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Relactation – a success story… Thanks to Jen :) - What is relactation
Relactation is induced lactation, when a woman induces milk production after stopping breastfeeding for some time. The time can be a week to induced lactation when a woman induces milk production after never having given birth. It appears some factors make relactation easier, these include: - If your baby will still latch on
- If the baby is less than three months old (as your hormone levels will still be relatively high)
- If you breastfed for four to six weeks
If you don’t fit any of these categories it doesn’t mean you won’t be able to relactate but it may just take a little longer. In my case I breastfed for 11 weeks and Finn still latched on but my period had returned and my milk completely dried up so we were starting from a low hormonal level. - How does it work??
In the beginning milk production is hormonally driven. Once lactation is established, milk production becomes a supply and demand process. Essentially as long as the baby is feeding, milk production should continue. Research indicates that there are prolactin receptor sites on the walls of the milk-producing cells of the alveoli in the breast. When the breasts are full of milk these receptor sites are blocked and prolactin cannot move into the cells to stimulate the production of milk. When the breast is emptied, prolactin can bind with these sites and instigate milk production. So by continually feeding and emptying the breast, we can produce more milk. For women who are relactating or inducing milk production, prolactin levels are usually low, as a result it can take longer to establish good supply, but it is possible. - Supply boosters
Pumping The single most important thing you can do to boost supply is to feed or express. Preferably feed as there is no more efficient sucker than your little baby (with the exception of a few) Medication Taking medication is not essential to re-establishing. Feeding/pumping alone can bring your milk supply back. Domperidone – Using domperidone can increase your supply by increasing the amount of prolactin in your blood stream. It has limited capacity to increase milk supply so consider if you really need to take it. It should also be noted that while many doctors are happy to prescribe Domperidone and the American Academy of Paediatrics supports the use of Domperidone for increasing milk supply, the American FDA has warned against using the drug while breastfeeding. Metoclopramide – has been shown to be very effective in aiding milk production however it crosses the blood-brain barrier and has been shown to cause depression in women. Herbal Galactagogues Fenugreek, Blessed Thistle, Brewers Yeast, Alfalfa are among a number of herbs that will help milk production increase. Alfalfa is known to have a few side effects – including alcohol production so it is best to speak with a trained naturopath or GP before trying this. - Expectation
Probably the most important of all is where to pin your hopes. Be realistic about what you are trying to achieve and remember if you only get to point where you express a little milk for your baby you have still achieved something amazing. Take it easy – its very tempting to go all gung ho in the beginning and pump all night but it is important to look after your health too. Fatigue has a huge effect on milk production so it is important to be rested while relactating. What I found was my motivation shifted. Initially I wished to breastfeed as I had done originally – however with each little success we have had I have learned to have a greater appreciation and enjoyment for feeding my son. What I hadn’t realized was that when I first had Finn, I knew so little about breastfeeding that deep down I didn’t trust that I could really produce enough to feed him. Ironically now I genuinely don’t produce enough but I am watching and learning as my supply increases slowly that I do have enough to give him all the health benefits of breastfeeding even if I do have to supplement with formula. - My experience
As I said, I breastfed Finn for 11 weeks and stopped for 10. I stopped out of confusion, tiredness and generally lack of understanding. I didn’t realize at the time that Finn would have horrible stomach cramps, chronic constipation (more so than most babies) and eczema from formula. One night when we were up five times with him crying in pain I decided something had to be done. I was very hesitant to give him brown sugar in water on a continual basis, especially as we have a strong history of diabetes in the family. By the time we decided to relactate I had dried up almost completely – you could get a sheen on my nipple if you squeezed hard! My hormone levels were also low and my period had returned. So all in all there were a few faces pulled when I said I was going to give it a try. I kept saying to myself – from little things big things come and sure enough here we are. I thought I’d give a week by week account of what I did to reestablish breastfeeding. Week 1. I went to the doctor and asked if she’d prescribe domperidone. I decided to take medication as I was returning to work in 6 weeks and I knew it would be more difficult to try if I was at work (though not impossible!). She was lovely – said she hadn’t heard someone w anting to try and relactate in 10 years! She didn’t know about domperidone so she rang the Royal Womens hospital in Melbourne, where we live, to ask them for advice. They gave her a dosage and she gave me the name of a GP who is also a lactation consultant so that I could get better help. I joined the Australian Breastfeeding Association and enlisted the help of a breastfeeding counselor. I start to take domperidone, fenugreek, blessed thistle, breastfeeding tea and magic milk cookies (yum but fattening!! So this week I am all full of nerves and excitement. I feel kind of silly and don’t want to see anyone. The plan of action is to stay indoors and pump like no woman has pumped before. I think to myself – sure it will probably only take ten days???? I am pretty much topless all day for the first two weeks J I think my husband loved it. First steps with Finn. We move him to the slowest flow nipples on his bottles. I start feeding him topless and generally having a lot of nudey time with him. It feels really weird and I’m not 100% comfortable with it all. He was feeding four bottles of milk (240ml) a day, we pull back to 120 mls eight times a day. He’s a bit confused but puts up with it after two days. I am pumping every two hours during the day and once at night. I set up a pumping station – there’s me, a chair, the internet and TV. I feed and pump while reading thebreastway.ie and anything else breastfeeding related I can find on the net. I bought an SNS from Medela. Every feed, especially in the morning, I wear the SNS with the tubes coming in behind a nipple shield. The tube is attached at a point which would match with the corner of Finns mouth rather than his mid upper or lower lip (as in the instructions), apparently it’s less disturbing this way. The SNS is made with the highest flow rate tubes in case he goes for a nibble J Initially he eyeballs it and is unimpressed and refuses the breast while I’m wearing it. I was gutted, he’d never refused my breast before. New tactic - I start to try to feed him from me in the morning while he’s still asleep, I get him up and feed him a little milk from the bottle, bringing the bottle close to my breast (which is all taped up and covered in a nipple shield) I swiftly take the bottle out and offer the breast – bingo! He latches on and has a suck. After this success I try it at every feed – we stick to one side per feed and pumping the other side after. Soon he is just feeding directly from me and the SNS and bottles are a thing of the past. A big, big success is when he wakes up, pulls off the breast looks up at me and gives me a big milky beam and then goes back on. Think I cried a little at that one! Further rewards – a squirt!! Within a week even my husband commented on how shiney Finn looked – he practically glowed with happiness. The extra cuddles are obviously suiting him very well indeed! This gives me motivation to continue, I just love seeing him this happy. We are now feeding every two hours, after each feed I pump for another ten minutes on either side. In the beginning it takes Finn an hour and a half for a feed so I am basically feeding and pumping non stop during the day. I try to make sure I feed him 8 times and pump 8 times a day, sometimes I pump up to 11 times a day. Week 2 – He goes on awake!! This is a big achievement – he starts to pick up the pace a little on the feeding sessions too, each now taking approximately 40 mins to 1 hour. Breastmilk must be getting through as he starts to fart like a trooper and I’ve been taking so much fenugreek even I’m farting! Confirmation comes in the form of one very liquidy mustard seed dirty nappy. Never have I been so happy to see those little seeds!! Getting rid of the nipple shield – this one was no mystery. It fell off mid-flight to NZ. Given no alternative both myself and Finn had to relax and after this we never used the nipple shield again. We are also going for both breasts with no problems. At this point I am still feeding Finn every two hours followed by some pumping after each feed. Pretty much its just a solid feed pump feed day. After 10 days I get my first drops. By drops I mean drop. It formed on my nipple while pumping, not enough to fall off and go into the bottle, or even the flange but a drop is a drop. Week 3 – Really tired but I’ve been trying so hard I am loathe to give up. We are in NZ for a few days, I’m trying to pump discreetly while everyone is having a BBQ and it happens. Drops! Enough to form a whole ml!!! By the end of the week I am nearing 5 ml to 10 mls pumping in 24 hours! I just leave the pump gear and wash it once a day but now I am getting some milk I’m able to use it at the end of each day in the last feed – so I start to sterilize everything after each pumping session – it’s a total pain. Discouraging moments – Finn is covered in eczema. It turns out that it is due to the fenugreek so I stop taking it. Week 4 – getting close to going back to work (one week away). My SNS breaks, I feel so vulnerable, I am down to the lowest setting but have to do a electrical tape job on it to keep it going until I get a replacement. I am so upset I hadn’t realized how attached I have become to breastfeeding Finn. I know I am not feeding him on my own but at this stage we’ve been through so much I can’t bear the idea of stopping. Reward J I pump 50mls in a day!! Week 5 – A total blur of getting ready to work interspersed with feeding and pumping sessions. I slowly start and stop the flow from the SNS while feeding so he gets used to my natural flow. By the end of the week we are officially SNS free for at least one feed! Week 6 – I am back to work – we’re not 100% there but we are so very close!! I feed him myself in the morning at 5.30 am with no supplemental feed from the SNS. I pump twice a day in work at 8 and 11, then pick Finn up at 2.45 and we go home to feed at 3pm. He then snacks at 5pm, 7pm and then pump once before bed at 9.30pm. Here I will be honest and say sometimes I just sit down with a beer and pump that last feed and pour it down the sink – I know a waste but sometimes I feel that we have been working so hard that every now and then a mammy has to just chill out. So our story is by no means over but I think its one big success - Finn is taking two formula feeds during the day in childcare but not full feeds so he has now gone from 960mls formula per day to 380ml formula and solely breastfeeding from me, at weekends he’s almost formula free. He now associates my breasts with food and lets me know he’s hungry by turning into my breasts for some yum yums. Most of all both myself and Finn are happier as a result – what looks like a lot of work in hindsight was really so worth it. To anyone who may wish to try and relactate – I would just say relax, take it one day at a time and celebrate every little victory along the way. Make sure you get as much support as possible. This has been an unforgettable experience. References http://www.kellymom.com/bf/supply/relactation.html www.breastfeeding.asn.au http://www.lact-aid.com/rpt025.htm http://www.infantfeeding.info/Motilium.htm Adoptive Breastfeeding & Relactation Induced Lactation and Adoptive Breastfeeding - Lawrence R, Lawrence R. Breastfeeding: A Guide for the Medical Profession, 6th ed. Philadelphia, Pennsylvania: Mosby, 2005: 713-734.
- Australian Breastfeeding Association. Relactation and Adoptive Breastfeeding. East Malvern, Victoria: Australian Breastfeeding Association; 2004 April.
- La Leche League International. The Womanly Art of Breastfeeding, 7th revised ed. Schaumburg, Illinois: La Leche League International, 2004: 302-306.
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Journal Articles Relactation - Banapurmath S, Banapurmath CR, Kesaree N. Initiation of lactation and establishing relactation in outpatients. Indian Pediatr. 2003 Apr;40(4):343-7.
- Menon J, Mathews L. Relactation in mothers of high risk infants. Indian Pediatr. 2002 Oct;39(10):983-4.
- De NC, Pandit B, Mishra SK, Pappu K, Chaudhuri SK. Initiating the process of relactation: an Institute based study. Indian Pediatr. 2002 Feb;39(2):173-8.
- Marquis GS, Diaz J, Bartolini R, Creed de Kanashiro H, Rasmussen KM. Recognizing the reversible nature of child-feeding decisions: breastfeeding, weaning, and relactation patterns in a shanty town community of Lima, Peru. Soc Sci Med. 1998 Sep;47(5):645-56.
- Rogers IS. Relactation. Early Hum Dev. 1997 Oct 29;49 Suppl:S75-81.
- Seema, Patwari AK, Satyanarayana L. Relactation: an effective intervention to promote exclusive breastfeeding. J Trop Pediatr. 1997 Aug;43(4):213-6.
- Thompson NM. Relactation in a newborn intensive care setting. J Hum Lact. 1996 Sep;12(3):233-5.
- Phillips V. Relactation in mothers of children over 12 months. J Trop Pediatr. 1993 Feb;39(1):45-8.
- Bose CL, D'Ercole AJ, Lester AG, Hunter RS, Barrett JR. Relactation by mothers of sick and premature infants. Pediatrics. 1981 Apr;67(4):565-9.
- Auerbach KG, Avery JL. Relactation: a study of 366 cases. Pediatrics. 1980 Feb;65(2):236-42.
Adoptive Breastfeeding - Gribble K. The influence of context on the success of adoptive breastfeeding: Developing countries and the west. Breastfeed Rev 2004; 5-13.
- Biervliet FP, Maguiness SD, Hay DM, Killick SR, Atkin SL. Induction of lactation in the intended mother of a surrogate pregnancy: Case report. Hum Reprod. 2001 Mar;16(3):581-3.
- Cheales-Siebenaler NJ. Induced lactation in an adoptive mother. J Hum Lact. 1999 Mar;15(1):41-3.
- Abejide OR, Tadese MA, Babajide DE, Torimiro SE, Davies-Adetugbo AA, Makanjuola RO. Non-puerperal induced lactation in a Nigerian community: case reports. Ann Trop Paediatr. 1997 Jun;17(2):109-14.
- Hartmann P, Atwood C, Cox D, et al. Endocrine and autocrine strategies for the control of lactation in women and sows. In: Wilde C, Peaker M, Knight D, eds. Intercellular signaling in the mammary gland. New York, NY: Plenum Press; 1995: 203-225.
- Nemba K. Induced lactation: a study of 37 non-puerperal mothers. J Trop Pediatr. 1994 Aug;40(4):240-2.
- Banapurmath CR, Banapurmath S, Kesaree N. Successful induced non-puerperal lactation in surrogate mothers. Indian J Pediatr. 1993 Sep-Oct;60(5):639-43.
- Amico JA, Finley BE. Breast stimulation in cycling women, pregnant women and a woman with induced lactation: pattern of release of oxytocin, prolactin and luteinizing hormone. Clin Endocrinol (Oxf). 1986 Aug;25(2):97-106.
- De Leo V, Petraglia F, Sardelli S, et al. Use of domperidone in the induction and maintenance of maternal breast feeding. Minerva Ginecol. 1986 Apr;38(4):311-5.
- Petraglia F, De Leo V, Sardelli S, Pieroni ML, D'Antona N, Genazzani AR. Domperidone in defective and insufficient lactation. Eur J Obstet Gynecol Reprod Biol. 1985 May;19(5):281-7.
- Auerbach KG, Avery JL. Induced lactation. A study of adoptive nursing by 240 women. Am J Dis Child. 1981 Apr;135(4):340-3.
- Auerbach KG. Extraordinary breast feeding: relactation/induced lactation. J Trop Pediatr. 1981 Feb;27(1):52-5.
- Kulski JK, Hartmann PE, Saint WJ, Giles PF, Gutteridge DH. Changes in the milk composition of nonpuerperal women. Am J Obstet Gynecol. 1981 Mar 1;139(5):597-604.
- Kleinman R, Jacobson L, Hormann E, Walker WA. Protein values of milk samples from mothers without biologic pregnancies. J Pediatr. 1980 Oct;97(4):612-5.
- Jelliffe DB, Jelliffe EF. Non-puerperal induced lactation. Pediatrics. 1972 Jul;50(1):170-1.
- Slome C. Nonpuerperal lactation in grandmothers. J Pediatr. 1956 Nov;49(5):550-2.
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Ages and Stages of feeding 
