other breastfeeding friends. But I thought it was worth sharing, because when I was experiencing that pain early on, it never occurred to me that it might be a normal phase of breastfeeding, and I would have loved to have found an article like this to suggest that possibility.
So, if you are having painful letdowns, discuss the issue with your health care provider, but do consider or bring up this possibility that all is actually well when making your assessment.
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