All About Letdowns- The Milk Ejection Reflex

What is a letdown? A letdown is the milk ejection reflex. This post will dive into what it is, when it happens, why it’s not happening correctly, what happens when it happens too much, how do we make it better, all that stuff. Let’s learn all about letdowns!

(This post was originally a video. Watch it below!)

What is a letdown?

The inside of your breast kind of look like a bundle of grapes and when you are lactating, those grapes get even bigger and fill up with milk. When you have a milk ejection reflex, or a letdown, the hormone oxytocin is produced. It contracts all of the lobules in the breast and pushes that milk from where it’s being stored. The milk goes to the milk ducts then out of the breast. That is the feeling of a letdown, when all the milk is being contracted and pushed out.


If you have been recently pregnant or have taken a birthing class, you have probably heard the word oxytocin. This hormone is part of our everyday lives. There are several different scenarios especially in conception, pregnancy, labor and breastfeeding where oxytocin is utilized.

Women can sometimes have a spontaneous letdown. That is because of an oxytocin surge! Hearing a baby cry, hugging someone, or having sex could all lead to a spontaneous letdown.

A lot of moms are very surprised to learn that you can have a milk ejection reflex during sex and sometimes the partner is very surprised. But really, they should pat themselves on the back because they got those hormones flowing and did a good job!

Don’t be surprised when you experience a letdown when you aren’t expecting it. That does get better over time. Usually after the first month, spontaneous letdowns slow down. Most women stop leaking altogether after awhile unless they’ve gone a long time without feeding.

We also talk about oxytocin in labor because it is the hormone that cause the uterus to contract. Oxytocin also contracts the breast. The milk is being stored in the breast and as soon as oxytocin is released, it contracts that milk down and out.

Variations in Letdowns

Here are some fun facts about letdowns. You can have more than one letdown in a nursing session. Some women only feel the first one, some women feel none. All of those variations are normal. Women that feel letdowns a lot sometimes can’t understand how other women might not feel them. But everyone’s normal is normal!

If you are a pumping mom, you probably notice when you have those second or third letdowns. For example, you might get to the end of your pumping session and feel another letdown. Or if you don’t feel it you might still notice more milk is coming down. This might make you feel like you need to keep pumping, but when you quit pumping in a session is up to you.

Letdowns can also make you feel sleepy. You might notice that you are really tired when you breastfeed, especially at night. It’s very common to have those hormones surge and you can feel tired, sleepy, really relaxed. Breastfeeding is really nice that way.

Dysfunctional Milk Ejection Reflex

There is something called D-MER which is Dysfunctional Milk Ejection Reflex. That is when moms have feelings of anxiety, stress, panic, nausea, or shakiness associated with a letdown. That is not normal, so if you are having some of these feelings, especially when you are having a letdown, that is something you should talk with your practitioner.

If D-MER sounds like a familiar feeling for you, check out this podcast episode! This episode is about a women who had a nursing aversion. She explained how she had these really yucky feelings. She talked very candidly and honestly about what that was like for her. It’s not all happiness and hormones here, but it’s not your fault if you are feeling weird with a letdown.

How do you know when you’re having a letdown?

How do you know when you are having a letdown? What does it feel like? This is a tricky thing to describe! Some women say it feels like pins and needles, that kind of tingly feeling when your foot falls asleep. It’s not the most pleasant sensation, but doesn’t necessarily hurt. It feels like a whoosh as the hormones kick in. It doesn’t last very long.

There are a few ways to tell this is happening or has happened if you can’t feel it. You should notice that the baby is starting to suck and swallow more often. This is a good sign that the milk is flowing! You can usually hear the baby’s swallowing sounds, too. Letdowns can be easier to notice when you are pumping because you can actually see more milk coming into the bottle.

Your breast can also suddenly feel full and heavy. Your milk is always in there, but once it’s letdown from where it’s being stored and moves closer down to the nipple, your breast can feel heavy and full.

Why am I having a hard time with a letdown?

Some common things that interfere with letdowns:

  • Anxiety
  • Pain
  • Embarrassment
  • Stress
  • Cold
  • Excessive caffeine
  • Smoking
  • Alcohol
  • Some breast surgeries if they have interfered with the anatomy of the breast
  • Other hormones that do the opposite of what oxytocin does, such as adrenaline

Being in a public place sometimes can stress moms out and could be hard to get a letdown there.

It could be hard to get a letdown if you are pumping and are not in a private spot.

If you are stressed or cold, again, difficult. Putting yourself in a comfortable and nurturing environment for breastfeeding is really going to help get that letdown quickly.

Please don’t stress about all the technical details of breastfeeding, it will really make it harder. A typical letdown usually comes within the first couple of minutes of breastfeeding., but it will take as long as it takes. The more you breastfeed, the quicker it should come.

It also depends a bit on the baby. If they are hungry, they might be more aggressively trying to trigger that from you. They might be kind of lazy and just sucking for fun or doing whatever they want, it might take a minute.

It might take a bit for you to relax and let the hormones work if you’re busy or stressed so take a breath, focus, and trust your body!

What is a forceful letdown?

Forceful letdowns can be an issue for some moms, when the milk is coming out in a really strong stream. It’s not a problem unless your baby is struggling with it. Older babies can handle this a little better than newborns usually.

Some of the signs that you are struggling with a forceful letdown is that your baby is gagging, gasping for air, going on and off the breast, excessive amounts of milk (even from the other breast) just milk everywhere. Those are some signs that you have an over active letdown.

How can I help baby handle forceful letdowns?

There are a couple of things you can try in this case. The first thing you should do is make sure you’re latching correctly. Your baby should have a lot of your breast in their mouth with the nipple very far back so that the milk just flows down their throat. Babies don’t actually keep milk in their mouth very much. They are just moving their tongue to move it down their throat. So if the nipple is shallow inside the baby’s mouth, they are getting a lot of milk in their mouth instead of their throat making them gag.

Next, you can try unlatching and relatching. Removing your baby from your breast when that big letdown happens if they just can’t handle it can help. Likely, the older they get, the easier it will become for them. They probably aren’t going to love that you took them away from the milk for just a minute, but it shouldn’t take too long. When you feel that letdown you can remove them, catch the milk in something, like a Haakaa or Milk Catcher, a towel, a breast pad or anything you want. Once the flow has lightened up, you can put the baby back on the breast and they should be able to handle it a lot better.

Other recommendations for Overactive Letdowns

Sometimes I see nipple shields recommended for an overactive letdown. These can help taper that flow for the baby.

You can also try some different positions for breastfeeding. With a laid back breastfeeding position, you can use gravity to your advantage. Using this position, gravity is helping keep the milk surge back.

Another good position for over active letdown is laying on your side. The excess milk can just fall out of the baby’s mouth. You will want a towel under you, but it does help baby regulate the flow from an overactive letdown.


Give these things a try! If you’re still struggling, you can schedule a consultation with me, here! Or join our breastfeeding community on Facebook!

All About Letdowns- The Milk Ejection Reflex
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