Relactation and Adoptive Nursing

By Anne Smith, IBCLC

Relactation is the process of rebuilding your milk supply once you have started nursing and then stopped for a period of weeks or months. Induced lactation is the process of building a milk supply in a mother who has either never nursed a baby, or who has nursed years before.

Relacation and induced lactation both take time, patience, dedication, and a lot of work. If you are considering either option, I strongly recommend that you contact an IBCLC (International Board Certified Lactation Consultant) to help you during the process. You can find an IBCLC in your area by contacting ILCA (International Lactation Consultant Association) at 312-541-1710 or by e-mail at ilca@erols.com.

Many mothers start out nursing their baby and end up weaning earlier than they had planned for a variety of reasons -- stress, nipple soreness, returning to work, taking a medication that is incompatible with breastfeeding, etc. Often when time has passed and their circumstances have changed, they regret their decision to wean and want to return to breastfeeding. One of the most common reasons for relactating is the baby's allergic reaction to formula.

The younger the baby, the easier it is to get him to return to nursing and to re-establish your milk supply. After giving birth, estrogen levels drop rapidly, and by three weeks postpartum, prolactin levels have dropped back down to normal levels. It is easiest to relactate if the process is initiated during the first three weeks after birth, but it is certainly possible to do it after that time as well. The most important elements to successful relactation are a mother who is highly motivated and has a good support system, has realistic expectations, and a baby with a good sucking reflex.

Most babies younger than three months can be coaxed back to the breast, especially if their attempts to suckle are promptly rewarded. Babies between three and six months may or may not be willing to nurse, depending on their individual temperaments. Babies older than six months are pretty set in their ways and usually can't be convinced to nurse.

I would start out by seeing if your baby will latch on and suck. You can offer the breast as a pacifer if he is willing to accept it, even before your milk comes in. Using breast massage and switch nursing (alternating between both breasts several times during a feeding) can help increase your milk production.

I would also recommend taking either Reglan (10 mg, 3 times a day) or Domperidone (10 mg 3 times a day, increasing to 20 mg 4 times a day after you have been taking it for a few weeks). Both of these medications increase prolactin production and have minimal side effects, but Domperidone is the safer of the two drugs, and unfortunately, is available in Canada but not the United States. Both medications must be prescribed by a doctor. In most studies of Reglan, major increases of prolactin and significant increases in milk production were observed, but when it was discontinued abruptly, the supply also decreased abruptly. Tapering the dose is recommended, usually by decreasing it by 10 mg per week. Use of Reglan for more than 4 weeks has been associated with depression, but some mothers have taken it for many months with no noticeable side effects. The average amount of time to take the Reglan is 7-14 days, and by that time, hopefully your supply will have built up and your baby will be providing lots of stimulation so that you don't need it anymore. If you prefer, you can relactate without the use of medications, but in most cases, I have found that it speeds up the process and the side effects are minimal.

Breastmilk is produced by sucking stimulation and supply and demand. The more often you nurse or pump, the more milk you will have. Start expressing milk with a hospital grade electric double pump, like the 015 Classic by Medela. These pumps are too expensive to buy, so most moms will rent them. Call 1-800-TELLYOU for a rental station in your area. Try to double pump 8 times a day for 10-15 minutes. Any stimulation at all is beneficial, so don't worry if you can't pump that often. Don't get discouraged by the amount of milk you pump. You are going for stimulation, and it may take a while to see any significant amounts of milk.