Tips for Relactation

Breastfeeding is much more than just a feeding method, it is a special relationship between mother and child. If breastfeeding finishes earlier than expected, some mothers can feel a great sense of loss and may long to go back to breastfeeding as time passes. Returning to breastfeeding is possible and has two parts: bringing back a mother’s milk supply, known as relactation, and getting a baby to breastfeed again. This article explains the steps involved in bringing back a breast milk supply after breastfeeding has ended and is a sister article to How to Get Baby Back to Breast.

Relactation basics

Hand expressing or pumping an empty breast can bring back a milk supply by stimulating prolactin—one of the hormones involved in milk production. If your baby will latch on and breastfeed, this will be even more effective. Nipple stimulation and skin-to-skin contact help release oxytocin, another hormone needed for breastfeeding.

A woman with a functioning pituitary gland and breasts can produce milk.

Relactation tips

#1 Pump or hand express

Pump or hand express at least eight to twelve times per day for 20-30 minutes so that you’re pumping every two to three hours during the day and once or twice at night 1.

#2 Skin-to-skin

Skin-to-skin contact with your baby stimulates his natural feeding reflexes, gives him an opportunity to latch on and helps stimulate your milk supply too. See Why Skin-to-Skin? for more reading.

#3 Find a breastfeeding specialist

breastfeeding specialist can be invaluable to identify the reasons why breastfeeding didn’t get off to a good start the first time round or to find the reasons why you had a low milk supply so that you can avoid running into the same problems again. With specialist breastfeeding help most difficulties can be overcome and you can be fully prepared for a successful breastfeeding journey.

#4 Consider galactagogues

Galactagogues are specific foods, herbs or prescription medicines that are thought to help a milk supply when coupled with efficient breast drainage. Galactagogues are not always needed for relactation—many mothers have brought back a milk supply by expressing or breastfeeding alone, particularly in places with a strong breastfeeding culture 2 3. See What is a Galactagogue? for further reading.

Check medications with your doctor

Discuss taking any herb or medication with your doctor so you are aware of any side effects or incompatibility with existing medication. Also check with your doctor that any existing medications you take are compatible with breastfeeding and discuss possible alternatives where appropriate.

#5 Keep baby well fed

Keep your baby well fed while you build your breast milk supply and introduce him back to the breast. A hungry baby will feel frustrated at an empty breast and a baby can’t be starved into latching on, they will only become weaker and less able to breastfeed. When your breast milk supply increases over a few days or weeks, your baby will naturally need less and less supplement. Keeping an eye on your baby’s dirty nappies and weight gain will ensure they are getting enough milk as your milk supply increases.

#6 Find a support circle

Finding a support circle of family, friends and other mothers who are relactating can motivate, inspire and help you to succeed with relactation.

Helping your baby to breastfeed

Physically latching and breastfeeding your baby is a very important part of relactation. A well latched baby can bring in a milk supply all on his own and having him breastfeed will be very encouraging for his mother. There are lots of ideas to encourage a baby back to the breast in How to Get Baby Back to Breast and see below for a summary:

#1 Skin-to-skin and constant close contact

Lots of skin-to-skin contact next to your breasts, without pressure to latch, helps your baby to associate the breast as a safe, and happy place.

  • A sling can help keep baby close during the day and bathing together can create a rebirthing experience
  • Some babies latch when they are relaxed and sleepy or latch in their sleep. Sleeping close to your baby can give more opportunities to latch 4. See Bed-Sharing With Baby for safe sleep guidelines.
Mother breastfeeds her baby
A sleepy baby may latch on

#2 Avoid artificial teats

Try to cut down using a dummy (pacifier) so that the breast can be the comforter instead. Consider avoiding using bottles for feeds too. Alternative feeding methods such as cup feeding, finger feeding with a supplemental tube and eventually a nursing supplementer at the breast can help encourage breastfeeding and break the artificial teat habit. Babies have a great need to suck and without a bottle or dummy they are more likely to be open to sucking something else. Once baby will latch, breastfeeding with a nursing supplementer until your supply builds means the breast will be stimulated to make milk during feeds and baby will learn to associate the breast with food.

#3 Make bottle feeds more like breastfeeds

If you do use bottles, try to make bottle feeding more like breastfeeding by using a slow flow teat, keeping baby upright, taking pauses in the feed, holding baby skin-to-skin and more. See How to Bottle Feed a Breastfed Baby for more tips.

#4 Make breastfeeding more like bottle feeding

Nipple shields can be helpful if baby won’t latch to a naked breast as the silicone shield will feel more like a familiar bottle teat. Make sure your baby is not desperately hungry while he practices otherwise he might associate the breast with frustration and hunger.

#5 Be patient

Never force your baby to the breast. Babies may touch, lick or nuzzle the nipple before they latch. Be patient. Dropping breast milk or formula on the areola towards the nipple can encourage a baby to lick the breast and latch (drop and drip).

Baby smiling at mother while breastfeeding
Try to make breastfeeding a fun thing to do

Once baby starts to latch

More breastfeeds, more breast milk

Once your baby will latch to the breast give them every opportunity to do so both as a comforter between feeds and for nutrition e.g. at least every two hours during the day and every four hours at night.

  • Night feeds are important for a milk supply as that is when prolactin levels are higher
  • Offering both breasts per feed helps build supply
  • Use breast compressions to increase the flow of milk and keep baby sucking as long as possible (being careful not to disturb your baby’s latch).

A good latch

Your baby needs to latch deeply and comfortably to help your breast milk production. An IBCLC lactation consultant or breastfeeding specialist can help you with positioning and breastfeeding management. See Breastfeeding Positions for Newborns, Latching Tips, Breastfeeding Videos and Breastfeeding Tips for Newborns.

Pump or don’t pump…

Continuing to pump after breastfeeds once baby is latching and swallowing milk can really help to boost your breast milk supply further. However if a mother finds pumping really stressful—using breast compressions, switching sides, and supplementing at the breast with a nursing supplementer may be sufficient to give the extra stimulation without pumping (Newman, 2015).

Continue to keep baby well fed

Ensure your baby is getting enough to eat by offering them unlimited supplement after a breastfeed or via a nursing supplementer and check weight gain regularly.

Breastfeeding with a supplementary feeding tube
Using a feeding tube to provide supplement at the breast

Frequently asked questions

Is relactation really possible?

Yes. There are many successful stories of relactation particularly in communities where the breastfeeding culture is strong e.g. in purpose built relactation centres in developing countries women relactate very successfully for their ill or severely malnourished babies who had been weaned too early 5.

Relactation is possible and practical for almost any woman if she is adequately 
motivated and supported. Age, parity, previous breastfeeding experience, and 
lactation gap, are less important factors.

Breastmilk can be produced when a woman is not specifically motivated, if the infant’s desire to suckle is strong. Grandmothers in Africa produced milk when they put infants to their breasts to soothe them in the absence of their mothers, without any intention to relactate.

The younger the baby the higher the chance of getting baby to latch on and establish a full milk supply especially in the first three months or if the baby has breastfed before. Babies younger than one month will often root and latch when placed skin-to-skin. After six months of age it can be more difficult to persuade a baby to latch (Wambach and Riordan, 2015) particularly if they have become used to feeding from a bottle.

How long does relactation take?

Milk production can return after a few days or a few weeks and varies mother to mother.

the majority of mothers produce breastmilk, usually starting within about one week. Roughly half of all mothers who relactate are able to breastfeed their infants exclusively within one month.

What are the signs of milk production?

You may notice your breasts start to feel fuller, hotter or tingle or you might leak milk or be able to express drops of milk once your milk starts to return. As your supply increases you will notice your baby wants less and less supplement but continues to gain weight. Your baby’s poops will start to become more like breastfed baby poop as they drink more and more breast milk. You may also notice changes in your mood such as feeling tearful or overwhelmed as hormonal changes take effect, there may be changes to your menstrual cycle too6.

How much milk will I make?

This is difficult to predict. Some mothers can make a full milk supply and others only a partial supply, however any amount of breast milk will be beneficial.

What is the composition of relactation milk?

Breast milk is still breast milk whether it is produced after the birth or produced later following relactation or induced lactation (see below)7. Kleinman et al 8 found mothers who had not been pregnant did not produce colostrum and instead their milk was similar to transitional or mature breast milk.

What is induced lactation?

Induced lactation or adoptive lactation is the process of bringing in a milk supply without having had a pregnancy, or recent pregnancy. Breastfeeding an adopted baby brings nutritional benefits of any breast milk produced and can strengthen the mother-baby relationship. Induced lactation is very similar to relactation—it is possible to produce milk without giving birth by using nipple stimulation and pumping. There are also medical protocols for induced lactation that may help yield more milk. However some of the causes of infertility that led to adoption may influence breast development and milk production (Mohrbacher, 2010).

Medical protocol to induce lactation

During pregnancy the breasts prepare for breastfeeding under the influence of many hormones. For a mother who plans to induce lactation, medication taken over a sufficient time interval before the baby arrives can mimic the pregnant state and promote breast growth and milk production.

The protocol involves the mother taking a combination birth control pill containing progesterone and oestrogen for six months or longer, and a prescription medication such as domperidone to raise prolactin levels and enhance milk production (Wambach and Riordan, 2015; Newman, 2014). Six to eight weeks before the baby is due, the birth control pill is stopped and the mother can begin pumping regularly to gradually build her milk supply before her baby arrives.

I prefer that the adopting mother be on the hormones, if she decides to take them, for at least three months. But what if the baby is due in a much shorter period of time? In this case, I usually suggest the mother not take the hormones at all, but proceed with taking steps to build her milk supply.

It is very important to discuss the health risks of taking any medication with your health care providers as all drugs have side effects, and could be incompatible with a particular health condition, a mother’s age, or existing medication. Further information to discuss with your doctors includes:

  1. Dr Jack Newman’s Guide to Breastfeeding (2014) has a chapter on induced lactation and relactation.
  2. The Newman-Goldfarb Regular, Accelerated and Menopause protocols produced by Jack Newman and Leonore Goldfarb. Adapted versions of these protocols are also in Breastfeeding and Human Lactation, Wambach and Riordan, 2015 and include a discussion of prescription and herbal galactagogues.
  3. Domperidone on Medsmilk [paywall] and Domperidone, Getting Started (Jack Newman)

Summary

It is possible to bring back a milk supply after breastfeeding has ended and even to induce lactation without having given birth. For some mothers relactation will bring a partial supply of milk and for others a full supply but any amount of breast milk will be valuable. Support and good information are essential.

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