Letdown, also known as Milk Ejection Reflex or MER, is the process by which the breast releases milk to the baby. It's one of those things about breastfeeding that you don't quite understand until you start doing it.

The most common times you might hear letdown discussed is in the context of "Overactive Letdown," a common occurrence in the early weeks or months of nursing, and in the context of letting down to a pump. But letting down to a baby can be tricky too, especially as the baby gets older and more distracted and fussy if letdown takes more than a few seconds. And in extended breastfeeding, my experience is that as milk supply starts to slowly drop, it can take a few minutes for a decent letdown. The most common suggestion that one hears about stimulating letdown is for pumping – to look at a photo of your baby. Pump-in-style pumps even come with a place to put the photo inside the case.

Frankly the whole photo thing has never done much for me. Plus, that doesn't help you in the middle of the night, when you are nursing for the 6th time in 3 hours and you are exhausted, low on milk and both you and baby are frustrated. Here's a couple suggestions that have worked for me:

• First, relax! -- I know that's a tall order sometimes, but it's critical. Take a few slow deep breaths. Close your eyes. Remember what a wonderful thing you are doing with your baby and how nursing is a fleeting time. Look at your baby's face and realize how short a time she'll want to lay in your lap and be one with mama.

• Visualize the milk flowing -- For those who have not done visualizations, this may seem cooky, but it really does work! While you've got your eyes closed, relaxing, actually picture the milk ducts gently contracting and pressing the milk out to your waiting nursling. (Yikes… even as I'm writing about this, I'm feeling a little bit of letdown pressure!)

• Drink some water -- Especially in the early weeks and months, this is a great strategy. Drinking a full serving or more of water each feeding is a useful way to keep hydrated and keep milk supply high. Just like running water in the bathroom to help you pee, drinking water while nursing can get things going! (Keeping water around the house where you might nurse is a great way for Dad to contribute to breastfeeding…see my article on Dads and Breastfeeding in related links below.)

• Stroke the breast gently from base toward the nipple -- I'm not sure why this works, but it does. Along with relaxation, a couple gentle strokes with your finger from the base of the breast toward the nipple can get the milk moving.

• Gentle Squeezes -- Just like my previous suggestion, a little physical stimulation of the breast while baby is also stimulating the milk by nursing can work. If you have an older nurser, you can also teach them to subtly do this themselves while waiting for the milk.

• Remove baby from the breast and then back on again -- Once your baby is beyond 4-5 months and interested in everything, you'll notice that no sooner do they pop off to look around then the milk lets down. It's mystifying and bit annoying sometimes, but removing the baby from the breast can stimulate letdown. Switching sides back and forth a couple times has the same effect and may not annoy the baby as much as just taking them off and on, since they are used to the breast switching action and know it means more milk is coming.

If your baby is getting impatient waiting for the rush of milk that comes with letdown, some of these tips may help. If you are in the early months of nursing, or experiencing overactive milk supply, it may seem unbelievable that you would ever need to help your milk let down, but it's true.

Have other tips and tricks to stimulate letdown? Share them in the Breastfeeding Forum.



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