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Coping With Painful Letdown

Keren Perles
July 20, 2015

If breastfeeding pain is making you cringe, here are some steps you can take to ease your discomfort. Find out the causes and treatment of painful letdown.

While breastfeeding your baby, do you feel a sudden rush of burning pain in your breast as soon as your milk starts to flow? Sure, pain and motherhood seem to go hand in hand sometimes, but is a painful letdown reflex normal? Experts say the answer isn't as simple you might think.

What Is a Letdown, and How Is It Supposed to Feel?
What we call "letdown" is technically the milk ejection reflex (MER). The pathway for the nerve that controls the MER runs through the brain, so infant sucking or thoughts about your baby can trigger the MER, causing uncomfortable letdown sensations in some women. However, it should not be excruciating and should only last a few seconds. If it's burning or stabbing or nipple pain, you should see your doctor.

While some women cannot feel letdown at all, those who do normally describe it as a "pins and needles" feeling or as pressure. "I liken it to a foot that falls asleep, and when you bang it on the floor, it starts to come back -- that's the most intense a woman would normally feel," says Robin Kaplan, an International Board Certified Lactation Consultant (IBCLC) and owner of the San Diego Breastfeeding Center.

Also, normal letdown sensations usually let up after the first month or two of breastfeeding. If the sensation goes beyond pressure and discomfort and becomes truly painful, it may be a sign of something atypical going on. 

In fact, Lisa Marasco, an International Board Certified Lactation Consultant (IBCLC) and co-author of "The Breastfeeding Mother's Guide to Making More Milk" experienced painful letdown herself for the first few months of breastfeeding without any pathological reason, which she says is somewhat unusual. In her case, she had an overabundance of milk that came out very forcefully. "I used to describe my letdowns as a freight train coming down the track," she says.  "It wasn't a debilitating pain, but it was uncomfortable."

At the same time, because the pain was limited to her letdown, it was manageable. A mother who experiences a pain during letdown for other reasons may describe it as a burning or stabbing pain, or as nipple pain, all of which need to be addressed by a doctor.

Ease the Pain
Treatment for painful letdown will depend on what's causing the pain. Here are some potential causes and how you should handle them:

  • An Overabundance of Milk and Fast MER
    This situation isn't dangerous but could be the culprit. If an overabundance of milk and fast MER is at fault, Kaplan recommends changing positions to slow the flow of the milk. For example, a lactation consultant might suggest leaning back while breastfeeding, in a reclined position, to force the milk to work against gravity. You should also make sure to avoid getting overly full, says Marasco, emphasizing that substituting a normal feeding for a bottle of formula can exacerbate the situation.
     
  • A Bacterial or Fungal Infection
    If the mother has experienced relatively painless letdowns in the past and painful letdown is a recent development, Marasco says she would suspect the cause to be a bacterial or fungal infection in the milk ducts. Some infections present with redness, but others are subclinical infections, meaning that they don't present with obvious clinical symptoms and are therefore harder to diagnose.

    Pain during letdown can also be a symptom of thrush or a side effect of previous breast reduction surgery, Kaplan says. If an infection is causing the pain, a course of antibiotics or alternative remedies can address the problem. In the short term, the Mayo Clinic says that ibuprofen is safe to provide some relief until the infection or inflammation has been treated.


Both Marasco and Kaplan encourage moms with a painful letdown reflex to consult a certified lactation consultant for help determining the cause and potential treatment. If antibiotics or other medical interventions are needed, the lactation consultant would notify your doctor, who can prescribe whatever's necessary.

Keren Perles has raised and breastfed three sons. As a freelance writer, she enjoys helping other moms share in the great experiences of motherhood.

* This article is for general informational purposes only. It is not intended nor implied to be providing medical advice and is not a substitute for such advice. The reader should always consult a health care provider concerning any medical condition or treatment plan. Neither Care.com nor the author assumes any responsibility or liability with respect to use of any information contained herein.

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