Miriam Levitt RN, IBCLC wrote:

I have always wondered when people talk about painful letdowns.  The
> experience of letdown seems to range from that to moms whose babies are
> thriving yet are not aware of having ever felt a letdown.  The
conventional
> "pins and needles" description was much too mild to describe how letdowns
felt
> to me.  It was more like a very intense pulling sensation, I suppose
could be
> decribed as painful, but the kind of intensity that requires the gritting
of
> teeth.  I never thought of it as a problem, just a very strong sensation
that
> would pass quickly.  But the "painful letdowns" may be something else.
If so,
> any data on causes?  Miriam"


I agree with you Miriam.  For me, letdown has seemed to get more
uncomfortable and more intense with each baby.  I've also noticed that if
I'm feeling full, it's more uncomfortable than if I'm not feeling full.  I
wouldn't call it painful.  It feels like an intense aching to me.  I rarely
noticed it with my first baby but have noticed it more with # 2 and #3.  It
reminds me of the similar aching pattern associated with afterpains and
oxytocin is involved with both letdown and afterpains.  Of course,
everyone's pain perception is different so I wonder if this is what is
leading to the description of "painful letdown".  One person feels pain,
another pulling, another aching.

I'm not aware of any data to support or dispel painful letdowns, but going
back to the physiology of lactation, I'm guessing the discomfort we are
describing is due to the contraction of the myoepithelial cells surrounding
the alveoli.  If the breast is full of milk, perhaps the myoepithelial
cells have to contract more to eject the milk. As for afterpains, they're
due to contractions of the myometrium.

Perhaps if a mother is having some serious discomfort with letdown,
recommending that she remove milk on a more frequent basis might help.
This is a purely anecdotal, not research based, recommendation .  It's
worked for me personally.

Maurenne Griese, RNC, BSN, CCE, CBE
Birth and Breastfeeding Resources  http://www.childbirth.org/bbfr
Manhattan, KS  USA
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