What causes painful letdown and how to get relief

Feb. 11, 2020

You’re nursing your sweet baby and soon after the milk begins to let down and start flowing, you feel a rush of shooting, burning pain in your breasts. It makes you hold your breath for a second. But within a minute or so, the sensation passes. You wonder: Is this normal? Is letdown during breastfeeding supposed to hurt this much? Is there anything I can do to fix this? 

It can be difficult to determine how common painful letdown is among breastfeeding moms, says Ginny Bowers, CNM, IBCLC, a board-certified nurse-midwife and lactation consultant from Anne Arundel Medical Group at Chesapeake Women's Health in Easton, Maryland. 

“Everybody’s personal perception of pain during letdown is a little different,” says Bowers. “It can change from one feeding to another — and one mom may even have a different experience between one baby and another.” 

In Bowers’ practice, she finds that about 20% of new moms experience what she would refer to as painful milk letdown.

What is the breastfeeding letdown reflex?

If you’re experiencing painful letdown and trying to figure out if there’s a solution, it’s helpful to understand what the letdown reflex is. 

“The breastfeeding letdown reflex, or milk ejection reflex, occurs when the nerves in the nipple are stimulated, leading to release of oxytocin, which causes contraction of the smooth muscle in the breast,” says Dr. Angela Dietrich-Kusch, a pediatrician and lactation support specialist with Riley Children’s Health

This causes milk to be pushed down into the milk ducts, where it’s extracted by your baby’s suckling, says Dietrich-Kusch. 

The letdown reflex is usually experienced at the beginning of a feeding and coincides with when your milk begins to flow, says Bowers. You may notice your baby gulping or swallowing milk at this point. Bowers says the letdown reflex doesn’t just happen when you are nursing, but it can also occur when you are pumping or even when you think about your baby or hear a baby cry. 

What does normal letdown feel like?

When it comes to letdown, says Dietrich-Kusch, it’s difficult to define normal since every person’s experience is different. However, she says, her patients usually describe letdown as “a mild to moderate tingling or tightening sensation in the nipple or breast.” 

During the immediate postpartum period, these sensations may coincide with normal cramping in the uterus, says Dietrich-Kusch. 

“But often mothers will not necessarily know when letdown occurs, especially in the first few days to weeks of breastfeeding,” she says. 

What does painful letdown feel like?

Wendy Cruz-Chan, a mom of two from Brooklyn, New York, says painful letdown felt to her like “a sharp pain pulsing.” 

Jennifer Sokolow, mom of three from West Hempstead, New York, describes it as “a tingling pain that also felt like the pain of stretching a tight muscle. It always made me think of a rubber tube stretching, like the bolus of milk was bigger than the duct so the duct had to stretch to accommodate it.” 

Sokolow said the pain lasted about 10 to 20 seconds per letdown. 

In her practice, Bowers says women who experience painful letdown often describe it as “toe-curling pain” or pain that is “a little more significant than the pins and needles pain that moms usually experience with normal letdown.” 

Common causes and remedies of painful letdown 

1. Overabundant milk supply

By far, says Bowers, the most common cause of painful letdown is overabundant milk supply.  Sokolow says this was the cause of her painful letdowns.

How do you know if you are dealing with overabundant milk supply? 

“Overabundant milk supply may make the letdown feel more intense,” says Dietrich-Kusch. “Other signs of this in the infant may be coughing, choking, sputtering at the start of the feed when letdown tends to be the strongest.” 

Remedies:

Breastfeeding in a reclined position, emptying the breast often (every two to three hours), and taking over-the-counter pain relievers can be helpful for painful letdown related to overabundant milk supply, says Bowers. 

In addition to frequent breastfeeding and making sure that the breasts never get overfull, Dietrich-Kusch recommends hand expressing or pumping a small amount of milk prior to latching baby to the breast. 

2. Bacterial infections

Bacterial infection of the breast (mastitis) is another common cause of painful letdown, though in most cases painful letdown isn’t the only painful sensation experienced. 

“Bacterial infections of the breast (mastitis) can also cause breast/nipple pain,” says Dietrich-Kusch. “This pain is not just with letdown. Other signs of mastitis are: breast redness, red streaking, increased breast tenderness and maternal fever and flu-like symptoms.” 

Remedies:

Bacterial infections require medical attention, says Dietrich-Kusch. She says moms who are experiencing a breast infection should continue to keep emptying their breasts through breastfeeding or pumping. 

“They should be seen by their physicians, as they will likely need to be treated with an antibiotic,” says Dietrich-Kusch. 

3. Vasospasm

A lesser-known cause of painful letdown is vasospasm of the breast. Cruz-Chan eventually found vasospasm to be the cause of her painful letdowns; Bowers has seen a correlation between moms who have vasospasm of the breast and painful letdowns. 

According to the journal Breastfeeding Medicine, vasospasm is caused by reduced blood flow to the breast. Exposure to cold and poor latch can cause vasospasm. Common symptoms are blanching (whitening) of the nipple, as well as a burning, throbbing sensation in the nipple, similar to how many moms describe painful letdown. 

Remedies: 

Bowers says applying heat to the breast can be very helpful with vasospasm and may relieve symptoms of painful letdown. Other remedies for vasospasm include making sure your baby is latching comfortably and wearing warm clothing during and after breastfeeding. 

4. Yeast infections

Yeast infections of the breast (thrush) are another possible cause of painful letdown. 

“Yeast infections can also cause a burning/stinging/deep pain in the breast,” says Dietrich-Kusch. 

She says this pain isn’t just associated with letdown; you would experience other symptoms of yeast infections as well, including “a more red or swollen appearing nipple.” 

Remedies:

Although some moms choose to try at-home remedies such over-the-counter fungal creams, breast yeast infections usually require a doctor visit. 

“If a mom suspects a nipple yeast infection, the mom should seek medical care,” says Dietrich-Kusch. “Both mom and baby should be treated with antifungal medication.” 

How long does painful letdown last?

Depending on the cause, painful letdown usually lasts about a month, rarely longer, says Bowers. For most breastfeeding people, painful letdown can be soothed with at-home remedies such as frequent breast emptying and good breastfeeding positioning. However, sometimes these solutions don’t work, and a visit to your healthcare provider for evaluation might be in order. 

“If the pain is severe enough for them to come and see me, it’s probably something that requires further assessment,” says Bowers.

Your healthcare provider may want to perform a breast evaluation and rule out any infections. 

The good news with painful letdown, says Bowers, is that for most of the moms she sees, the experience is usually temporary, manageable and resolves on its own.

Tips and stories from parents and caregivers who’ve been there.

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