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

Supplementing the Breastfed Baby: Lactation Aid Feeding Tubes vs Supplemental Nursing System & Lact-Aid Nursing Trainer

     In my practice as a board certified lactation consultant, there were times when it was medically necessary to supplement.  Whether it was due to a poor suck or mismanaged milk supply, we need options when recovering from these issues and getting back to breastfeeding.  Many times, I would recommend finger-feeding with a syringe to keep moms from using a bottle nipple.  I would have rather recommended a Supplemental Nursing System which has a container with tubes that runs to the breast; but I didn't want to see mom spending the extra money when her budget was so tight.  At that time, the only options were the Supplemental Nursing System (SNS) by Medela and the Lact-Aid Nursing Trainer.   These cost mom $50 or more and had small tubes to be cleaned which were cumbersome.   Now, with more options available, Moms can use a short-term feeding tube which accomplishes the same thing and can be cleaned for a few days before disposing of it.  It is a small investment in comparison to the commercial systems.  While moms who are adopting babies and inducing lactation, rather than just building milk supply may still want a commercial unit; the Lactation Aid Feeding Tubes are the best course for the short term situation.  Thanks to IBCLC, physician and lactivist, Dr Jack Newman videos and instructions are available for using these feeding tubes.  You simply cut a slightly larger hole into a bottle nipple.  Insert the adapter end into the bottle and feed the tube into the babies mouth while he is latched on.  You may also use medical tape if you prefer to have the tube in place prior to latch.  These can be purchased from the International Breastfeeding Center in Canada, but due to the long ship time of up to three weeks, we have added them to our selections at Lactation Connection.  Sold in a two pack for under $10, these will last up to two weeks while mom is re-establishing milk supply or training a baby with a weak suck.  Each tube is in an individual sterile pack ready to use.  Instructions are included with the feeding tubes when purchased here:  https://www.lactationconnection.com/Jack-Newman-s-Lactation-Aid-Feeding-Tube-p/54-5036-2.htm
     Dr. Jack Newman also has a helpful instructional video on YouTube.  I encourage you to view it and encourage lactation consultants and breastfeeding counselors to recommend and use these feeding tubes for short term situations of supplementation. 
http://www.youtube.com/watch?v=ezGIkIkhC_o&feature
     It is also important to recognize the appropriate amount of supplementation.  Always assess milk supply first, then only give the difference of what mom is producing and the actual need of the baby.  This is to say that you supplement not how much the baby will drink, but the need of a baby of that weight.  Here is a link to a chart for appropriate milk intake to show how much to feed per pound of body weight:  https://www.lactationconnection.com/Feeding_s/1907.htm  For example, a 7lb baby who is older than 6 days needs 2.25oz eight times per day.  If mom is making 1.25, then the appropriate amount of supplementation is 1 oz. per feeding.  Contact you local lactation consultant for further instructions on supplementation or give us a call at 800-216-8151 9-5 M-F CST. 


Lactation Aid Images: 

Note:  Most lactation aid feeding tubes sold are slow flow.  They are 36" in length so that the flow is regulated.  Shorter tubes change the flow to a faster rate.  If you do need a faster flow for an older baby, medium flow lactation aid feeding tubes are now available at: https://www.lactationconnection.com/Jack-Newman-s-Lactation-Aid-Feeding-Tube-p/54-6036r.htm 

Happy Nourishing!

Tanya

Induced Lactation: Protocols for Adoptive Breastfeeding Mothers

Motivation as in anything is extremely important in breastfeeding and even more important is tenacity when inducing lactation.  The success rate for the following protocols according to Nemba in the 1994 Journal of Trop Pediatrics was 89%.  In this study 33 of the 37 women nursed their babies for 9 months or longer.
These mothers began with a 100 mg single priming dose of medroxyprogesterone (Depo Provera).  After 7 days, they began 25 mg of chlorpromazine 4 times daily or 10 mg of metoclopramide (Reglan) 4 times daily until adequate lactation was established.  Frequent pumping before infant's arrival and/or frequent suckling afterward is encouraged.  A supplemental feeding device is necessary until adequate lactation is established.  Inducing lactation is a gift of time and love!
Breastfeeding an adoptive baby is more than about breastmilk.  It is about bonding.  Skin to skin contact is essential.  Use a lactation aide to feed donor milk or formula at each feeding.  This is essential for stimulation of the milk production, bonding and success.

Best wishes for nurturing and nourishing your baby,

Tanya Roberts, BSEd, IBCLC

www.lactationconnection.com