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It hurts when my milk "lets down." What could be causing this and how can I remedy this situation? What if my pain is deep in my breast?

A painful let-down reflex can occasionally happen while your body adjusts to feeding your baby. You may find that using relaxation techniques that were helpful during labor might help you cope with this early discomfort.

Make sure you are using good positioning techniques and are not straining or leaning over your baby as you are breastfeeding your baby. Your back, arms, feet and elbows should be well-supported, and your shoulders and neck muscles relaxed.

Some deep breast twinges during let down can occur as the milk ducts constrict to force the milk towards the nipple. As your body becomes more used to breastfeeding, these disappear.

There can be several other causes of painful let-downs that you may want to consider:

1. Lots of milk. Some women find that they make a great deal of milk and/or their milk-ejection reflex (let-down) is very strong. If this is the case, you will notice your baby choking or sputtering on the volume and intensity of the milk as it is let-down. Some mothers have found that breastfeeding on one breast only per feeding is helpful. When your milk lets down, you may find that your baby is more comfortable if you gently break suction, allow the milk to spray into a towel, and then re-latch him when the flow slows down. In time, your supply and let-down will become more manageable for the baby to handle and your discomfort should lessen.

2. Yeast. Another cause of painful let-down is yeast (a candida yeast infection) that has entered the milk ducts of the breasts. For more information about yeast, read FAQ on Thrush. This site does not mention yeast of the milk ducts, but it does offer a lot of other helpful information about yeast. Contact your local La Leche League Leader, IBCLC board certified lactation consultant or your health care provider if you suspect you have yeast.

3. Engorgement. Engorgement can cause breast discomfort. For more information about engorgement, read FAQ on Sore Nipples.  

4. Muscle strain or injury during birth. Straining or injuring chest muscles which support the breasts may also cause what seems to be deep breast pain.

4. Breast infection or plugged ducts. In the early weeks it is also possible that you may have plugged ducts or acquired a breast infection from your hospital stay. If you have a fever, red streaks on your breasts or if you feel like you have the flu, contact your health care provider to rule out a case of mastitis. For a breast infection or plugged ducts, nurse a lot, rest a lot and drink a lot of fluids will help.

Several other causes of deep breast pain (not necessarily during let-down) are:

  • vasospasms and/or Raynaud's Syndrome(for more information read Seeking Relief)
  • improper breast pump usage
  • an ill-fitting bra
  • injury or surgery to the breast tissue
  • premenstrual pain
  • fibrocystic breast pain

Also, some mothers with very large breasts have experienced deep breast pain.

One other cause of deep breast pain or painful let-down is that the baby might be clamping down instead of suckling. You will not hear the baby doing much swallowing if this is the case. A baby who is not breastfeeding properly should be assessed by someone knowledgeable in breastfeeding to help him learn to breastfeed.

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