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Milk Ejection Stimulation
The role of the milk ejection reflex (let-down) in milk production is indirect yet very important. Milk must be removed from the breast in order to stimulate more milk to be made, but it is not removed easily without the assistance of the milk ejection reflex, where oxytocin causes the muscle-like cells around the milk-making cells (alveoli) to contract and push milk out. The process of milk ejection is both amazing and complex in that it can be triggered both by physical stimulation and mental thoughts or emotions.
Another possible component that is often overlooked is the influence of the fullness of the ducts and alveoli. The principle is similar to the concept of a water balloon. When the balloon is very full and then let go, the water gushes out quickly; when it only has a little bit of water, it comes out more slowly when released. Your milk ejection is like a hand lightly squeezing that water balloon; when your breast is very full, milk tends to come out fast, but if it is only partially full, milk comes out more slowly.
Women with low milk production often complain of few or no noticeable symptoms of milk ejection. This is likely to be more a reflection of the low volume of milk than a problem with the reflex, but mothers often believe that they have a problem with milk ejection when they don’t readily feel it. When milk production increases, one of the first positive signs may be a stronger or more noticeable ejection. It really was there all the time, it just wasn’t as efficient or noticeable with lower milk volume. Watch your baby and observe for increased gulping or whispered “kuh” sounds, and watch your opposite breast for drops of milk. If pumping, watch for an increase in flow, even it is from drops to a steady drizzle. These tell you that your ejection reflex is happening even if you don’t feel it.
If you do find that your milk ejection is taking a while to happen, the following physical techniques may help to trigger it. These may be especially helpful if baby is not breastfeeding long enough or vigorously enough and you must pump for additional stimulation.
Many mothers find that warm, moist compresses, applied to the breasts just prior to nursing or pumping, makes milk ejections happen more easily. There are commercial products for moist heat, but you can make your own by filling a tube sock with uncooked (not instant) rice, and sewing or tying the end closed. Lightly dampen the sock and microwave for 30 seconds or so, testing to make sure the sock is not too hot. The shape of the sock allows it to be wrapped comfortably around the breasts. You may also find that a warm, wet washcloth is very helpful. Hot showers are famous for initiating milk ejection, although they may not always be convenient. You can even try nursing your baby in a warm bath.
Rubs and Massages
Breast massage before a feeding or pumping session not only helps to work milk down closer to the nipple, but it also may help to trigger milk ejection. Experiment with light touch versus a deeper, firmer massage. Shoulder massages and back rubs also seem to have an effect on the reflex. One particularly effective method is to have someone “spine walk” with their knuckles on either side of your spine, from the neck to your waist. This may trigger a shiver or chill sensation, which seems to trigger the milk ejection reflex as well. Another technique is to have someone massage your shoulder at a point close to the neck as you are nursing or pumping. This stimulates an acupressure point that some mothers have found triggers milk ejection. At the very least, you should be feeling more relaxed after some “spa” treatment!
Nipple stimulation, such as gentle tickling, rolling or pulling, can be effective to encourage milk ejection when a mother is feeling stressed or anxious. Reverse Pressure Softening (RPS) can also be helpful. The tactile stimulation of any of these techniques results in oxytocin release, which not only causes milk ejection, it induces a feeling of calm and well-being, which helps soothe stress and encourage additional milk ejections.
Synthetic Oxytocin Spray
Synthetic oxytocin spray has been used effectively by many nursing mothers to overcome physiological or psychological issues that inhibit milk ejection. However, a recent study of mothers of preterm infants who used unmarked sprays containing either synthetic oxytocin or saline suggests that its effectiveness may be nothing more than a placebo effect because all mothers in the study had the same improvement in milk ejections.(1) Another study of three women paralyzed from the neck down demonstrated effective milk ejection with the use of synthetic oxytocin spray.(2) So the jury is still out on whether or not it works, but because many women find that it does, it may be worth trying. There are no commercial synthetic oxytocin spray products currently available in the North America, however, a compounding pharmacist can make it by prescription by combining other ingredients.
Conditioning the Milk Ejection Reflex
A recent study found that milk ejection is, at least in part, a conditioned response.(3) Having a special nursing station where you take the baby to nurse creates a psychological routine that helps to train the milk ejection response. Just as we see delicious food on TV and our salivary glands activate, “letting down” saliva into our mouths, we can condition ourselves to let down our milk when we are in specific situations and places. This principle works in the same way as when a new mother is out shopping and hears a baby cry and looks down to see that her blouse has wet spots from a spontaneous milk ejection.
(1) Fewtrell, M., Loh, K., Blake, A., et al. Randomised, double blind trial of oxytocin nasal spray in mothers expressing breast milk for preterm infants. Arch Dis Child, Fetal Neonatal Ed 2006; 91: F169-F174.
(2) Cowley, K. Psychogenic and pharmacologic induction of the let-down reflex can facilitate breastfeeding by tetraplegic women: a report of 3 cases. Arch Phys Med Rehabil 2005 Jun; 86(6):1261-4.
(3) Kent, J., Ramsay, D., Doherty, D., et al. Response of breasts to different stimulation patterns of an electric breast pump. J Hum Lact 2003; 19(2):179-186.