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Possible Reactions to a Let-Down

A let-down is the quick milk flow. As you possibly noticed, when you pump, your milk doesn’t always flow at the same pace. You first see drops coming out, then a faster flow that lasts for seconds to a couple of minutes, and then drops again. A woman may experience multiple let-downs within the same feeding.


And how do you know when you are having a let-down?


You may feel a prick, a pinch, a current discharge, tickles, or just movement inside your breasts. Most women describe it as not painful but a peculiar sensation.


Some women don’t feel anything at all, though. I like to ask all of my patients what they feel at a let-down (if they do), and probably only 50% of them report having any sensation at all.


On the other hand, when the baby is on the breast, he’ll probably change his sucking pattern to a more active, gulping mode, and that’s how you know you’re having a let-down.


In some cases, moms may experience more extreme reactions, and whether they’re not very common, there’s some research about it, which I believe is worth mentioning.


Two other types of severe reactions to a let-down are currently well-documented in the literature. One is called “Dysphoric Milk Ejection Reflex (D-MER),” and the other one is called “Lactation Anaphylaxis”.


D-MER, the first one, is an uncommon reaction to the hormonal boost when a let-down takes place. The mother experiences a wave of negative emotions that lasts for a few minutes and then disappears as the let-down ends. Some of the common feelings include sadness, anxiety, hopelessness, self-hate or low self-esteem, panic, or even rejection of the baby.


The Lactation Anaphylaxis is a severe allergic reaction. While rare, it could present as hives or airway blocking, potentially life-threatening. This is also caused by the sudden drop in progesterone that happens at birth. According to the Infant Risk Center, the reactions may be worsened by the use of painkillers, as they’re linked to exaggerated histamine responses.


During my years of practice, I only encountered one mom with lactation anaphylaxis symptoms. She was having hives every single time she breastfed, which made her very uncomfortable.


However, despite how scary these uncommon reactions sound, symptoms usually improve or completely disappear with the proper treatment and after hormones settle down. It is rarely needed to stop breastfeeding. There’s always a good alternative to treat symptoms without compromising the breastfeeding dyad.


It is essential to mention that all of these symptoms are physical and not psychological, which means they’re hormonal-driven due to chemical body reactions that mothers cannot control.


If you’re experiencing any of these conditions, talk to your healthcare provider and your local IBCLC to get the proper treatment and, at the same time, provide you with a strategy to support and protect your breastfeeding journey.  

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