LETDOWN/EJECTION REFLEX

Very often sucking difficulties may also result from a child not getting enough milk. This is usually because the reflex, which is essential to enable the milk to come out of the breasts, is temporarily inhibited. This is the ejection/let-down reflex. It does not merely release the milk – but causes muscular contraction in the breast, which forces the milk out. This ejection reflex can be inhibited for a number of reasons. In a maternity ward, it may be because a mother is afraid or embarrassed by the unfamiliar environment or the presence of the strangers, or depressed or nervous about her motherhood or perhaps her future. The reflex is also inhibited if the mother worries too much about her milk, and lacks confidence in her ability to satisfy her infant.

Many common problems with breast-feeding result from inhibition of ejection reflex. This causes symptoms like: ‘baby fussing at the breast’, ‘baby crying again only a short time after having been fed’ or ‘the milk seems suddenly to have disappeared’.

To make a diagnosis, see if you feel tense, prickling ‘let down’ sensation beneath your nipples when the baby begins to suck. However, many successful nursing mothers do not feel these sensations in the early weeks of nursing and some large-breasted women never feel them at any time.

Your judgement of whether the reflex works properly or not may therefore have to be based on whether the baby seems to be getting milk, rather than on probing what you, the mother can feel. The ejection reflex is easily influenced by the mother’s psychological state. Hence treatment must be psychological than physical.

How you can help yourself:

1. Before putting the baby to the breast, try to calm down, for instance by resting for some time, having something nice to drink, etc. This should become a ritual, repeated before each feeding session. For instance you might make a cup of tea and drink it, or lie down with closed eyes for five minutes.
   
   
2. Be sure to sit or lie down in a comfortable position and that you can remain undisturbed.
   
   
3. Make sure that your baby is sucking strongly, is in a good position, and not causing you pain.
   
   
4. Routine and habits may be important. If possible you should feed in the same place each time – i.e. in a particular corner of the house, in one special chair and so on.
   
   
5. Sometime for this kind of problem, scheduled feeding is said to be helpful. But give the baby a say in establishing the schedule according to his needs. Starting when an infant wakes up in the morning, you should feed him regularly throughout the day, for instance every two or three hours, thus ‘conditioning’ both the breasts and the infant for scheduled feeding hours.