Let Down
When your baby begins to nurse, hormones are released that cause your milk to flow towards the milk stores behind your nipples. This is called the "let-down reflex". Sometimes, just the sight or thought of your baby may start the reflex and make your milk flow. On the other hand, the let-down reflex can be delayed or inhibited by stress, pain, embarrassment or other unpleasant feelings. In these cases, the milk flow may be interrupted temporarily, anywhere from a few minutes to several hours. This situation can always be reversed. According to the World Health Organization, "It is not physically possible to "lose" your milk or your ability to breastfeed".

The let-down reflex occurs every time you breastfeed. It may take a few minutes the first few times you breastfeed. Later, let-down will occur more quickly, usually within several seconds.

The experience of let-down is different for each woman. When your baby begins nursing, you may feel a tingling sensation, a prickling or even slight pain in your breast. Milk may start dripping from the breast that is not being suckled. You may also feel strong cramping in your uterus when your milk lets down. Oxytocin, which is the hormone that stimulates milk flow, also causes the uterus to contract. In fact, breastfeeding helps your uterus go back to its original size faster than if you didn't breastfeed. These are all normal symptoms of the let-down reflex. You may experience all, or none, of these signs.

If you feel like you need help with the let-down process, try these tips:

• Set aside a quiet place where you will not be disturbed during feedings.
  
  
• Make sure you are comfortable and relaxed. Position your baby correctly.
  
  
• Stay hydrated and keep water nearby.
  
  
• Listen to quiet music.
  
  
• Wear nursing bras and clothes that are comfortable and easy to undo.
  
  
• Sometimes just thinking about your baby or nursing her can help let-down occur.
  
  
• Remember that your ability to breastfeed, and the process of making milk is a very simple and natural physiological function. Don't stress out about it.

Engorgement
Engorgement can occur when your breasts switch from colostrum to mature milk, usually 3 to 5 days after giving birth. This is also refered to as your milk "coming in." A feeling of fullness, some swelling and slight discomfort is normal as your breasts begin the production of milk. With frequent nursings, this fullness should diminish, usually within 10 days.

The actual state of engorgement is preventable. It occurs when your breasts aren't emptied thouroughly or often enough of the initial mature milk. Colostrum remaining in the duct system can lead to engorgement also. Your breasts become over full, the tissues of the breast swell and become more prone to infection. Your breasts may be extremely swollen and hot to the touch. The skin and nipple area of your breast can become shiny, taut and very tender. Most women feel some discomfort and fullness from engorgement, many find it very painful. Engorgement can also happen later on if you are producing milk and enough of it isn't being removed.

Tips to help prevent and relieve engorgement:

• Nurse, nurse, and nurse some more! As soon as possible after birth and then as frequently as your baby is willing. You should nurse your baby as long as possible on the first side to get as much milk on as possible. Once her sucking has slowed down, and the flow of milk has subsided you might try gently massaging the breast she is feeding on in a downward motion to try to empty out as much as possible. Make sure to start her on the opposite side for the next feeding as she may not have the appetite to "drain" both breasts in one feeding.
  
  
• If you can hand express a bit of milk before feedings, it will soften up your breast and areola and make it easier for your baby to latch onto the nipple and get that milk out. This is very important. The swelling can make it very difficult for your baby to grasp onto your nipple with her mouth. If the baby can't latch on well, she won't be able to get the milk out efficiently, leading to a worsening of your engorgement, mastitis, breast infection, sore nipples, and a hungry baby.
  
  
• Express only enough to relieve the pressure. Excess expression can stimulate milk production!
  
  
• Applying moist heat before feeding, hand expressing or pumping will help increase the flow of milk. Try:
  • Towels or cloth diapers soaked in hot water and wrung out.
    
  • If you use disposable diapers, soak one with a cup or two of water and then microwave it - only as long as your microwave takes to heat it. This can then be molded around your breast. You can re-use it numerous times.
    
  • A warm shower. Great when you are severely engorged because the mess of excess milk leaking is simply rinsed away.
  
  
  

• Cold packs placed on your breasts between feedings help to soothe swelling, aches and pains. Try:

  • cold wet cloths
    
  • an ice pack (or a bag of frozen peas) wrapped in a towel
    

Nursing your baby frequently and as long as she will, is the best way to remove milk from your breasts, and thus prevent and/or reduce engorgement.

Dr Newman's Treatments for Problems discusses the use of cabbage leaves for engorgement.