Relactation

If you are looking to induce lactation (in order to breastfeed a baby born by surrogate or an adopted baby), rather than to relactate, see this article.

It is possible to start breastfeeding again even after you have stopped for several weeks or months

However, first of all, it is important that mothers know that almost never is it necessary to stop breastfeeding.  Most reasons given for stopping breastfeeding are not valid reasons and most problems resulting in mothers stopping breastfeeding could have been prevented or treated. Many mothers stop breastfeeding because of some issue, believing that they will simply restart breastfeeding once the issue is sorted out.  But stopping breastfeeding for even a few days may result in great difficulties going back to breastfeeding.

Why do mothers feel they must stop or are told they must stop breastfeeding?

• The mother is not producing enough milk. Too many health professionals seem to have the idea that some breastmilk is worse than none at all. This is due to the mistaken impression that breastfeeding is necessarily painful or tiring, or “takes too much out of the mother”. This is simply not true, or rather, it should not be true.  Breastfeeding should be easy, pain free, not tiring, and a pleasure for the mother and the baby.  The reason breastfeeding does not always fit this “ideal” picture is due to many reasons, including interventions during labour and birth, especially the large amounts of intravenous fluids the mother receives as well as many other interventions. As well, after the birth, mothers and babies are subjected to rules about weight loss for which no good evidence exists.  Furthermore, the lack of training of hospital staff and physicians with regard to breastfeeding, often results in introduction of bottles and formula when not necessary, and undermining of the mother’s confidence in breastfeeding and making her believe that she is not producing enough milk.
• Breastfeeding hurts.  Except that breastfeeding should not hurt.  Nipple pain and breast pain can be prevented and if it occurs, it can often be treated easily, especially if help starts early, in the first few days, preferably on the very first day.  We get referrals to our clinic for mothers having sore nipples for 8 weeks and sometimes more.  What is the doctor or midwife thinking? Usually, that “it is normal that breastfeeding hurts, and eventually the pain will stop”.  But this thinking results in mothers suffering unnecessarily for weeks and often mothers stopping breastfeeding. As with all breastfeeding problems, the earlier the mother gets good help for sore nipples and breasts, the easier it is to fix the problem.
• The mother is told that the baby needs formula in the first few days postpartum because of low blood sugar or because the baby is jaundiced or because of 10% weight loss.  The use of bottles may result in the baby not latching on, or breastfeeding not becoming well established.  Even if supplementation is truly necessary, it should be given at the breast with a lactation aid.
• The baby does not latch on.  The main problem with the baby not latching on is the rush to do something, when in fact there is usually no need to rush.  Often when the baby does not latch on, he can be fed by cup or spoon until the mother’s milk “comes in”.  Often, when the milk increases around the third or fourth day, the baby will latch on, especially if the mother has good help available to her. Too often the baby does not latch on because of the early introduction of bottles for dealing with low blood sugar or jaundice or 10% weight loss.  The most common unnecessary and harmful intervention when the baby is not latching on is for the hospital staff to recommend a nipple shield.  But for most mothers, all a nipple shield does is give the impression that the problem is fixed, when in the long term, and even the short term, the result for most mothers is a decrease in milk supply, and subsequent introduction of bottles and not infrequently breast refusal.

• The use of nipple shields is wrongly, but commonly recommended, for nipple pain, breast engorgement, the baby not latching on, and to “teach” a premature or even full term baby to breastfeed, this latter reason an absurdity if ever there was one. All these issues can be solved differently and better without use of a nipple shield.  There is nothing that can be done with a nipple shield that cannot be done better without one.
• The mother must take medication and is told that she cannot breastfeed while taking this medication.  In fact, it is rare that a mother must stop breastfeeding for medication she must take.
• A mother with an infection is told that she must not breastfeed because she will pass the infection on to the baby.  In fact, the best protection for the baby against getting sick in the vast majority of cases is to continue breastfeeding.
• A mother with a non-infectious illness is told that she should not breastfeed because she will need medication which is rarely true, or because breastfeeding is tiring and hard on the mother.
• The baby has “breastmilk jaundice“.  Too often, the mother is told she must stop breastfeeding when, in fact, it is completely unnecessary.  Even stopping breastfeeding for 2 or 3 days is enough to cause significant breastfeeding problems.
• And there is a host of other reasons, ranging from the absurd to the ridiculous, for which mothers are told they must stop breastfeeding.  Or interrupt breastfeeding for various times (for example, some radiological tests, the mother having surgery) and are told that “you can simply just start again” after the “interruption”.  But, it is simply not true that the mother and baby can simply go back to breastfeeding as it was. After interrupting breastfeeding for even a few days and replacing the baby’s feeding with bottles, it can be very difficult to go back to breastfeeding as it was.  Even if the mother uses her own milk in the bottle. The issue is not so much what is in the bottle, but rather, the bottle it self. And don’t believe the advertising, there is no bottle that simulates breastfeeding. The result? The frustrated mother then stops breastfeeding.

Thus, the most important step in relactation is to avoid the need to relactate at all, to get good hands on breastfeeding help and advice.  Unfortunately, good breastfeeding help is not easily available everywhere.  

But you are not breastfeeding any longer.  So, what do you do?  

The information below is also valid for a mother who is exclusively pumping.

There are two points to deal with:

1. Getting the baby to take the breast.
2. Increasing/re-establishing the milk supply.

• If the baby is willing to take the breast, everything is possible.  However, if the baby has not been breastfed for a while, you will probably need to supplement unless your baby is being fed exclusively with your own expressed milk. Even then, the baby, used to bottles, may not latch on well to the breast, resulting in the baby not getting milk well and/or the mother starting to get sore nipples.
• Try to get the best latch possible. Know how to know when the baby is drinking milk from the breast or not getting milk from the breast.  If the baby is not drinking, only nibbling, try breast compression to keep the baby drinking.  When the baby is no longer drinking, switch sides and repeat the process.  If it is necessary to supplement the baby, it is best done with a lactation aid at the breast.  Domperidone can increase the milk supply.  We start with a dose of 30 mg (3 ten mg tablets) 3 times a day, for a total of 90 mg/day.
• It is best to keep the baby skin to skin as much as possible, with the breast available to the baby.  What is good for premature babies in terms of skin to skin contact, is good for all babies of any age.
• If the baby is reluctant to take the breast or completely refuses to take the breast, it is still possible to help the baby latch on.  Note that a baby on a nipple shield is not latched on and offering a nipple shield is not an answer.
• An important step is to stop using bottles and pacifiers. An open cup or a small spoon can be used to feed the baby and work even in premature babies and are easy to use if the mother is shown how.  If the baby is older, say over 3 or 4 months of age, it can be easier to stop the bottles.  Instead of feeding the baby by bottle, the baby can be fed food, as much as the baby will eat, as frequently as the baby will eat them without forcing. Commercial infant cereals are not a good food as they are low in calories and nutrients (except for iron, but most of the iron ends up in the baby’s diaper).  Many babies this age will eat all sorts of high calorie foods like banana, avocado (30% fat), and foods like mash potatoes without problem.  Liquids, preferably breastmilk, butter or oil (vegetable, olive, etc) can be added to the solids.

This four month old has never been exclusively breastfed.  This baby does latch on and has continued to latch on because he was always being supplemented with a lactation aid at the breast. But the mother wanted to stop using the lactation aid. Instead of starting bottles, she could she start using a an open cup or a small spoon to supplement the baby. But it is possible and preferable to start the baby on solids as well. So the baby breastfeeds and eats solids – just as any baby would be after about the age of six months. I believe the baby is being offered avocado in this video but it could be banana.

• Skin to skin contact as much as possible with the baby with the bare breast close to the baby. If the breast is available to the baby, the baby may latch on.  By increasing the milk supply with domperidone, the baby will sense the presence of milk in the breast, the Montgomery glands of the breast letting the baby know that milk is available.  If the mother can manage to feed breastmilk (by cup, spoon) when skin to skin with the baby and the baby near the breast, this may help the baby to latch on. Taking a bath with the baby, skin to skin, sometimes helps too.
• If nothing is working, the use of domperidone and hand expression/pumping will at least get you more milk to feed the baby your breastmilk (used only when you have given the above methods sufficient time and the baby is just not latching on).
• Be patient.  Getting the baby back to breastfeeding may take time but there are many babies who have re-started exclusive breastfeeding after weeks and even months of no breastfeeding.

Need help with breastfeeding?  Make an appointment with our Toronto based breastfeeding clinic.

Copyright: Jack Newman, MD, FRCPC. 2018