What happens during milk let-down?
A few days after birth, the colostrum is replaced by a transition milk. This point in time is noticeable by the onset of milk. The breasts and nipples swell considerably, may be tense or even cause pain. The skin is sometimes red and warm. Even a slightly increased body temperature is not uncommon.
However, the word “lactation” is somewhat misleading. Contrary to what the name suggests, about two-thirds of the increase in breast volume is due to lymphatic congestion in the glandular tissue – and only one-third to the inflowing milk itself. Thus, lactation is primarily a swelling of the mammary glands.
Lactation is triggered when the hormone levels of estrogen and progesterone drop after the placenta is shed after birth. Usually, therefore, during this time, the mother’s mood tends to be down. The mammary glands swell, and breast volume and blood flow increase. The level of the hormone prolactin, which is responsible for milk production, also increases.
The baby also has a part to play in this: by sucking, it stimulates the release of prolactin, but also that of the “cuddle hormone” oxytocin, even more. Oxytocin supports milk transport in the breast via gentle contractions in the breast tissue.
Lactation begins about two to five days after birth. During this phase, the composition of the milk changes: the colostrum becomes a transition milk, which is subsequently replaced by the mature breast milk. The onset of milk after cesarean section begins around the third day after birth.
However, milk may begin to come out of the breast toward the end of pregnancy. Women who are having a baby for the first time mistakenly think that this is already the onset of milk. However, milk that comes out before birth is called colostrum. This has nothing to do with the actual milk supply. The high estrogen level during pregnancy prevents milk from coming in before birth.
Lactation: How long does it last?
The length of time it takes for the milk to come in varies from woman to woman. However, the discomfort should subside after a few days. It takes about two weeks for the colostrum to turn into mature breast milk.
Lactation: pain
The extent to which the onset of milk is noticeable varies. For some women, the swollen breasts are merely unpleasant; for others, they hurt.
Lactation: relieve pain
During lactation, it is important to regularly breastfeed the infant. This does not increase milk production in this case, but alleviates the symptoms. Infrequent lactation, on the other hand, causes the amount of milk to decrease and the symptoms to worsen. Therefore, if necessary, you may gently wake the baby for breastfeeding when the milk is coming in.
Make sure that the baby has a good grip on the nipple during latch-on. This is not always easy, especially with full breasts. It is good to take some pressure off the breast before breastfeeding, either by briefly applying the breast pump or by stroking or massaging the breast. This softens the breast, the discomfort subsides and the breast empties more easily. You can read more about “breast expression” here.
Moist heat before breastfeeding also makes the breast tissue more pliable and allows the milk to flow more easily. A warm shower or a warm washcloth is sufficient.
Cooling compresses after breastfeeding have a pain-relieving effect. However, you should be gentle so as not to put additional stress on the skin and tissue. This means: no shock cooling with ice! A good home remedy for cooling are breast pads with curd or cabbage. In addition, a tight bra is said to relieve pain during milk let-down.
Promote milk let-down – is that possible?
Milk let-down is triggered by hormones. In addition, it is important for smooth milk production to put the baby to the breast for the first time in the first one to two hours after birth.
In the following two to three days, you should empty the breast eight to twelve times in 24 hours by putting the baby on or expressing or pumping the milk. Emptying acts on the pituitary gland in the brain and causes even more prolactin to be produced and milk production to be maintained (galactopoiesis).
A disease of the mother (e.g. diabetes mellitus, polycystic ovary syndrome, hypothyroidism, also: breast surgery) can affect milk production. There are medications that affect prolactin levels, thereby stimulating milk production and thus milk let-down.
These include the prescription dopamine antagonists metoclopramide and domperidone. However, they are not approved for increasing milk volume, so are used off-label for this purpose. Domperidone appears to be more effective and to enter breast milk to a lesser extent, but appears to promote cardiac problems. Careful clarification and monitoring by the treating physician are therefore absolutely necessary!
Preventing lactation
Milk let-down can be prevented by taking so-called prolactin secretion inhibitors such as cabergoline (dopamine receptor agonist).
