Relactation Protocols for Bringing Back Milk Supply

If you are considering relactation, your foundation for success is frequent, effective milk removal.  And the good news is that your breasts have made milk previously and mammary tissue and prolactin (milk producing hormone) receptors are established. It can take time to re-establish milk supply so be ready to put the effort in for the length of time that it has been since you last nursed.  For example if it has been two weeks, you may be able to relactate in as little as two weeks.  If it has been two months, it may take that long.  However, the protocols below may help expedite this process.

Protocols

• Frequent pumping or nursing (8–12x/day, including overnight when prolactin levels are highest)

• Latch your baby on if possible.  Feeding tubes allow you to supplement your baby at breast until milk comes in.

• Get skin to skin with your baby often as it increases oxytocin (milk ejection hormone)

Lactation Aids

• A high quality electric breast pump such as a Spectra S1 or S2; wearable are not as effective

• Lactation Aid Feeding Tubes can help keep baby to the breast for assistance with keeping the baby at breast to boost oxytocin for better let-down

• Supplements can be used to help, but will not work without adequate stimulation and extraction

Medications & Supplements

• Motherlove More Milk Plus - Tried and true herbal supplement containing goat's rue and fenugreek. Fenugreek is not recommended if you have diabetes, hypoglycemia, or PCOS subtypes sensitive to glucose shifts.

• Legendairy Milk Liquid Gold - Combination herbal supplement with goat's rue, milk thistle, shatavari, fennel, alfalfa and anise. Not recommended for mothers with SLE disease, plant allergies associated with ingredients listed.  May lower blood sugar.

• Metoclopramide (Reglan):
  Prescription only. Used occasionally, short-term, and cautiously. Evidence for meaningful volume increase is mixed, and side-effect risk limits routine use.

Manage Expectations

Frequent, effective removal of milk by baby or high quality double electric breast pump is essential.  Pack your tenacity as you will need to keep this up 8-12 times per day and include night feeding or pumping until milk supply is well established. Be prepared that volume increases gradually over weeks and manage your expectations. While a comprehensive study* shows that 79% of moms were successful at being able to resume breastfeeding, full milk supply may not always be reached. Some moms were only able to produce 25-50% milk supply, but every ounce counts for the health of your baby.

Hang in there mama!

Tanya

References:

*Matern Child Nutr. 2022 Oct 12;19(1):e13440. doi: 10.1111/mcn.13440

J Trop Pediatr. 1997 Aug;43(4):213-6. doi: 10.1093/tropej/43.4.21

Milk Supply: How Do I Know if My Newborn Baby is Getting Enough Breast Milk?

Once your newborn is at least 6 days old, there are some guidelines to help you be sure of your milk supply.  Note that insufficient milk supply is rare.  What is more common are practices that can hinder your milk supply or baby's feeding which I will detail at the end of this post.

To assess good milk transfer, answer the following:

1. Is the baby wetting 6-8 diapers in 24 hours? (Disposable diapers are so absorbent, that it might be hard to tell.  If you are unsure, take a clean diaper in one hand and the removed diaper in the other and you should be able to tell by the slight weight difference.)
   Yes  |  No
2. Is the baby having 3-4 bowel movements in 24 hours that are mustard yellow with curds in them? (These shold be silver dollar size or larger, not just a stain.)
   Yes  |  No
3. Do the breasts feel full before feeding and softer after feeding? 
4. Yes  |  No
5. Do you hear swallowing when the baby is breastfeeding?
   Yes  |  No
6. Is the baby eating at least 8 times in 24 hours?
   Yes  |  No
7. Does the baby seem satisfied after a feeding?
   Yes  |  No
8. After the initial weight drop, has your baby started gaining 3/4 - 1 ounce per day?
   Yes  |  No                                                               
9. If tyou had some nipple soreness, is gone?                                                                                    Yes  |  No

Practices that hinder milk supply include "scheduling".  Making an infant wait for feedings, lowers milk supply and slows weight gain.  Infants may need to eat at 1-3 hours apart during the day, especially between day 10 and three weeks when the first grown spurt occurs.  The only scheduling that should occur is if the infant has not asked to be fed at the 3 hour mark from the beginning of the last feeding, it is time to nurse.  A mininum of eight times a day is normal for a newborn.  The longest stretch you could hope for is one 5 hour stretch.  It is common for newborns to feed up to 12 times per day during a grown spurt.  This practice ensure a healthy milk supply for a growing baby as milk supply follows a demand and supply principle.

Other practices that can hinder milk supply are the use of a nipple shield.  While they have a time and place to assist in latch.  They are not a cure for sore nipples and should not be used unless necessary and discontinued as soon as possible.  When using a nipple shield, a cut out ultra thin silicone nipple shield is best.  Place the cut out at the baby's chin so that the skin to skin can elevate your hormone response which increases milk supply.

Another practice than can reduce milk supply is unresolved engorment.  When the milk first comes in 3-5 days postpartum, softening the breasts with warm moist heat from a compress or disposable diaper doused with hot water and warmed in the microwave is essential before nursing or pumping so that milk is more effectively extracted.  Milk that is not extracted actually reduces milk supply as your body is being signaled that you do not need the milk.  That is why the practice of waiting for an insurance pump is not the best idea.  If your insurance company will not allow you to get a pump until after the birth, go with a private pay DME.  That way, you can order the breast pump on the day of the baby's birth and it will be at your doorstep between 3-5 days when you need it most.  You then have to file for reimbursement with your insurance company, but it beats waiting around for a company to bill your insurance and you may not have your pump when you need it most. 

Here is to a Healthy Milk Supply, Mamas!
Tanya

Comprehensive Guide to Increasing Breast Milk Supply

Your body makes milk on a supply and demand basis. Although we don't need ounce markers on the side of our breasts to know the baby is getting enough, we tend to fret over milk supply.   Here is a comprehensive guide to ease your worries and address your concerns.

Is my baby getting enough?
When your baby is first born, his wet diapers should increase daily. On day one, he should have at least one, day two, he should have two, up until day six. After six days of age, they have six to eight pale wet diapers daily and three to four "cottage cheese and mustard" stools. Other ways we can tell the baby is getting enough milk is that he makes quiet swallowing sounds at the breast. The breast feel full before the feeding and softer afterward. The baby seems satisfied after twenty minutes of swallowing. Babies may loose 7-10% of their birth weight, but begin regaining at day 6 and gain 5-7 ounces per week on the average until 6 months of age. The stools can change at 4-6 weeks of age. Only if your baby is not gaining well, invest in a baby scale that you can use to monitor breast milk intake and growth. You will want a scale that shows 1/2 oz increments or greater.

Do I need to drink more water?
Water does not make milk, but make sure you are drinking to thirst. If you are dehydrated your body does not function optimally.  
Can I increase my milk supply with supplements?
If you want a boost increasing milk supply, there are several galactagogues on the market. Fenugreek is safe and effective and can be found in most areas. Make sure you are talking a quality brand like Nature's Herbs or Natures way in an appropriate quantity.  You should take 600-626 mg capsules that only contain Fenugreek.  This normally increases milk supply in about 48 hours.  If you are an average size mom, you should take three capsules, three times daily so 9 per day.  Plus size moms can take up to 5  600-626 mg capsules per dosage for a total of 15 per day.  Make sure you are not getting loose stools and check milk supply after 3 days by nursing the first session in the morning and then double pumping with a good quality double pump like the Hygeia EnJoye LBI, Spectra S2, or the Ameda Finesse Breast Pump for 15 minutes. 

How much is enough?
You should be yielding 2.5 oz per lb of baby's body weight per day.  To calculate if you are making the appropriate amount take your baby's weight for example 8 lb multiply by 2.5 which in this case would equal 20 oz per day.  Then divide by 8 times per day for a baby under 6 months.  This means from both breasts you should be making 2.5 oz for an 8 lb baby.  Here is a link to a page where you will find to an easy to read milk intake feeding supply chart.

Can my baby help increase my milk supply?
Yes!  If your infant will suckle at the breast, this is a highly effective way of increasing milk supply.  Offer the breast every 2 hours with a longer stretch at night for a minimum of 12 feedings per day.  If the infant will suckle for at least 20 minutes each time, your milk supply should increase by day 6.  Remember, breast milk adheres to the supply and demand rule, so the more you demand, the better the supply.

Can I increase my milk supply with a breast pump?
Yes!  If your baby will nurse frequently even if milk supply is low, use the baby; but if your baby will not latch or will not stay latched long enough for you to get adequate stimulation, by all means use a quality pump like the Hygeia EnJoye Cordless, Spectra S2, Ameda Finesse or the Ameda Platinum Breast Pump.  If your baby is under six months old, you should be pumping or nursing at least 8 times per day for 10-15 minutes of double pumping.
If you are already nursing eight times per day, use your breast pump to simulate a growth spurt.  Studies show that you need one hour of additional stimulation per day to increase milk supply.  Pump an additional 10-15 minutes three times per day for five days in a row to simulate a growth spurt and increase milk supply.  If you miss a day, start the process over. You can accomplish this by moving feedings and or pumping to every 2 hours instead of every three or pump.  Frequency is better than duration for increasing milk supply so don't cheat by making pumping times longer.  They need to be more often.

Are there other supplements that help with maintaining milk supply?
Motherlove More Milk Plus comes in a liquid filled capsule with just the right combination of galactagogues to increase milk supply in most mothers.  In addition, products from Motherlove offer specific instructions for dosage in relation to lactation.
There are several other supplements that I would recommend substituting for snacks. Instead of a cookie, grab a Milkmakers Lactation Cookie.  Moms do need an additional 500 calories per day to make milk.  Most of us get them instinctively, but if you are already over your calorie limit, a good mothers milk tea is a good option.  

Are there other tips for maintaining a healthy milk supply?
Busy moms can sometimes miss feeding and or pumping.  Don't just forget them, make up for missed pumping times at work when at home or put later in the day pumping closer together if you have a meeting.  If you are out for a short time and someone else is fed the baby before you could make it back, make sure to pump immediately upon return.  This helps milk supply as well as restocking your freezer.

Is my body capable of making enough milk?  
Insufficient milk supply syndrome is actually very rare.  A mother with a complete mastectomy on one breast can still nourish a baby just as a mother of twins can nourish two. Most milks supply issues are about mismanagement of stimulation of the breast and insufficient extraction of the milk, making your body think it doesn't need to make more.  
What other tips do you have for managing milk supply?

• Nurse within the first 30 min to 1 hour after birth, delaying the bath for skin to skin contact.
• Try to minimize engorgement and don't leave engorgement unresolved.  Nurse often, waking the baby every 2-3 hours.  Use warm compresses and a breast pump if the breasts are too hard for the baby to latch on.  The first day, the baby tends to sleep longer after the initial hour after birth, but continue to try and after that 6-10 hour period increase your efforts.
• Don't miss feeding unless you are pumping.
• Don't forget about growth spurts when you are working.  If you are away from your baby at the 3 week, 6 week, 3 month or 6 month time period, pump every 2 hours instead of every 3 for a total of 11-12 nursing or pumping sessions per day.
• Delay solid foods until the baby had not only double his birth weight but is sitting alone unassisted.  Sitting without help (even from a Boppy) coincides with the loss of a tongue thrust reflex that indicates readiness for solids.
• Feed solids only after breastmilk.  Breastmilk is still the main source of nutrition for at least the first year so do not fill the baby up on inferior food.  Nurse or give breastmilk first.  Besides, who wants green beans on your breast?

Here's to a healthy milk supply!
Tanya

References:
Fenugreek: One Remedy for Milk Production by Kathleen Huggins, RN, MS
Fenugreek: Overlooked but not Forgotten by Rima Jensen, MD

Updated:  2/19/19

Pump Up Your Production: Milk Supply and the Pumping Mama

With today's easy to use breast pumps, moms sometimes think they just need to pump at work at lunch and break and then just go about their business.  Pumping, just like breastfeeding should be intentional.  We don't choose to breastfeed because someone said it is better for your baby.  We breastfeed because we educate ourselves to want the best for our child.  Pumping should also not be so haphazard.

First choose a quality hygienic breast pump.
There are many breast pump out there that while commonplace, are not the best choice.  You need an auto-cycling breast pump that does at least 60 cycles and has a closed system like Hygeia, Ameda and Spectra offer.  Double pumping increases the prolactin levels as well as save you time. Prolactin is the milk producing hormone.

Next determine your pumping schedule.
A mother of an infant under six months should pump at least every 3 hours that she is away from her baby.  That time frame is from the beginning of one pumping or nursing session to the beginning of the next.  If your schedule is erratic, you should still pump 3 times per day on an 8 hour work day. Just put some of them closer together if needed to get this time in.

Allow enough time for pumping.
You should allow a full 10-15 minutes for double pumping and then an extra few minutes to rinse your parts and put them away.  Do not stop pumping if milk stops flowing unless the time on the clock has passed.  Otherwise your body will think you don't need as much milk.  A good rule of thumb is that if milk is flowing for less than 10 minutes, pump for 10. If it is flowing past the 10 minute mark, pump for 15.  These extra few minutes simulate the non-nutritive sucking your baby does when nursing and is imperative for milk supply.

Don't forget about growth spurts.
Infants nurse more frequently during growth spurts.  At 10 days to 3 weeks, the first growth spurt is evident with the baby asking to be fed more frequently.  Breast pumps don't cry to be used so we have to intentionally pump more often during this 5 day period.  Pumping every 2 hours is best during the baby's third week, sixth week and three month milestone.  If this is not possible at work, pump at home after feeding the baby at least three extra times per day.  Don't worry about the amount of milk you are extracting.  This is more for stimulation than extraction, indicating to your body that your baby is about to grow and will need more milk.

Maintain your breast pump.
Professional grade breast pumps like the Hygeia EnJoye, Spectra S2 have systems that are dependent on maintaining suction.  Replacing breast pump valves and filters every six to eight weeks is essential for keeping your breast pump working at it's optimal level.  Keep breast pump parts on hand and replace on schedule or more often if you notice evidence of decreased suction or damage to your parts.

With good information prior to embarking on full time pumping or working and breastfeeding it is entirely possible for you to maintain a healthy milk supply.

Happy Pumping!
Tanya

Exclusive Pumping: Keeping Up Breast Milk Production While Pumping

I often get moms who want to exclusively pump instead of breast feed directly.  If you choose to pump exclusively, it is very important that stimulation starts in the hospital within 1 hour of the baby's birth.  Moms should double pump with a hospital or professional quality pump like the Ameda, Medela or Hygeia hospital grade rental pumps or a brand new (not used) professional quality pump like the Ameda Purely Yours,  Hygeia EnJoye Breast Pump or Spectra S2 Breast Pump. 



To initiate milk supply, pump every 2-3 hours with a 5 hour stretch at night for a total of at least 8 times per day of 10-15 minute double pumping sessions.  Many pumping moms get discouraged during the first 3-5 days as it is hard to see much going into the bottles as colostrum comes in teaspoons, not ounces.  Do not let this dissuade you, but draw this liquid gold up in a syringe and give it to the baby as it is chalked full of antibodies.  This schedule goes on for the first six months for the most part, but there are times when normal babies go through growth spurts that you will have to simulate with a pump.  When the baby is 2-3 weeks old and again when the baby is 3 months old, set aside a 5 day period that you will step up the pumping schedule to every 2 hours for a total of at least 11-12 times per day.  This must be 5 days in a row.  If your schedule gets interrupted, start over.   As you can see, this is a lot of pumping and cleaning of pump parts.  You will want at least 2-3 sets of breast flanges to use.  Some moms start this because it only takes 10-15 minutes to pump and a newborn baby takes 45 minutes to nurse, but as the baby gets older breastfeeding directly is much easier.  No bottles or pump parts to clean and most 2-6 month old babies will nurse in 20 minutes so you may want to reconsider your decision.  Pumping is great for the working mother, but if you choose to exclusively pump, experience shows me that these moms do not nurse as long as their direct breastfeeding counterparts.  If you breastfeed directly, it gets much easier by 6 weeks and by 3 months you feel sorry for moms who mix formula.   After all, have milk will travel!

If you do choose to exclusively pump, in addition to a quality breast pump a few key accessories will make your life easier.  These include a hands-free pumping bra so that you can multi-task while you are pumping, a breast pump cooler bag for transporting your pump and breast milk, an air dry bag to store and dry your breast pump parts on-the-go, and re-usable sterilizer bags to keep your parts sanitary anywhere you pump that you have access to a microwave.

Happy Traveling,
Tanya
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