Psychogenic and Pharmacologic Induction of the Let-Down Reflex Can Facilitate Breastfeeding by Tetraplegic Women: A Report of 3 Cases

Although an increasing number of women are becoming pregnant and rearing children after spinal cord injury (SCI), scant literature exists on breastfeeding after injury. In particular, it is unclear whether women with SCI above T7 can sustain breastfeeding in a manner similar to neurologically intact nursing mothers. A functional let-down reflex is required to provide adequate milk to a nursing infant. Infant suckling activates tactile receptors in the breast, and this signal is carried via afferent nerves in the T4-6 dorsal roots to the spinal cord and then to neurons in the hypothalamus, which release oxytocin into the bloodstream. Oxytocin triggers milk ejection from the breast. Suckling-induced afferent stimuli are absent in women with SCI above T4 and are reduced if the injury is between T4 and T6. This report describes the breastfeeding practices of 3 tetraplegic women and shows that breastfeeding can be maintained for extended periods (12-54wk) after delivery. Two women required active mental imaging and relaxation techniques, or oxytocin nasal spray, to facilitate the let-down reflex. These findings suggest that although an absence of suckling-induced afferent stimuli may impair the let-down reflex, long-term breastfeeding can be maintained.