Relactation
Relactation - Information and tips
Lucy Lowe IBCLC - July 2024
Relactation is the process of starting to make milk again (re-establishing your breast milk supply) after a period of not producing milk.
Parents may wish to relactate for many reasons, such as the adoption of a new baby or feeling sad that breastfeeding ended sooner than they had hoped. Some parents want to relactate to ensure their baby receives some or all of their nutrition from them, and they may wish for this to be through directly breastfeeding or via an external source like a bottle or cup.
How relactation works:
“Lactation is a supply and demand process that requires
1) nipple stimulation and
2) milk extraction.
Frequent stimulation of the nipples by pumping, hand expression, and/or an infant nursing is required to re-establish milk production. Once milk production has begun, frequent and complete removal of the milk helps to develop a milk supply.” (1)
If the parent has had a long period since they stopped producing milk and then try to relactate, it could be more challenging and a longer journey to reestablish their supply. Lactation Consultant Lucy Ruddle says that the time it takes to reestablish your supply may be similar to the length of time it has been since you stopped breastfeeding stimulating your breasts (2).
Tips to help aid relactation
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Support:
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Seek support! Contact a local breastfeeding counsellor or lactation consultant (IBCLC) to help you. Breastfeeding support groups are always welcoming to families looking to relactate. We have a list of local free support groups in our area here and head to LCGB to find IBCLC support in your area by clicking here
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Talk to people close to you about your desire to relate. Having a team of supporters around you can be invaluable while navigating relactation. They can provide practical and emotional support (e.g. cook for you).
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It might be little drops to start with!
Example of good pump fit
Breast stimulation and milk removal:
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Milk needs to be removed frequently to make more milk. Be patient, as it may take time.
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Encouraging your baby to suckle at the breast can help increase milk supply.
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Some parents may find that latching their baby to their breast alone increases their supply, but more commonly, parents need to also rely on hand expressing and electric pump use.
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8+ breast stimulation and milk removal sessions per 24 hours is ideal to encourage your milk supply to increase.
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These ‘breast stimulation sessions’ could be hand expressing sessions, pumping using a double electric pump, breastfeeding your baby, or a combination of the above.
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At least one session should be during the night as (1 am to 5 am) the milk-making hormone (prolactin) is higher at night.
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Avoid long gaps between expressing sessions (no more than 4 hours in a day and no more than 6 hours at night). This helps keep your milk-making hormone high, which means more milk!
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You could express for just a few minutes on your first few attempts and gradually work up to 15-20 minutes. You may get nothing to begin with or teeny drops of milk. Either is fine!
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Anything that relaxes you while you are expressing can help milk production. For example, a massage, watching a funny programme or video, looking at your lovely baby, or eating your favourite food.
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If possible, express for 15-20 minutes each time session. If you can’t manage that length of time, then something is better than nothing!
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You might want to hand express only for the first few expressing sessions and start using a pump later. Any milk you get is fantastic and your baby will benefit from it. Hand, pump or use of both - do whatever works for you and what you feel happy with.
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Research shows that double pumping produces up to 40% more volume than expressing one breast at a time.
Tips for pumping
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Using a pumping bra to free up your hands is a good idea. You can buy or create your own - interesting idea here!:
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How to Hand express:
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A double electric hospital-grade pump is the ideal pump to stimulate your supply. You can rent a pump from us for free if you live in the Lowestoft and Waveney area, click here
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The part of the breast that goes over the breast (called the shield or flange) must be the right size to ensure the best nipple stimulation and, therefore, the best milk volume output:
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Before hand expressing or pumping, try putting warm compresses on your breasts or having a warm shower or bath.
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Breast massage and nipple rolling is recommended for a few minutes before expressing.
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“Hands-on pumping,” which involves massaging and gentling compressing your breasts whilst pumping, can really help your milk production. You will need to experiment to find the right place on the breast for you.
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Finish a pumping session with a few minutes of hand expression.
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Don't set the pump's vacuum too high. Pain is not a good thing - if you are in pain, you will not release your milk as effectively, and painful pumping can cause breast and nipple damage.
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If milk still flows after 15 minutes, continue until it stops, but avoid expressing for more than 30 minutes per session.
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If your baby can latch well, you could start or finish the expressing session by breastfeeding.
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Some parents like to “Power pump” once a day. This can help boost milk supply and mimic ‘cluster feeding’.
Galactagogues:
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Galactagogues are substances (herbal or medical) thought to increase milk supply. We cannot recommend their use but can provide information so you can make an informed decision about them. Although some people try galactagogues, very few studies support that they work, and there can be side effects and contraindications. Galactagogues are only to be used with the support of a GP. https://breastfeeding.support/what-is-a-galactagogue/
Signs that your milk supply is increasing include:
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Experiencing hormonal changes
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Breasts feel fuller, warmer, tingling
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Being able to express more milk
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Feeling thirsty when breastfeeding
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Leaking milk
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You may find your milk production drops temporarily just before or during menstruation. If you continue to breastfeed and/or pump, it will increase in a few days.
Returning baby to the breast:
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If your baby is not interested in returning to the breast, rejection of the breast does not mean they will always refuse.
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Older babies may take longer to adapt to latching.
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If you are bottle feeding, the paced bottle feeding method is the safest, healthiest, and most protective of breastfeeding. This method can help babies transition back to the breast because it is more like breastfeeding. Video here and more information here
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Equally, there is no need to use a bottle if you want to try alternative methods that support breastfeeding. Options include cup feeding, an at-breast supplementer, finger feeding and periodontal syringe use:
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Always aim to keep your breasts a happy place for your baby. Be patient and calm. Even if you don't feel relaxed, try to pretend you are! This can help the baby be calm, and in turn, you can feel calmer.
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Lots of skin-to-skin time with you when they are relaxed and not hungry will help (it will also help boost your milk supply!). ​
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A baby is more likely to go to the breast if they can take their time without pressure. It’s essential for them to not to have negative experiences at the breast.
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Other ideas for helping a baby feel safe at the breast include bathing together, baby wearing/baby carriers, baby massage and offering the breast at a time when they are sleepy to see if they are happy to suck.
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If/when they return to your breast, encourage a deep attachment so feeding is comfortable for you. They are more likely to get more milk and stimulate your breasts better if they are well attached.
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Some parents find using nipple shields helpful in encouraging a baby to return to the breast. However, shields should only be used with the support of a breastfeeding specialist and only once the milk supply is really increasing.
When a baby returns to breastfeeding:
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If your baby shows interest in suckling at the breast, you could consider an at-breast supplement. This device lets you give your baby extra breast milk or formula while feeding at your breast. Like nipple shields, we recommend only trying this with the support of a breastfeeding specialist. Information here
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It is very important that you keep pumping and supplementing with their current volumes of formula or donor milk until you are confident they is getting enough breast milk. Seek support from a breastfeeding specialist to help you with this.
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It is essential to monitor nappy output, weight gain, and baby behaviour and learn to recognise signs of effective milk transfer at the breast. These elements help ensure your baby gains weight well throughout the process and dictates the safety of reducing formula.
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Once you are confident of good milk transfer at the breast, you can consider gradually reducing the amount of milk you are giving via bottle/cup/at-breast supplementer. We have a guide on how to do this here
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If your baby does not return to the breast at all, or you choose not to return baby to the breast and continue to exclusively bottle/cup feed, then as your breast milk increases, you can simply replace, for example, 1oz of formula with 1oz of breastmilk. Always be led by your baby; if they show you they need more milk, then offer more.
An excellent book to provide you with more in-depth information on relactation is: Relactation - A Guide to Rebuilding Your Milk Supply by Lucy Ruddle IBCLC.
References and further reading:
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Relactation - A Guide to Rebuilding Your Milk Supply by Lucy Ruddle IBCLC.