Breastfeeding is the ideal food for babies up to six months of age, and later accompanied by other foods up to two years or more. However, sometimes there are difficulties that prevent the baby from breastfeeding exclusively, suckling directly from the breast and/or stopping breast milk: premature or very low birth weight babies, maternal admission, abnormalities of the baby that require surgery or income, need for separation for other reasons or due to maternal desire to wean.
But once the problems are overcome or if the mother’s desire changes, she can go back to breastfeeding or go from mixed breastfeeding to exclusive breastfeeding . This process is called relactation.
When it comes to a baby who has never suckled before, we talk about induction of lactation.
What to know before relactating
One of the fundamental things for relactation to work is to assess the reason that led to not breastfeeding, to the interruption of breastfeeding or to mixed breastfeeding.
In some cases, the “problem” may be resolved: for example, a mother who required hospitalization and has already been discharged, a baby who has required surgery and is now recovered, or a very large preemie who has already grown.
In cases of mixed breastfeeding in which it has been necessary to prescribe supplements, the reason why they were necessary must be well evaluated: review latching and suction, review breastfeeding guidelines, rule out problems such as ankyloglossia that can hinder the transfer of breast milk.
We must know that the vast majority of women are capable of producing enough milk to breastfeed their children, but there are some cases in which it is not possible (we speak of primary hypogalactia ): primary hypoplasia, Seehan’s syndrome, some surgeries of the breast in which the areola is sectioned…
The most important:
Almost the most important thing about this whole process is knowing that it can be long and complicated . You have to be constant and difficulties are likely to arise. Although in many cases complete relactation is possible (achieving exclusive breastfeeding), in others we may not be able to do so.
Success depends primarily on two factors: the mother’s determination to achieve her goal and the baby’s ability to breastfeed . Even fulfilling these two premises, sometimes the objective will not be achieved.
We should also know that it is more difficult to relactate the longer it has been since the last time you breastfed, the older the baby is and if he is bottle fed (instead of other forms of supplementation).
A relationship has also been found with maternal age (higher success rates when the mother is younger). It is of course easier to go from mixed to exclusive breastfeeding than it is to achieve exclusive breastfeeding in a baby who is exclusively formula fed.
Lastly, it is advisable for a professional expert in breastfeeding to accompany the mother and the baby throughout this process, in order to carry out an adequate follow-up and to be able to vary guidelines and seek solutions to possible problems that arise.
The three steps to relactation
There is no single way to carry out this process and we must individualize based on each mother-baby dyad. Achieving these three steps is essential. The first and second steps can be done almost simultaneously in babies who were not drinking any breast milk. In the case of babies with mixed breastfeeding, who are fed directly from the breast, step 2 is not necessary (logically).
1. Increase breast milk production
This step is essential. The more we stimulate the breast, the greater the milk production will be.
It is preferable to make short extractions frequently , than fewer but longer. Early morning and late afternoon pumpings are especially important. It also seems that better results are achieved if we start the expression with an electric breast pump and finish it manually . Using a double breast pump is ideal, because we send a signal to our body that it needs to produce for two, in addition to taking advantage of the ejection reflex that is bilateral (it occurs in both breasts, even if we are only stimulating one). As we increase the amount of milk, we will have to lengthen the extraction times.
There are some medications that can increase milk production (galactogogues) ; however, they are not harmless and have adverse effects. They must always be prescribed by a health professional under medical prescription and individually.
2. Getting the baby to latch on to the breast if he didn’t before
As we have mentioned, in babies who are doing mixed breastfeeding and are already suckling directly from the breast, it is not necessary, but it is advisable in any case to check the latch and make sure that there is a good transfer of milk .
Those babies who were exclusively fed formula may now have trouble latching on to the breast. To achieve this, a lot of skin-to-skin contact is recommended, closeness, pampering, caresses … and co- sleeping may be convenient (always meet the requirements for safe co-sleeping) . Most babies suck with a better technique when they are sleepy, so it may be a good idea to offer them the breast when they are not yet fully awake. Of course, always offer, never force , because it would be totally counterproductive.
If we have already managed to hook it to the chest, it is convenient to check that this hooking is correct. We will offer the breast frequently, whenever the baby shows interest and at least every two hours during the day and every three hours at night.
3. Reduce the amount of formula progressively
Before starting the process we must calculate approximately how much formula our baby receives throughout the day. If you take a small amount (less than 100 or 140ml), we can stop it “cold turkey” by dedicating a few days intensively to breastfeeding.
If she does not breastfeed or receives a large amount of formula, we must gradually reduce the amounts. Nor is there a single pattern here. It seems sensible to wait until there is an increase in breast milk production, and of course successful latch-on, before starting to taper off supplements. When we start we will do it little by little , for example, lose 60ml a day (it can be divided into several doses, for example, reduce 30ml in 2 doses) and we will maintain it for a few days. If the baby shows no signs of hunger and is gaining weight adequately, we will lower the supplements a little more. If, on the other hand, he does not gain enough weight, we will continue with that pattern for a few more days.
Some mothers prefer to supplement only some feedings (for example, late at night, which seems that babies demand more), or alternate feedings only of formula with others only of breast…).
Tips to promote relactation
As we are seeing, relactation can be complex. Here are some tips that can help in this transition:
– Have support at home . It is essential that the mother be able to devote all her efforts to relactation. To do this, it is ideal that someone help you with household chores, prepare food and/or take care of other sons or daughters, if any.
– Avoid teat-nipple confusion . We know that the breast is not sucked in the same way as a bottle or a pacifier. Although some babies do not have a problem and can adapt without problems, others will experience so-called teat-nipple confusion and may have difficulty with breastfeeding. Therefore, it is advisable to avoid the use of pacifiers and bottles during relactation.
– Find other ways to give supplements . The bottle is not the only way to supplement. We can do it with a cup, spoon or finger-feeding (finger/syringe). The relactator can be especially beneficial in relactation. It is a device (it can be made at home) that consists of a container in which to place the milk to be supplemented, from which a probe or conduit comes out, the outlet of which is placed next to the nipple. When the baby suckles, he must take part of the areola including the probe. By sucking, you will get milk from both the breast and the relactator. In this way, it obtains the amount of milk it needs, stimulates the mother’s breast more and we avoid teat-nipple confusion.
If it is not possible to supplement in another way and we need to give a bottle (for example, the baby is not yet properly latched on to the breast and takes a large amount of supplement), we should offer it following the Kassing method.
Finally…
I do not want to finish this post without encouraging all the mothers who wish to relactate to do so, those who are having a mixed breastfeeding and want to get an exclusive and those who have seen their breastfeeding interrupted, for whatever reason, and want to breastfeed again. . It is hard but the reward is very satisfying . Even in the case of not achieving exclusive breastfeeding, the benefits are still many. So I recommend you, if you are convinced, to contact a lactation expert and start this path.
