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

Breastfeeding with PCOS

If you have Polycystic Ovary Syndrome (PCOS), maintaining milk supply requires intensive milk extraction due to risks of delayed milk "coming in" and potential hormonal interference from insulin resistance and/or high androgens. To endeavor to get milk to come in and keep your milk supply, below are some protocols that may help.

Immediate Postpartum Protocols

Early Initiation: Start nursing or hand expression within the first hour of birth.

Frequent Removal: Breastfeed on demand or use a hospital-grade pump at least 8–12 times every 24 hours (roughly every 2–3 hours).

Night Feedings:  Pitocin levels are the highest between 12pm-5am, so don't take advantage of nursing or pumping twice during those hours..

Antenatal Expression: Begin expressing colostrum at 38 weeks (with medical approval as it may cause contractions) to "wake up" breast tissue and build a supply before birth.

Avoid Early Supplementation: Unless medically necessary, avoid formula in the first few days to maximize biological stimulation of the breast. 

Skin to Skin Contact: Even if pumping, use skin to skin contact with baby to boost oxytocin which aids with let-down. 

 Advanced Extraction Techniques

Breast Pump & Flange Selection: Make sure to use a good double electric breast pump, not a wearable and measure for correct flange size to use.  A wearable breast pump should only be used on occasion.

Triple Feeding: If the baby cannot latch effectively, nursing is followed by 10–15 minutes of pumping on each breast to ensure thorough drainage.

Hands-On Pumping: Use a hands-free bra and perform breast massage while pumping to increase milk output by as much as 48%.

Power Pumping: Simulate cluster feeding once a day for several days by pumping for 20 minutes, resting for 10, pumping for 10, resting for 10, and pumping for 10.

Night Pumping: Prolactin levels are highest between midnight and 5 a.m.; ensure at least one extraction session occurs during this window. 

Metabolic & Hormonal Management

Insulin Sensitivity: High insulin can block milk synthesis. Manage this through a low-glycemic index diet and, if prescribed, continuing Metformin, which is considered safe during lactation.

Galactagogues: Certain herbs like Goat’s Rue (which supports insulin sensitivity) and Moringa may be more effective for PCOS-related supply issues than traditional herbs like Fenugreek.

Stress Management: High cortisol from stress can trigger androgen spikes that inhibit milk flow. Use skin-to-skin contact (Kangaroo care) to boost oxytocin and lower cortisol. 

Non-insulin Resistant PCOS

Following the immediate post-partum protocols and advanced extraction techniques is essential.  Poor prolactin response could be the culprit of low milk supply additional pumping especially between 12pm-1am and switch nursing (moving baby back and forth between breasts every 5 minutes) may be helpful.

Lifestyle, diet and weight management can help regulate hormones.  

Some find Myo-inositol and Vitamin D supplements helpful. Vitamin D dosage in prenatal vitamins is often 400-600IU/day which is insufficient.  Recommended dosage is 1000-2000IU/day to begin with upper level dosage at 4000IU/day.

Recommended Support

Prenatal Consultation: Meet with an IBCLC (International Board Certified Lactation Consultant) before birth to assess breast development (checking for Insufficient Glandular Tissue) and create a custom plan.

Weight Monitoring: Frequent weight checks for the infant in the first two weeks are critical to ensure they are transferring enough milk despite potential PCOS-related delays. 

Having PCOS does not mean you are unable to breastfeed, but it does pose challenges and milk supply may wain even with your best efforts.  The initial colostrum is your baby's first immunization and any breastmilk is liquid gold for you baby's health. Don't be discouraged if your milk supply is not like the next moms.  Your tenacity and effort to give your baby the best is what counts.

Every ounce counts,

Tanya

Are Lansinoh Glass Bottles Lead-Free?

Lansinoh glass bottles are a great option when needing a larger than 5-6 oz wide mouth bottle in glass for your infant.  There was some question about three years ago as to whether the paint on the logo was lead-free.  This type of information stays on the internet forever, so we wanted to clear things up.  

Lansinoh changed their logo in 2023 and sources from Lansinoh recently stated to Lactation Connection in writing that the bottles contain no lead so you can be assured that they are now lead-free aka Pb-free if you are purchasing the Lansinoh 8oz Glass Bottles with the new logo.

We would not recommend buying older bottles with the older oval logo shown above out of an abundance of caution.  Above is an image of the older logos along with the dates of use by Lansinoh.  Below are images of the new glass bottles and where you can purchase to be assured you are receiving only the new style. 

Lactation Connection as a company prides itself on sending you what is pictured so as another example if you are buying Spectra bottles two-pack you will see pictured the new beige cap style which is what you are being sent or the Spectra pink logo bottle singles which are also always sent as pictured.  The pink logo bottles are being discontinued so the pink Spectra bottles will only be available while supplies last.

Here's to finding the feeding supplies you need,

Tanya

How to Express More Milk with your Spectra Breast Pump

At Lactation Connection, we are frequently asked which setting mom should use on the popular Spectra S1 and S2 breast pump to get the most milk.  While settings are important, flange size is equally important.

Your goal with your Spectra flange size is to engage the milk sinuses which are located an inch behind the nipple.  So it is really important that the flange allows the nipple to move freely without drawing in too much tissue.  You can use the guide below or a silicone nipple measuring tool.

What about the settings?  Cycle pumping is recommended by Spectra when using the S1 or S2. Below is the procedure to start using the Spectra pump effectively.

      Cycle 70 (Massage Mode) for 5 minutes 

      Cycle 54 (Expression Mode) for 5 minutes 

      Cycle 70 (Massage Mode) for 5 minutes 

      Cycle 38 (Expression Mode) for 5 minutes 

Some moms leave their pump on higher setting, but know that the Expression Mode (38 cycles per minute) is very effective at draining the breast and relieving clogged milk ducts.

In addition, relaxed pumping is best. You first need realistic expectations of how much you should be getting when you pump.  After the initial week postpartum, you should only expect what your baby needs.  To determine this amount, take your baby's weight and multiply by 2.5.  Then divide by 8 feedings.  This is the amount you are looking to pump in total from both breasts.  For example, a 10lb baby x 2/5 + 25oz ÷ 8 is 2.5 oz.  So you may get one once on one breast and perhaps an ounce and a half on the other.

Effective tools for relaxation to aid with let-down include the following:

1.  Once you position the breast shields, don't watch the bottles!

2.  Look at your baby or baby's picture.

3.  Wrap a swaddling blanket around your neck so you can smell the baby.  

4.  Relax your shoulders.  Hold the breast flanges in a c-hold at the flanges instead of by the bottles so you can drop your elbows and relax your shoulders.

5.  Make sure you are comfortable.  Use a short stool if needed to bring your lap up and keep you from leaning too far forward and straining your back.  Pumpin' Pal angled flanges are excellent for keeping you from leaning forward and are a real back-saver!

Best wishes for an abundant pumping session!

Tanya

Ninni Co Breast-like Pacifier Review

While I did not dissuade the use of pacifiers for breastfed babies in the past, I had never found one that I could fully endorse.  Now, after 32 years serving nursing mothers, I feel confident in giving the Ninni Co pacifier my full endorsement.  As a retired International Board Certified Lactation Consultant, I love the graduated shape, the breast-like soft feel, the breathable shield and the view into the baby’s mouth for suck assessment.  This pacifier is not only recommended by lactation consultants for nursing babies to transition between breast and bottle more easily, but it has also been recommended for use in suck training and oral motor development in pediatric feeding therapy. 

Why is the Ninni pacifier so highly recommended?

1. This breast-like super soft medical grade silicone pacifier mimics the tissue of the breast which encourages baby to create strong suction and a vacuum effect similar to breastfeeding.

2. For proper use, baby’s mouth needs to open wide and remain open while using their tongue to suck in a natural peristaltic wave unlike other pacier styles which encourage a pursed mouth and chomping.

3. This breast-like pacifier can be used as a training tool to help babies with oral dysfunction develop a more effective suck technique. It’s great for post-op rehab for tongue ties and cheek ties or a disorganized suck.

Here's to more natural suckling,

Tanya

Spectra Replacement Parts Best Practices

Below are the top 5 questions I get from moms about their breast pump parts so I thought I would share the answers with you.

1.  How often do I replace my breast pump parts?

While most parts are replaced as needed when they age or if you need a new size flange, some parts are essential to replace on a regular basis.  For example, if you are pumping for work three times a day, replace your valves every 4-6 weeks and diaphragms or backflow protectors every 8-12 weeks to prevent your aging breast pump parts to reduce your suction and your milk supply. Valves should be checked to make sure that they close properly.  This is not just a visual check when they are at rest since new valves can have a slight openin. To check them properly, squeeze the sides of the tip between your thumb and index finger and the end should close for a moment when you release it.  

2.  Is it ok to buy off-brand breast pump parts? 

Absolutely not.  Each pump manufacturer tests their pumps for optimal suction with the parts they design and manufacture.  If you change anything from the valve to the backflow or even the tubing, it will change the mmHg (miligrams of mercury) which is how suction is measured.  Anything less than optimal suction can affect your milk supply. To give you an example, below are images of the Spectra valves  and "valves for Spectra pumps" created by after-market companies.  You can see by the underside that they are in no way the same and therefore the suction can in no way be the same!

Even the length of the tubing can change the suction on your breast pump so we encourage moms to only purchase original manufacturer's parts.  They can be expensive on the manufacturer's website, but Lactation Connection offers discounted prices on premium brand name parts. And you certainly don't want to buy from Amazon whose "free shipping" is actually tacked onto the price and if you read the reviews you will see where moms have received used items that have been returned and resold.

The one caviat to the rule of only using original parts is when it comes to flanges.  If Spectra does not make the flange size you need or you prefer a silicone flange for small nipples or an angled flange for larger nipples, it is acceptible to buy Pumpin' Pal with MayMom adapter as they fits exactly with the parts that create the suction including the tubing (without adding an aftermarket adapter), the valves and the backflow protectors or diaphragms so your suction will not be affected.

3.  How do I clean my breast pump parts?

Use the manufacture's instructions but as a general rule, you only sterilize the parts that come into contact with the milk. Using a steam sterilizer is the best way.  The microwave steam sterilizer bags are really convenient and unlike boiling water, it is unlikely you will overheat and warp or cloud your pump parts.

4.  Is it ok to use pre-owned breast pump parts?

Again, absolutely not. Yeast naturally occurrs in our bodies, but overgrowth of yeast can cause nipple pain, pass an oral yeast infection called thrush to babies and even be the reason moms terminate breastfeeding early.  Yeast cannnot be killed by sterilization and it harbors in microscopic scratches on plastic pump parts so it is imperative that you do not share breast pump parts just as you would not want to share a toothbrush.

5.  How do I find the parts I need?

Below is a Spectra replacement parts diagram.  I will list the item numbers for genuine Spectra parts and links for your convenience.

1. Spectra bottle

MM011909 Spectra Bottles - 2 Pack

2. Spectra valve

MM012388 Spectra Duckbill Valves - 2 Pack

3.  Spectra flange available in sizes 16mm, 20mm, 24mm, 28mm and 32mm

MM012716-S Spectra 16mm Flange - Single

MM012753-S Spectra 20mm Flange - Single

MM012302-S Spectra 24mm Flange - Single

MM012319-S Spectra 28mm Flange - Single

MM012326-S Spectra 32mm Flange - Single

4. Spectra backflow protector

MM011992 Spectra Backflow Protector - Single

5. Spectra tubing

MM012401 Spectra Tubing - Single

Best wishes for keeping the milk flowing!

Tanya

Preventing Breastfeeding Roadblocks: Finding a Pro Breastfeeding Pediatrician

 

There are some roadblocks to breastfeeding than come up often when moms are in the hospital or at their first pediatrician visits.  Depending on a mom's personality some are good advocates for themselves, but a lot of moms just go along with what they are told without questioning.  Often even if the pediatrician is pro-breastfeeding, a staff member will give you a biased opinion of what needs to be done in a certain situation.  While there are times supplementing with formula is helpful, often it is not necessary and depending on how the supplementation is done can hinder breastfeeding success.  

Common scenarios that present barriers to breastfeeding are listed here including science-based evidence for this information in case you need to pass it along to any health professionals who may disagree so that you be your baby’s advocate. 

1. The baby has low blood sugar.

The high protein content of colostrum helps with glucose stabilization and promotion of ketogenesis which is as effective as formula supplementation.

https://www.jognn.org/article/S0884-2175(15)31316-2/fulltext

2. The baby has jaundice.

There is a difference between breastfeeding jaundice and physiological jaundice.  Physiological jaundice appears within the first few days and can be a normal result of an immature liver which is not removing bilirubin quickly enough.  Colostrum is an effective treatment because it helps the baby pass meconium, the first stool, which removes excess bilirubin from their body.

The cause of breastfeeding jaundice is unknown, but it is most likely related to infrequent feedings. It does not usually present itself until after the first week of life.

https://www.ncbi.nlm.nih.gov/books/NBK537334/ 

Phototherapy is common protocol to treat jaundice.

3. The baby is big and “needs” supplemental formula.

Birth weight can increase the stomach capacity,  but supplementation, especially without expression hinders the mature milk from coming in on time.

The defense is a good offense.  Initiate the first feeding within 30 minutes of birth because after the first 1-2 hours baby goes into rest mode and is difficult to feed well for the next 8-12 hours, but any attempts at suckling will help stimulate milk production.  Approximately 5ml to 10ml is the typical colostrum feeding in the first 24 hours of life so if the baby is larger, it is important to feed more frequently than 2-3 hours as normally recommended.  Studies show that babies can metabolize up to 20ml per hour and since colostrum comes in approximately 5ml teaspoons, feeding every hour is beneficial. Mature milk normally comes in between the 3-5 day postpartum so frequent feedings can help the mature milk to come in on the earlier end of this range and help offset the big baby syndrome.

https://pubmed.ncbi.nlm.nih.gov/23662739/

4. The baby has lost too much weight and “needs” supplementation.

Typically, the baby’s first pediatrician’s appointment is on day 5-6.  It is normal for breastfed babies to lose 7-10% of their birthweight as the mature milk does not come in until day 3-5 and moms and babies are learning how to breastfeed.  Formula babies only typically lose 3-5% of weight since larger amounts than are necessary are often fed and bottle nipples drip formula into the baby’s mouth without effort. Not putting formula standards on breastfed babies can prevent unnecessary supplementation which can interfere with breastfeeding success.

https://www.ncbi.nlm.nih.gov/books/NBK536449/

  

It is beneficial when interviewing a pediatrician to tactfully get a feel for how quickly they recommend supplementation. 

Here are some sample questions:

 

I understand some jaundice is common, do you recommend pumping and feeding the baby colostrum or formula?

 

Is low blood sugar a reason I would have to supplement formula instead of colostrum?

 

When is the follow up visit scheduled after birth?

 

How much weight is ok for my baby to lose the first week while I am breastfeeding?

 

How the pediatrician answers these questions may help you determine how pro-breastfeeding they are.  It is more difficult to determine how pro-breastfeeding their staff is without being a patience, but if at any time you get advice from a doctor’s staff that seems contradictory to the doctor’s values, don’t hesitate to ask for a phone call from the pediatrician in person.

 

That being said, sometimes supplementation is necessary but sometimes moms are bullied into supplementing even when not necessary.  If either is the case, it is important to stand firm on not using a bottle nipple to supplement.  A 10cc slip tip syringe can be used to finger feed the baby easily and this method keeps the baby’s tongue in a good position for breastfeeding.  In addition, it is easier to slow the pace of the feeding with a syringe which keeps baby on track with moms increasing milk production instead of exceeding her production where she is always playing catch-up.

Here's to all the pro-breastfeeding pediatricians and nurses out there!  They do exist!

Tanya