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.
Two important hormones involved in making and releasing breast milk are prolactin and oxytocin which come from the pituitary gland (a small organ in the brain). Regularly hand expressing or pumping an empty breast can bring back a milk supply by stimulating the production of prolactin. If your baby will attach (latch) to the breast to suckle, this will be even more effective. Nipple stimulation and skin-to-skin contact with your baby also promote oxytocin.
#1 Pump, hand express or breastfeed
Pump or hand express at least eight to twelve times per day for 20-30 minutes so that you’re expressing every two to three hours during the day and once or twice at night 1. If your baby will suckle at the empty breast this can bring in a milk supply more quickly than a pump—see #5 below for how to provide a supplement at the breast to encourage your baby to keep breastfeeding.
- Frequency. The more often you can express, or encourage your baby to suckle, the quicker your milk supply will respond. Remember to pump at night.
- Hand expressing. For tips and videos on hand expressing see Hand Expressing Breast Milk.
- A good pump. Consider hiring a hospital grade pump for more efficient breast drainage and see How to Increase Milk Supply When Pumping, Exclusively Pumping Breast Milk and How to Make More Breast Milk for more tips on building a milk supply.
- Breast massage. Breast massage combined with pumping (often called hands on pumping) can help to increase your milk supply.
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. See Why Skin-to-Skin? for more reading.
#3 Find a breastfeeding specialist
A 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 attaching to the breast, they will only become weaker and less able to breastfeed.
Supplementing at the breast
If your baby will latch but you don’t have any milk yet, it is possible to “breastfeed” by using a supplementer at the breast. This is a narrow feeding tube that transports baby’s milk from the bottle to the breast so that a baby can have the experience of drinking at the breast. See Breastfeeding With a Supplemental Nursing System. When your breast milk supply increases over a few days, weeks or months, 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 and supplements are reduced.
#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. UK Relactation and Adoptive Breastfeeding Support is a supportive Facebook Group run by an IBCLC lactation consultant.
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.
#2 Avoid artificial teats
Try to cut down using a dummy (pacifier) to encourage the breast to 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 and Best Bottle for 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.
#5 Keep baby well fed
Make sure your baby is not desperately hungry while he practices so that he does not associate the breast with frustration and hunger.
#6 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).
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 higher5
- 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.
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 6.
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.
Is it too late to relactate after a certain time?
The younger the baby, the easier it can be to encourage a baby to latch on and to establish a full milk supply especially in the first two to 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 but it is still possible.
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 too7.
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 for your baby.
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)89. Kleinman et al 10 found mothers who had not been pregnant did not produce colostrum and instead their milk was similar to transitional or mature breast milk. However another study found the milk was similar to colostrum 11.
Can I make milk without ever being pregnant?
It is possible to bring in a milk supply without having had a pregnancy, or recent pregnancy, this is often referred to as induced lactation or adoptive lactation. Breastfeeding an adopted baby or baby born to a surrogate parent 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, latching a baby to the breast and/or pumping. However some of the causes of infertility that led to adoption may influence breast development and milk production (Mohrbacher, 2010). There are also more medical based protocols for induced lactation involving herbs or medications that may help yield more milk.
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.
One protocol favoured by Dr Jack Newman, a Canadian paediatrician and breastfeeding advocate, 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 (mimicking birth) and the mother can begin pumping regularly to gradually build her milk supply before her baby arrives.
The person inducing lactation should be on the combination birth control pill for at least 16 weeks and continue it until about 6 to 8 weeks before the baby is born and then stop the combination pill completely. This implies a period of 22 to 24 weeks total.
What if I don’t have 22 to 24 weeks time before the baby is born?
My preference is not to use the birth control pill, but then to take only the domperidone.
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:
- Breastfeeding Without Birthing online resources and book from IBCLC lactation consultant Alyssa Schnell. Information includes an overview of five protocols for inducing lactation.
- Dr Jack Newman’s Guide to Breastfeeding (2014) has a chapter on induced lactation and relactation or see Dr Newman’s web page on Inducing Lactation.
- Hale’s Medications and Mothers’ Milk [paywall] has information on the prescription drug domperidone and see Domperidone (2018) by Dr Jack Newman for further reading.
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.