What is Let Down Reflex and How does it Occur?

Your let-down reflex, milk flow, or milk-ejection reflex happens naturally while breastfeeding and it is basically what makes the milk flow out of your breast. I like to think of the milk as being pushed out of, or released from the breast.

It is a physical and emotional reflex or response. On a physical level when your baby sucks at your breast the stimulation causes contractions in your nipple which helps to push out the milk.

On an emotional level, some mums find that thinking about their baby, hearing their baby cry, or any sort of emotional feeling toward their baby can trigger a letdown.

What does the let-down reflex feel like?

Usually, the let-down reflex happens a few times during breastfeeding but you may find that you only feel it the first time. And if you don’t feel it at all, that’s perfectly fine too, it doesn’t mean it’s not happening.

I used to get strong tingling sensations in my nipples and in the first few days after my sons were born I would get strong period type or labor pains too. These were a lot stronger with my second baby and I’m told they get stronger again with the third and so on.

Another sign of milk flow is milk leaking from the breast your baby isn’t feeding on. And if you pay attention to your baby’s sucking you will notice it change from a fast suck suck suck rhythm to a slower suck swallow once the let-down reflex has happened.

Ok, so I guess you might be wondering why you need to know about the milk-ejection reflex, especially if it’s supposed to happen naturally. Well basically, it is key to fixing low milk supply as well as to expressing breast milk.

Sometimes in the case of low milk supply, the let-down can be stalled by poor attachment and positioning.

When you are expressing breast milk the let-down reflex probably won’t happen naturally, and if it doesn’t happen at all expressing can become very difficult.

How do you trigger a let-down reflex?

There are a few things you can do to trigger the reflex, either while breastfeeding or expressing breast milk:

  • Relaxing…use anything that will help you relax like music, a comfortable chair, candles, sitting somewhere warm, even simply relaxing your shoulders can help.
  • Massaging your breasts towards the nipple or putting a warm cloth on your breast.
  • Focusing on your baby, smelling an item of their clothing, looking at their photo, or sitting near your baby can help.
  • If you’re expressing breast milk, try watching TV or taking your mind off it. Expressing into a container that doesn’t have measurements on the side can help. I used to keep on checking how much I had expressed and then get nervous if it wasn’t enough…not helpful when trying to achieve a let-down.

Dysphoric milk ejection reflex – How common is it?

how common is D-MER

Described for the first time in 2007 by  Alia Macrina Heise, the dysphoric ejection reflex ( D- MER ) is very little known to the general public and even to health professionals.

To date, we do not know exactly what proportion of women are affected by the phenomenon, but it has probably always existed without us being able to put words to describe and understand it.

Dysphoric milk ejection reflex symptoms

The dysphoric let-down reflex results in the appearance of very negative feelings at the time of the let-down reflex, ranging from sudden great sadness to a deep feeling of emptiness, even suicidal impulses in the most severe cases.

Note that D- MER may or may not co-exist with postpartum depression, but they are two very different things.

How to manage D- MER – How long does it last?

These unpleasant emotions can last only a few seconds, and sometimes up to two minutes.
They are always linked to the let-down reflex that occurs during feedings but also sometimes between feedings, whether the baby is at the breast of the mother expressing her milk.

D- MER can occur several times during the same feeding. , which can therefore be very difficult to live with, especially since it tends to be more recurrent in those who experience the most negative emotions.

This same feeling can also be experienced during sex. Among mothers least affected by D- MER, the phenomenon generally ceases after 3 or 4 months.

For others, it eases from the 10th or 12th month of breastfeeding. Unfortunately, for those in whom the D- MER is the strongest, it generally only stops at the time of weaning, or even sometime after.


If you are breastfeeding successfully or you haven’t had your baby yet it’s good to have an idea of how the let-down reflex occurs and your milk flow works.

If you are experiencing a low milk supply or need to express it, then understanding it can help you avoid breastfeeding problems and put you on the road to really enjoying it.

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