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

Breast Milk Intake Chart: Infant Weight - How Much Breast Milk

One of the top questions we get, is how much do I leave for my baby in a bottle when I am away at work?  After all, your breasts don't come with ounce markers because your baby feeds on demand.  But for moms who are working or away from their baby short term, it is important to know how to determine how much milk is appropriate to leave.  For infants up to six months old, the quickest way to determine this is to take your baby's current weight rounding up to the nearest half pound and multiply by 2.5.  For example, a baby who is 10 lbs will need 25 ounces per day.  Then divide by the number of feedings per day, normally 8 for an infant under six months of age.  Therefore 25 ounces divided by 8 feedings is 3.12 ounces per bottle which we will round up to the nearest quarter ounce.  In other words, leave 31/4 ounces for a 10 lb baby for every 3 hours that you will be away.  Also leaving an extra frozen bottle is a good idea for emergencies.  Here is a link to a breast milk intake chart for those of you who are like me and have a mental block when it comes to math.

If you are trying to determine breast milk intake in those early days for your peace of mind or if your baby doctor is indicating that your baby is slow to gain weight, an affordable accurate baby scale with memory is a great tool.

Remember, diapers are a great indicator that your baby is getting enough.  Infants from day 6 through 6 weeks should have 6-8 wet diapers per day and 3-4 dirty diapers larger than a silver dollar.  Also note that older babies who are on solid food do not use this chart.  At that age, they take an average of 24-32 oz per day in addition to three solid meals per day.  When feeding solid foods, breastfeed first as breastmilk is still the main source of nutrition.  

If you still have concerns, having an affordable accurate digital baby scale is a plus.  Choose a digital baby scale that is accurate within 5 grams and has memory for before and after feeds to give you an idea of your baby's breast milk intake.

Best wishes!

Tanya