Relactating and building your milk supply

Are you mixed feeding your baby and would like to grow your supply to meet your baby's needs?

Are you currently formula-feeding but would like to resume (or start!) breastfeeding?

Have you weaned your baby and would like to breastfeed again?

Then this is the blog post for you!

(It's a long one, though. So I apologize in advance. ;) And I'll probably update it once in a while, so check back often!)

I've recently received a number of questions from some mamas about relactation and resuming breastfeeding after a hiatus. Rather than rehash the information time and again, I thought I'd put all my tips and tricks for relactating into one easy-to-reference -- if lengthy! -- post. If you have any questions after reading this, please feel free to email me!

Disclaimer: I am NOT a lactation consultant (though I've considered becoming one!), nor am I a doctor or other licensed healthcare professional. I'm but one mama who has relactated and would like to share her knowledge and experience with others who wish to do the same. Always contact a healthcare professional and lactation consultant before beginning any medications, herbs, or other treatment for low milk supply, and if you have any other medical concerns. DO NOT attempt relactation if you are pregnant.

This process is very much twofold:

1. You will be reteaching your baby to equate nursing and the breast not only with food, but with comfort as well.
2. You will be redeveloping a milk supply, which requires nipple stimulation and milk removal. If your baby will nurse (and hopefully, this post will help reestablish that relationship!), that will prove most beneficial.

It's not all about just making milk, though; even if you never establish a full supply, there are many non-milk-related benefits to breastfeeding, not the least of which are bonding and oral development.

First and foremost, find a local lactation consultant for support and advice along your journey. Not all are experienced in relactation, but they are invaluable for working out issues that may come up in breastfeeding, including poor latch, tongue and lip ties, low supply, and so forth. Your best bet is an International Board Certified Lactation Consultant (IBCLC). You can find one through the International Lactation Consultant Association's FALC search engine-- enter either a name or your city/state and the country code to search.

Second and also importantly, monitor baby's output throughout your journey. Count his wet diapers a day and make sure he has at least six really wet diapers each 24-hour period. You may also want to get him weighed every two weeks or so to be sure that food intake is adequate, until it is clear that he is gaining well.

Okay... let's get started!

Invest in a quality double-electric breast pump, and pump every 2-3 hours. The goal is to imitate the needs to a newborn baby, which will help trigger your body into making milk. Once your supply starts growing, you can back it off to every four hours or so, but the initial push for 2-3 hours will send signals to start milk production.

I recommend starting off with a hospital-grade pump rental, but relactation can be achieved with your standard double-electric as well. Be sure all parts are in good working order and perform pump maintenance whenever necessary. Popular brands include Medela, Ameda, Spectra, and Lansinoh. I have personally used a Medela PISA and Spectra Dew 360, with excellent results.

You may come up dry for a while before you start to see anything, and that is completely normal. When you do start producing milk, it might initially be thick and yellow -- this is colostrum, the "starter milk" and first secretions from the mammary glands. You may have leaked a similar milk when you were pregnant or first started breastfeeding. This milk will quickly transition into a lighter-colored, thinner milk, more "mature milk".

If you experience chafing while pumping, first troubleshoot your pump to be sure you have the right size flanges. I personally recommend Pumpin Pal flanges; they come in a set of three, and you may need to experiment to find out which size works best for you. Once you've figured out the size, coconut oil or lanolin will help reduce friction. You do NOT have to have your pump set to the highest suction; this may end up bruising delicate breast tissue and actually inhibit the flow of milk. Keep the suction as low as needed; the point is stimulation, not necessarily suction.

When the milk starts flowing, pump 3-5 additional minutes after the last spray of milk, which will trigger your body to make more over time. Do not exceed 25 minutes of pumping in each session, as this could also bruise delicate breast tissue. I also found that hand-expressing after pumping gets some last bits of creamy milk out and actually triggers my body to make more, so definitely try that as well.

The amount of time it takes for your breasts to start making milk and reaching a certain supply is different for every woman, but typically correlates to the length of time between breastfeeding cessation and restarting; in my case, three months had elapsed before I attempted relactation, and it took about three months to reestablish a full supply. Don't get discouraged if you initially start off with nothing -- I did, too!

Practice lots of skin-to-skin contact. Not only will this also send messages to your body to start creating milk, it will also get your baby reacquainted with you! This can be easily achieved by each of you being shirtless and hanging out in bed, on the couch, or in a carrier. You can also bathe with your baby; just be sure to keep a good grip at all times, as babies are ridiculously slippery when wet.

Go shirtless (and even braless!) while bottle-feeding as well, and snuggle close with your baby as you feed him. This will imitate the act of breastfeeding and will help your baby associate your bare skin with food and comfort.

If your baby is willing and able to latch, then nurse often, at least every 2-3 hours. Offer the breast anytime you can, including when baby is not hungry, upon falling asleep or waking up, and whenever he wants comfort. Consult your IBCLC for help with proper latch.

If your baby is NOT willing to nurse...

Let's get that baby back to the breast! Generally, the younger a baby is, the more willing he may be to latch back on. Note that not all babies will return to the breast, so be patient and know that you're trying your best. Exclusive pumping is not a sign of failure.

Do not withhold feedings or starve your baby in an attempt to get him back to the breast; a baby getting the right amount of calories and nutrition will be best able to learn how to nurse, and baby will not just "nurse when he's hungry enough".

La Leche League lists the stages that babies go through as they transition back to breastfeeding, which may help keep everything in perspective:

• The baby aggressively fights the breast.
• The baby cries more when being held than when he's put down.
• The baby is willing to be held in some positions, even if it's not a cradle hold.
• The baby tolerates being held in the cradle hold.
• The baby will attempt to root.
• The baby will lick at milk on the nipple.
• The baby will attempt to suck, using in-and-out movement.
• The baby will take milk from the breast.
• The baby nurses well, even before the let-down occurs.

Note that this is not a simple "give babe the boob" (we all wish, right?), but a process that requires patience and perseverance.

So how do we do this? First, find a comfortable position. Many mamas find that the cradle or football hold is most comfortable for them and their babies. You'll want to be calm and relaxed, so don't try if either of you are stressed. Second, if your baby is tolerating it well, practice latching for up to 10 minutes or so. If baby is getting upset, go with shorter sessions. It's not a good idea to practice any longer than 10 minutes, as baby may grow tired and will be less apt to want to latch. You don't want to create an aversion to the breast!

It may help to offer some supplementation prior to attempting to latch, as baby will not be as desperate for food. If you're working on latching and baby isn't attempting due to hunger, feed the baby! You can always offer enough supplement to calm him down and resume the latching attempt. And if you're both totally frustrated? Go for a full supplemented feed, then offer the breast afterward.

Instant reward may get baby more agreeable to breastfeeding. You may want to hand-express or pump before a feed so your let-down reflex happens more quickly, fill the tip of a nipple shield (below) with milk before he latches, drip expressed milk or formula onto the tip of your nipple, or use an SNS (below) to increase milk flow to the breast.

There are some tools to help get baby back to breast, both of which require the assistance of an IBCLC:

• Nipple shield. (I've linked y'all to my favorite!) These are flexible silicone nipples that are worn over mama's nipple during a feeding, and can be helpful for transitioning a bottle-fed baby back to the breast. They should be considered short-term use and a transitional device only, though there are some moms who use nipple shields throughout their breastfeeding careers. Consult an IBCLC when learning to wean from the nipple shield.
• Supplemental Nursing System (SNS). These are feeding tube devices meant to provide babies with supplemental feedings at the breast. A bottle hung around the neck is filled with milk or formula, a small tube is placed over the nipple, and the baby feeds from the breast and takes in supplemental nutrition while stimulating mama's body to create more milk.

Learning to breastfeed should be an enjoyable experience, though we all know it can be frustrating when baby wants nothing to do with the breast! Avoid pressuring baby to nurse, instead offering the breast in a casual way and pretending you don't mind if he refuses. Don't hold baby's head or pull him towards the breast, and don't try to make him go back if he pulls off the breast. Just try again later! Let your baby tell you when he is ready.

Need to increase your supply? Try galactagogues! The efficiency of galactagogues is highly debated in the breastfeeding world, but in my personal experience, they have worked wonderfully to build and increase my supply. As with all supplements and medication, please consult a medical professional before taking any galactagogues mentioned here or elsewhere.

Herbal supplements include:

• Fenugreek and blessed thistle, 3 caps of each 3x/day. These seem to work best when they are taken together, and they work relatively quickly, with some women seeing results within 12-24 hours of startng them. If they don't, they will likely not work for you. You'll know you're taking enough (of the fenugreek, at least) when you start to smell like maple syrup!
• Others: Alfalfa, spirulina, goat's rue, raspberry leaf, fennel, brewer's yeast, stinging nettle, shatavari

Foods that may increase milk supply:

• Oatmeal (steel-cut is best)
• Garlic
• Ginger

Prescription drugs include (and should be used under doctor supervision!!):

• Metoclopramide (Reglan). Do not or discontinue use if you have a history of or start to experience depression. Should be for short-term use only. Considered an L2 drug (safer) for breastfeeding.
• Domperidone (Motilitum). Do not exceed 120mg/day. Discontinue use and see a doctor if you experience any heart-related issues such as dizziness, lightheadedness, fainting, racing heart, arrhythmia, or other side effects. Considered an L1 drug (safest) for breastfeeding.
• Sulpiride (Eglonyl, Dolmatil, Sulpitil, Sulparex, Equemote). I do not know enough about this drug to make any educated notes on it. Considered an L2 drug (safer) for breastfeeding.

My personal arsenal of galactagogues include the following:

• Domperidone, 30mg 2x/day, 20mg 1x/day
• Fenugreek, 2 caps 3x/day
• More Milk Special Blend, 2 caps 3x/day

Your dosages may vary. I can't say this enough: Please consult a doctor before starting any herbal remedies or prescription drugs!

Finally: Be patient and persevere, and no matter what, you are not a failure. Bringing your milk back and getting baby to latch again are both tremendously huge endeavors, and you should be applauded for even considering to do either! This is not an overnight process, and while many women do experience great results when relactating, they have also learned to be gentle with themselves and their babies. You deserve the same respect, so be sure to give it to yourself!

Like I mentioned before, I've been able to relactate for my son after not breastfeeding at all for three months. While it was hard, and arduous, and mostly frustrating, it ended up being a great experience that brought me closer to my son and helped me learn more about my body (and how fascinating it can be!).

If you ever need advice or a virtual hug on your own journey, please feel free to email me. I'm more than happy to help support you.

Happy lactating! ♥


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